EMORY UNIVERSITY
Nell Hodgson Woodruff School of Nursing
ABSN Clinical Performance Evaluation Form
The Clinical Performance Evaluation is used to assist the student/faculty in determining the student's level of achievement in meeting course objectives. Additionally, this tool serves to provide evidence of student progress in meeting each level of outcome objectives of the BSN program as well as core clinical competencies.
Achievement of behaviors listed will be determined through observation of performance and evaluation of written work.
Purpose:

Describes conduct and competencies that must be demonstrated in every clinical course in the baccalaureate curriculum of the NHWSN.

Describes clinical behaviors that have been identified as essential competencies for every undergraduate in order to advance in the clinical curriculum.

Competency is defined as consistent performance of the desired behaviors and seeking appropriate guidance/assistance as needed. The competency reflects incorporation of prior learning and selfassessment in order to successfully perform the desired behaviors.

Competency which has been achieved is expected to be demonstrated consistently throughout future clinical courses.
DEFINITION OF TERMS: Clinical performance and professional conduct/competency during each clinical rotation are evaluated on an ongoing and summative basis.
Excellent : The student consistently exceeds performance expectations for level of BSN outcomes and core clinical competencies, demonstrating independent thinking and initiative to maximize learning
Exceeds Expectations: The student occasionally exceeds performance expectations for level of BSN outcomes and core clinical competencies, exhibiting independent thinking and initiative to maximize learning
Satisfactory (Pass): The student meets the performance expectations for level of BSN outcomes and core clinical competencies demonstrating the ability to apply theories and concepts to clinical practice situations with minimal guidance and demonstrating safe competent nursing practice.

The student will receive a clinical grade of Satisfactory when criteria listed in every competency are met.
In Progress (Need for remediation): The student demonstrates progress towards meeting the expected level of
BSN outcomes and core clinical competencies, but requires further opportunity to demonstrate competence.

If the student is not meeting expected competencies at any point in a clinical rotation, the student, clinical instructor, and course coordinator or BSN program director will meet together as soon as possible to review the specified issues/concerns and to develop a written contract for remediation. This contract will outline a plan, criteria, and timing for satisfactory performance in the clinical area. The student’s mentor will be notified of the plan for remediation. A copy of the contract will remain in the student’s evaluation folder.

Rating as In Progress (IP) is allowed at the end of a specialty clinical rotation (Pediatrics/maternity) when the rotation ends partway through the semester, but not at the end of a course/semester. If a student’s contract is still being fulfilled when the clinical site/rotation is changing, that contract will remain active until the appropriate time for re-evaluation. It is necessary for the student and both clinical instructors to meet to discuss this contract before the second clinical begins. By the end of the
Draft: Spring 2010 (CA/DT)

semester the contract will either be fulfilled (earning a satisfactory for the clinical requirement for the course) or failed, and the student’s clinical performance can no longer be rated as in progress (IP)
Unsatisfactory (Fail): The student has not demonstrated the ability to apply theories and concepts to clinical practice situations commensurate with expected level of function as described in BSN outcome objectives and core clinical competencies. The student fails to demonstrate safe competent nursing practice.

An evaluation of unsatisfactory (U) will be made if, by the terms of a remediation contract and/or the clinical evaluation tool, a competency is not met.

Students may automatically earn an Unsatisfactory for not meeting the competencies related to clinical outcomes, competency or professional conduct (behaviors that compromise quality and safety or professionalism).

Students who earn an unsatisfactory and who choose to appeal this evaluation may continue to attend classes, but cannot attend clinical until the appeal is resolved.

All missed and/or make up clinical experiences must be completed prior to beginning the next clinical rotation.

A failure in any one competency warrants a failure for the course.
PROCEDURE
 The student’s clinical performance, conduct and competency are evaluated at the end of each clinical assignment and at midpoint at the discretion of the instructor or student.

Evaluation conferences are scheduled at a time appropriate for the instructor and student to review evaluation data.

Because self-evaluation is an integral component of professional behavior, the student is expected to complete a self evaluation prior to every evaluation conference.

The form is meant to serve for the entire program and should be passed on to the next instructor whenever students change clinical sites.

Joint conferences can be held at the request of either the faculty member or the student.

