Clear Form
CLINICAL EVALUATION TOOL: NURS 4580
College of Nursing
2021 - 2022
STUDENT NAME:
CLINICAL SITE:
STUDENT NUMBER:
TERM:
PRECEPTOR:
These performance indicators can be applied to a range of nursing roles and clinical sites and are based on the College of Registered Nurses of Manitoba (CRNM)
Entry Level Competencies for Registered Nurses in Manitoba (May 2019) and the CASN Entry to Practice Public Health Nursing Competencies (2014). The Entry
Level Competencies are available at: https://www.crnm.mb.ca/uploads/document/document_file_92.pdf?t=1568320210.
Mid-Term Evaluation: Indicate the level of performance by selecting one of the following descriptors from the drop-down menu. Students will provide two
examples of each role as the student contribution to the assessment process.
•
Meets Early Developmental Requirements (MEDR): Students meeting requirements at the mid-term are those who consistently demonstrate safe
and competent performance at a beginner level of the competency with occasional assistance or supervision by the preceptor. The student
consistently and with minimal assistance is able to prioritize and provide care for 50-75% of preceptor’s normal workload.
•
Further Development Required (FDR): Students require more than occasional assistance from the preceptor to demonstrate the competency or are
demonstrating growth but are not consistently meeting the requirement at a beginner level.
•
Does Not Meet Requirements (DNMR): Students require constant monitoring and frequent assistance from the preceptor in order to demonstrate
the competency. A Supportive Learning Contract will be implemented.
Final Evaluation: Indicate the level of performance by selecting either PASS or FAIL. Students will provide two examples of each role as the student contribution
to the assessment process.
•
PASS: Student demonstrates consistent achievement of all key roles at a beginner level, either independently or with minimal direction, from the
preceptor. Student is safe and competent in the delivery of care for 80-100% of the preceptor’s normal workload. Student demonstrates consistent
growth throughout the clinical placement and meets the requirements within each role.
•
FAIL: Student does not demonstrate the achievement of all roles at a beginner level, or requires frequent or constant preceptor direction in order to
do so. Student is unable to meet the requirements of each role. Student shows little or no growth, is inconsistent, or has declined in his/her
performance while completing the clinical placement. The terms of the SLC are not met.
August 24, 2020
CLINICAL EVALUATION TOOL: NURS 4580
College of Nursing
MIDTERM EVALUATION
At Midterm, student consistently and with minimal assistance is able to prioritize and provide care for 50-75% of the
preceptor’s workload.
Remediation:
Yes
No
Supportive Learning Contract required:
Yes
No
Areas of Strength:
Areas for Development:
Student:
______________________
Preceptor :
Date:
Faculty Advisor: ___________________________________
Date:
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CLINICAL EVALUATION TOOL: NURS 4580
College of Nursing
FINAL EVALUATION
At Final, student is independently and consistently able to prioritize and provide care for 80-100% of the preceptor’s
workload.
Clinical Hours Short Entering 4580:
Near Miss/Occurrence:
Yes
Absences in 4580 (in hours):
No
Number of Declarations:
Final Self-Reflection & Goals Review complete: Yes
No
Areas of Strength:
Areas for Development:
Student:
Preceptor :
Date:
Faculty Advisor: ___________________________________
Date:
Course Leader:
Date:
Pass
Fail
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CLINICAL EVALUATION TOOL: NURS 4580
College of Nursing
This evaluation tool is based on the CRNM entry-level competencies role-based format. Each role includes a brief description of the
expectation of competent entry level RNs. The descriptors for evaluation are provided in the table under each role. The expectation is
that the student meets the competency as described at a beginner level and all care is client-centered.
1. Clinician: At a beginner level
Registered nurses are clinicians who provide safe, competent, ethical, compassionate, and evidence-informed care across the lifespan in response to client needs.
Registered nurses integrate knowledge, skills, judgment and professional values from nursing and other diverse sources into their practice.