Indicators are examples only. There are many other behaviors that can be used to show achievement of outcomes.
Draft: Spring 2010 (CA/DT)

Nell Hodgson Woodruff School of Nursing
Emory University
Clinical Site & Faculty Identification Form
Clinical
Course
Clinical Site &
Dates
th
Faculty Name # Tardies
&
Absences
Conference with
Mentor (Date)*
*Document Contract Dates and Summary of Key Issues
Draft: Spring 2010 (CA/DT)
Midterm
Conference with
Student (Date)

Nell Hodgson Woodruff School of Nursing
Emory University
BSN PROGRAM OUTCOMES
The graduates of the NHWSN BSN program will have the following characteristics and behaviors:
Leader : Provides leadership and collaboration within the health care team. Improves patient care outcomes through evidence-based innovations. Fosters quality and safety health care practices. Provides patient-centered care. Understands policy development, power, politics and the economics of health care.
Scholar: Applies and translates evidence based findings to nursing practice and inquiry. Strengthens the intellectual skills of inquiry, engagement, reflection and collaboration
Socially Responsible Provider : Engages in socially responsible care which improves patient outcomes.
Understands the role social change, advocacy, equity, access and justice play in health.
Ethical Clinician: Reflects on and applies ethical principles to nursing practice in accordance with the professional code of ethics and professional standards of practice.
Critical Thinker : Applies critical thinking evidence-based methodologies in collecting, assessing and analyzing relevant data, establishing priorities, making appropriate decisions, raising questions and questioning assumptions.
Clinician: Provides safe, effective, evidence-based, culturally appropriate patient-centered care. Collaborates with patients, families and health care providers. Acts as client advocate. Assumes leadership in delegating and supervising care.
Effective Communicator : Provides clear and effective written and verbal communication with patients, families, peers using clear and culturally appropriate language (verbal, non-verbal, and written). Demonstrates competency with patient care plans, electronic medical records, informatics, formal and technical writing.
Educator: Provides patient with evidence-based health promotion and disease prevention information and resources in order to improve patient outcomes.
Draft: Spring 2010 (CA/DT)

Nell Hodgson Woodruff School of Nursing
Emory University
CORE CLINICAL COMPETENCIES
Safety:
Use of safety protocols which promote an environment for the client’s physical and emotional safety.
Safety concerns specific to individual populations,(i.e. pediatrics, geriatrics, mental health) may include acts performed by the student or failure of the student to perform an act. Examples include: leaving side rails down when the client is in jeopardy of falling or leaving any syringes with needles or medications in the client’s room when client is unsupervised, small objects in the bed, etc.
Universal Precautions: Behaviors and techniques which prevent the introduction and/or transmission of pathogens or any potentially harmful material to the client, self or other persons. Examples of correct use of universal precautions include: recognizing breaks in sterile technique, discriminating clean versus unclean areas, washing hands & using gloves as appropriate when needed to protect either self or client from contamination.
Professional Accountability: Adherence to and fulfillment of expected standards for conduct in the practice of nursing as identified in the Undergraduate Handbook for the Nell Hodgson Woodruff School of Nursing Scope and Standards of Practice, School of Nursing Honor Code, and ANA Code of Ethics for Nursing. Examples include: Reporting for clinical assignments and completion of written assignments in a timely manner as determined by individual faculty of each clinical rotation, maintenance of respectful behavior toward instructor, client and staff in the clinical facility in which the student is practicing, maintaining confidentiality of client information including appropriate accessing of the EMR from a Emory healthcare facility only, avoidance of excessive dependent behavior, and demonstration of adequate self-care to properly care for patient.
Communication: Verbal and nonverbal transmission of information. Examples of situations which may result in failure in any one area of communication include: repeated errors in documentation on the medical record, failure to document relevant information, constant problems in communicating effectively during clinical experiences or conference, using demeaning terms to a client or family, disrespectful verbal or email communication to faculty, telling the client that you are unsure of what you are doing, sharing personal information during the clinical care period, inappropriate use of language, body mannerisms or inappropriate communication, i.e. jokes, laughter, etc.
Draft: Spring 2010 (CA/DT)

BSN Outcome Objectives
N360
BSN Outcomes: Clinical Performance Evaluation
Excellent
Leader Check all that apply:

Demonstrates basic understanding of mission, vision, philosophy and values of the healthcare institution.

Identifies leadership hierarchy and management roles on clinical unit.

Participates actively in group discussions, reporting observations of quality and safety in the clinical setting.

Identifies examples of strong leadership skills in healthcare team.

Identifies own strengths and weaknesses related to leadership ability.

Recognizes situations in the care of his/her client that warrant patient advocacy.

Performs nursing assessments pertaining to continuous quality improvement initiatives (e.g., fall risk, central line audits, functional assessment).
Additional comments:
Scholar Check all that apply:

Shares observations of clinical unit, comparing expectations with reality, in journal and clinical conference.

Utilizes scholarly resources in preparation for clinical practice and cites them appropriately in care plan.