Number
1.1
1.2
1.4
1.5
1.6
Competency
Provides safe, ethical, competent, compassionate, client-centred and
evidence informed nursing care across the lifespan in response to
client needs.
Conducts a holistic nursing assessment to collect comprehensive
information on client health status. Assessment may include, but is
not limited to: observation, interview, history taking, gathering,
interpretation of laboratory data, mental health assessment,
physical assessment, including inspection, palpation, auscultation,
and percussion. Example: Student seeks out CXR and urine culture
results and applies their significance to the client’s status.
Analyzes and interprets data obtained in client assessment to inform
ongoing decision-making about client health status and make a diagnosis
when appropriate. Example: Client’s bloodwork shows a drop in
hemoglobin. Student looks at potential sources of bleeding in the patient.
Develops a plan of care using critical inquiry to support professional
judgment and reasoned decision-making. Example: Identifies priorities in
care after receiving report at shift change. Student assesses the sickest
patients first, clusters care and tasks to be focused and efficient.
Mid-term
Final
element
Evaluates effectiveness of the plan of care provided and modifies accordingly.
Example: Actively seeks formative feedback from preceptor as soon as reasonably
possible. Student decides to mobilize the client before dialysis treatment instead
of after the treatment as student realizes client will be fatigued post dialysis.
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CLINICAL EVALUATION TOOL: NURS 4580
1.7
Identifies actual and potential health risks and possible unintended outcomes.
Example: Student recognizes a geriatric client is taking a medication which may
cause loss of functional ability. The client has multiple comorbidities and is taking
many medications.
1.8
Recognizes and responds immediately when client safety is affected. Example:
Student notices and bring immediate attention to coffee-ground NG aspirates on
a client with a heparin infusion.
1.9
Recognizes and responds immediately when client’s condition is deteriorating.
Example: Student notices a sudden change in client’s WOB. Administers oxygen,
takes vital signs and calls for assistance.
1.10
Prepares clients for and performs procedures, treatments, and follow up care.
Example: Student assesses urine output, BP, HR & serum K+ after Lasix is
administered.
1.11
Applies knowledge of pharmacology and principles of safe medication practice.
Example: Student understands impact of drug level results on next scheduled
dose.
1.12
Implements appropriate practices of pain prevention, manages client’s pain, and
provides comfort through pharmacological and non-pharmacological
interventions. Example: Student actively assists a laboring client by using nonpharmacological interventions such as counter pressure.
1.13
Implements therapeutic nursing interventions that contribute to the care and
needs of the client. Example: Student reviews care plan at shift change. Client
requires wound care to a skin graft. Student plans and is prepared to provide
wound care when the plastic surgeon does their rounds.
1.21
Incorporates knowledge from the health sciences, including anatomy, physiology,
pathophysiology, psychopathology, pharmacology, microbiology, epidemiology,
genetics, immunology, and nutrition. Example: Student demonstrates an
understanding of their chosen area of senior practicum including conditions,
nursing interventions and medications.
1.22
1.23
Incorporates knowledge from nursing science, social sciences, humanities, and
health-related research into plans of care and client health outcomes. Example:
Student considers how living in poverty impacts a client’s discharge planning.
College of Nursing
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CLINICAL EVALUATION TOOL: NURS 4580
1.25
1.27
College of Nursing
Uses strategies to promote wellness, to prevent illness, and to minimize disease
and injury in clients, self and others. Example: Student provides a diabetic client
with a referral to a foot care nurse to help prevent tissue injury to the feet.
Implements evidence-informed practices for infection prevention and control.
Uses best evidence to make informed decisions.
Example: Student uses aseptic technique and follow policy & procedures to
change PICC caps & PICC dressing. Implements isolation precautions
appropriately and uses the correct PPE.
2. Professional: At a beginner level
Registered nurses are professionals who are committed to the health and well-being of clients. Registered nurses uphold the profession’s practice standards
and ethics, and are accountable to the public and the profession.
Number
2.1
2.2
2.3
2.4
2.6
Competency
Mid-term
Final
Demonstrates accountability, accepts responsibility, and seeks assistance as
necessary for decisions and actions with the legislated scope of practice.
Example: Student recognizes limitations and gaps in knowledge and seeks out
appropriate guidance prior to providing care.
Demonstrates a professional presence and confidence, honesty, integrity,
and respect in all interactions. Example: Student is well prepared but
recognizes limitations and gaps in knowledge and seeks out appropriate
guidance prior to providing care.
Consistently uses agency policies and procedures or consults with
preceptor/staff nurse in the absence of relevant policies and procedures.
Example: Student seeks direction on how to make lumen patent on a PICC
lumen which is plugged.
Maintains client privacy, confidentiality, and security by complying with
legislation, practice standards, ethics, and organizational policies.
Establishes and maintains professional boundaries with clients and the health
care team. Example: Student puts effort towards interacting with others and
does not seek to isolate oneself.
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CLINICAL EVALUATION TOOL: NURS 4580
2.8
Demonstrates professional judgment to ensure social media and information
and communication technologies (ICT’s) are used in a way that maintains
public trust in the profession. Example: Student does not post information on
social media related to practicum experience, clinical site or individuals
involved.
2.9
Adheres to the self-regulatory requirements of jurisdictional legislation to
protect the public by:
a) Assessing own practice and individual competence to identify learning
needs.
b) Developing a learning plan using a variety of sources.
c) Seeking and using new knowledge that may enhance, support, or
influence competence in practice.
d) Implementing and evaluating the effectives of the learning plan and
developing future learning plans to maintain and enhance competence as
a registered nurse.
Demonstrates Fitness to Practice. Example: Student manages lifestyle choices
and need for rest and focus during full time clinical practice.
Recognizes, acts on, and reports harmful incidents, near misses, and no harm
incidents.
2.10
2.13
College of Nursing
3. Communicator: At a beginner level
Registered nurses are communicators who use a variety of strategies and relevant technologies to create and maintain professional relationships, share information,
and foster therapeutic environments. The entry-level RN demonstrates English language proficiency (reading, writing, listening and speaking). Entry-level nurses
have the ability to express and receive written, verbal or non-verbal information, and the ability to interact with others in a clear, respectful and professional
manner.
Number
3.2
Competency
Engages in active listening to understand and respond to the client’s experience,
preferences, and health goals. Example: Student uses client’s shared
information to help organize and plan care as able.
Mid-term
Final
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CLINICAL EVALUATION TOOL: NURS 4580
3.3
3.6
3.7
3.8
College of Nursing
Uses evidence informed communication skills effectively to build trusting,
compassionate, and therapeutic relationships with clients.
Example: Student considers the client’s mental health and coping
strategies related to their admission to facility. Student considers the
client’s relationship with their family & friends in this process.
Uses information and communication technologies (ICTs) to support
communication. Example: Patient is from out of town with all family
supports several hours away. Student encourages regular phone
calls/video conferencing with family to maintain communication.
Communicates effectively in complex and rapidly changing situations.
Example: Student provides a concise report which includes most
important information, to healthcare team members at shift change,
rest breaks and patient deterioration.
Documents and reports clearly, concisely, accurately, and in a timely manner.
Example: Student completes charting throughout the shift rather than only at the
end of a shift.
4. Collaborator: At a beginner level
Registered nurses are collaborators who play an integral role in the health care team partnership.
Number
4.1
4.5
Competency
Mid-term
Final
Demonstrates collaborative professional relationships.
Example: Communicates and collaborates with discharge planning team to
expedite discharge from acute care setting.
Contributes to health care team functioning by applying group communication
theory, principles, and group process skills. Example: Student takes an active
role in communicating with the interprofessional health care team during daily
rounds.
5. Coordinator: At a beginner level
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CLINICAL EVALUATION TOOL: NURS 4580
College of Nursing
Registered nurses coordinate point-of-care health service delivery with clients, the health care team, and other sectors to ensure continuous, safe care.