Utilizes computerized data management system within the health care agency to obtain information related to client care.

Identifies gaps in knowledge and seeks answers from credible sources.

Actively uses data at the point-of-care (e.g. Nursing Central, ePocrates, clinical research databases, institutional Policy and Procedures).

Relates an evidence-based, nursing research article to the care of his/her client.
Additional comments:
Socially Responsible Provider Check all that apply:

Identifies areas where the health care system at the clinical unit level is not effectively meeting the needs of the clients.

Identifies factors that make a patient vulnerable (e.g., language, culture, religion, socioeconomic status, age).
Draft: Spring 2010 (CA/DT)
Exceeds
Expecta- tions x x
Satisfactory x
Needs
Improvement
Unsatisfactory

 Conducts assessment of client’s health and social history (including health behaviors, education level, and home/living environment) that impact his/her access to healthcare, health promotion, and disease/injury prevention.

Identifies gaps in care created by transitions between providers, units, levels of care, and/or discharge from current care setting.

Assumes responsibility for own learning and demonstrates self-awareness.
Additional comments:
Ethical Clinician:

REQUIRED: Meets core clinical competencies for Professional Accountability
Check all that apply:
 Performs nursing care that is respectful of client’s privacy and adherent to ethical/legal requirements for confidentiality.
 Demonstrates awareness of patient goals for health, which are based on the patient’s own values, beliefs and right to make own health care decisions.

Practices in a nondiscriminatory manner, regardless of patient ethnicity, gender, age, wealth, or religious belief.

Recognizes influence of own values, culture and religion on clinical decision-making.

Reports real and potential clinical practice errors honestly and immediately.

Initiates discussion with appropriate individuals when ethical issues arise.
Additional comments:
Critical Thinker Check all that apply:

Uses internet, intranet, and personal resources to provide theoretical basis for nursing decisions.

Gathers data, creates problem list, and produces a plan of care for the client.

Demonstrates ability to transfer or apply knowledge from other academic areas to the clinical setting.

Questions unclear or unknown information regarding patient care.

Appropriately seeks assistance from the instructor or health care team when questions arise.
Additional comments:
Draft: Spring 2010 (CA/DT) x x

Clinician:

REQUIRED : Meets core clinical competencies for safety and universal precautions.
Check all that apply:

Actively performs clinical skills in a simulated situation prior to clinical practice until a beginning level of competency is attained.

Demonstrates awareness of limitations and seeks assistance and validation to assure safe practice.
 Notifies faculty or RN immediately of any significant change in client’s health status.

Arrives for clinical practice promptly, prepared with working knowledge of patient-specific data, unit-specific policies and general literature regarding the patient’s health history and current medical condition.

Elicits client values, preferences and needs when interviewing patient and implementing care.

Identifies roles and functions of the interprofessional health care team.

Recognizes examples of both strong and less than ideal patient advocacy.

Begins to utilize patient care technologies (e.g. monitors, pumps, medication administration system) specific to unit.
Additional comments:
Educator Check all that apply:

Identifies education as a core tenet of the role of the professional nurse.

Performs a health history, including social and family history to identify health risks.
 Assesses client’s beliefs, attitude, current practices, and readiness for change regarding a health/illness behavior.
 Assesses client’s current level of knowledge level regarding admitting diagnosis and plan of care.

Observes discharge planning and teaching in the clinical setting.

Involves family in explanations of care including nursing care and medication administration.
Additional comments:
Effective Communicator:

REQUIRED: Meets core clinical competency for communication.
Check all that apply:
 Discusses client’s medical history and plan of care with peers and faculty in conference setting while maintaining confidentiality.

Interacts professionally and effectively with client by explaining nursing actions and expected
Draft: Spring 2010 (CA/DT) x x x

outcomes.

Receives report on assigned client, maintains communication with nurse and ancillary personnel regarding any changes in client status, and reports off to appropriate staff member when leaving the unit.

Demonstrates understanding of own communication skills and takes initiative to improve own communication skills (verbal, nonverbal, and written).

Utilizes appropriate, unit based charting requirements to document assessment findings, nursing care and client response to nursing care, medications and treatments.

Demonstrates beginning competency in navigating the electronic medical record.