Number
5.1
5.2
5.3
Competency
Mid-term
Final
Consults with clients and health care team members to make ongoing
adjustments required by changes in the availability of services or client
health status. Example: Student recognizes that home care services for
wound care is not available upon discharge in the client’s home rural
community. Student consults with team to discuss possible options.
Monitors client care to help ensure needed services happen at the right
time and in the correct sequence. Example: Student recognizes that
their patient needs to be seen by OT prior to discharge for a wheelchair
seating assessment.
Organizes own workload, assigns nursing care, sets priorities, and
demonstrates effective time management skills. Example: Student
prioritizes tasks and cluster care for clients; completes assessment and
interventions in a reasonable amount of time.
6. Leader: At a beginner level
Registered nurses are leaders who influence and inspire others to achieve optimal health outcomes for all.
Number
6.3
6.4
6.6
Competency
Mid-term
Final
Participates in innovative client-centred care models. Example: Student
encourages client/family to participate in daily rounds.
Participates in creating and maintaining a healthy, respectful, and
psychologically safe workplace. Example: Communication with all members
of the health care team is respectful at all times.
Demonstrates self-awareness through reflective practice and solicitation of
feedback. Example: Student is receptive to feedback from their preceptor
and the health care team.
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CLINICAL EVALUATION TOOL: NURS 4580
6.11
7.
College of Nursing
Adapts practice to meet client care needs within a continually changing
health care system. Example: Student is able to reorganize self to admit,
discharge or “pick up” a patient.
Advocate: At a beginner level
Registered nurses are advocates who support clients to voice their needs to achieve optimal health outcomes. Registered nurses also support clients who cannot
advocate for themselves.
Number
7.1
7.2
7.6
7.7
7.10
7.12
Competency
Mid-term
Final
Recognizes and reports situations where client safety is actually or potentially
compromised. Example: Student initiates reporting of safety issues to preceptor
or staff nurse.
Resolves questions about unclear orders, decisions, actions, or treatment.
Example: Student seeks clarification from preceptor with unclear plan of care or
physician’s orders.
Advocates for safe, competent, compassionate and ethical care for clients.
Example: Student honours and supports client and family requests such as use of
Indigenous healing practices, presence of family, diverse life choices.
Supports and empowers clients in making informed decisions about
their health care and respects their decisions. Example: Student
respects the client’s wish to refuse a medication or blood product
when contrary to best evidence, but supports values and beliefs.
Client understands the pros and cons of the decision they made.
Advocates for client’s rights and ensures informed consent, guided by
legislation, practice standards, and ethics. Example: Student consults
MAID as requested by a client.
Assesses client’s understanding of informed consent, and implements
actions when client is unable to provide informed consent.
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CLINICAL EVALUATION TOOL: NURS 4580
College of Nursing
8. Educator: At a beginner level
Registered nurses are educators who identify learning needs with clients and apply a broad range of educational strategies towards achieving optimal health outcomes.
Number
8.1
8.3
Competency
Mid-term
Final
Develops an education plan with the client and team to address learning needs.
Example: Student identifies and documents client’s gaps in knowledge and takes
action whenever possible or informs the health care team.
Selects and uses relevant teaching strategies to address diverse clients and
contexts, including lifespan, family and cultural consideration. Example: Student
incorporates creative approaches with the pediatric population such as puppets,
games, story telling. Student requests interpreter for client/family for whom
English is not a first language.
9. Scholar: At a beginner level
Registered nurses are scholars who demonstrate a lifelong commitment to excellence in practice through critical inquiry, continuous learning, appli cation of evidence to
practice, and support of research activities.
Number
9.1
9.8
Competency
Mid-term
Final
Uses best evidence to make informed decisions. Example: Student is able to locate,
read and apply appropriate policy for care of a CVAD.
Engages in practices that contribute to lifelong learning.
• Seeks out new knowledge and learning experiences to enhance, support or
influence competence in practice.
• Actively engages in their own learning experience; motivated and shows
initiative.
Example: Student researches respiratory issues & other side effects which may
arise after a client recovers from a COVID-19 infection.
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