Performs report on client utilizing the SBAR communication format in a role-play with fellow students.
Additional comments:
Comments:
I have reviewed the above evaluation and agree with the clinical performance evaluation.
Student Signature _Grace Kim ________________________________________Date _8/3/10______
Faculty__Sandra White_____________Date__8/3/10______
Excellent = Consistently exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Exceeds Expectations = Occasionally exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Satisfactory = Meets performance expectations for beginning practitioner, requires minimum guidance
Needs Improvement = Performance adequate but requires guidance
Unsatisfactory = Performance not improved in spite of guidance and feedback
Draft: Spring 2010 (CA/DT)

BSN Outcome Objectives
N361D Pediatrics
BSN Outcomes: Clinical Performance Evaluation
Excellent
Leader

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Demonstrates understanding of own unique role in the provision of high quality nursing care, aligning self with the patient care initiatives on the clinical unit and the missions/values/philosophy of the institution at large.

Recognizes and seeks to emulate nurses and other staff who provide quality, patient-centered care.

Collaborates with the interdisciplinary health care team in the provision of care to his/her client(s).

Demonstrates initiative by integrating feedback from faculty and staff to improve clinical decision making, collaboration, and communication in the care of his/her client(s).

Presents an evidence-based, nursing research article during clinical conference, including its impact on the care of his/her client(s).

Assumes a leadership role in discussions during clinical conference on more than one occasion.

Applies nursing assessments pertaining to continuous quality improvement initiatives (e.g. fall risk, central line audits, functional assessment) to improve the quality/safety of care given to his/her client(s).
Additional comments:
Scholar

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Identifies sources for current, clinical practice guidelines (e.g. AHRQ, AACN, JCAHO).

Formulates formal questions regarding evidence-based practice.

Performs self-assessment and reflection of clinical practice, identifying areas requiring growth.

Uses appropriate texts, internet sources, and journal articles to find current research relevant to clinical practice setting and population.

Discusses with faculty and peers the applicability of research findings to specific clinical situations.

Prepares a plan of care for his/her client(s) that is evidence-supported, reality-based, and takes into account patient preferences.

Utilizes library and/or internet resources to seek answers to unclear or unknown information regarding patient care.

Explains rationale for nursing action which demonstrates understanding and application of course content.
Draft: Spring 2010 (CA/DT)
Exceeds
Expecta- tions
Satisfactory x
Needs
Improvement x
Unsatisfactory

Additional comments:
Socially Responsible Provider

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Observes and constructively evaluates the quality of health care services provided in the clinical practice setting.

Identifies resources available to vulnerable populations (e.g., language interpretation, social workers, clergy, discharge planners, nursing leadership).

Prepares plan of care that is patient/ family-centered and health promotional, taking into account patient’s learning needs, socioeconomic/cultural influences, behavioral patterns, and age.

Demonstrates awareness of cost containment issues in the delivery of nursing care.

Evaluates ways to prevent gaps in care created by transitions between providers, units, levels of care and/or discharge from current care setting.

Demonstrates understanding of how own culture, values and beliefs influence behavior.

Demonstrates respect for client's different cultural values and beliefs and their right to make health care decisions.

Continues to develop self awareness and uses constructive criticism to improve performance.

Identifies and discusses with faculty individual learning needs and goals.

Actively seeks learning experiences.
Additional comments:
Ethical Clinician

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.

REQUIRED: Meets core clinical competencies for Professional Accountability.
Check all that apply:

Performs nursing care that is respectful of client’s privacy and adherent to ethical/legal requirements for confidentiality.
 Demonstrates awareness of patient goals for health, which are based on the patient’s own values, beliefs and right to participate in their own health care decisions.

Practices in a nondiscriminatory manner, regardless of patient ethnicity, gender, age, wealth, or religious belief.

Reflects on the influence of own values, culture and religion on clinical decision-making.
Draft: Spring 2010 (CA/DT) x x


Reports real and potential clinical practice errors honestly and immediately.

Initiates discussion with appropriate individuals when ethical issues arise.
Additional comments:
Critical Thinker

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Demonstrates beginning use of patient information, standard of practice and evidence-based literature in making decisions for nursing care.

Identifies critical thinking behaviors in self and others.

Asks pertinent questions in clinical to aid understanding.

Demonstrates clinical judgment and questioning of assumptions at a beginning level. (e.g.,— holding medication until appropriate lab results return, prioritizing pain medication over scheduled medications).

Care plans and case presentations demonstrate logical and prioritized thinking.
 Demonstrates analysis of client’s problem list and prioritization of care.
Additional comments:
Clinician

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators.

REQUIRED: Meets core clinical competencies for safety and universal precautions.
Check all that apply:

Demonstrates increasing independence in the performance of technical skills and documentation.

Demonstrates awareness of limitations and seeks assistance and validation to assure safe practice.
 Notifies faculty or RN immediately of any significant change in client’s health status and begins to formulate an appropriate plan.

Arrives for clinical practice promptly, prepared with working knowledge of patient-specific data, unit-specific policies and general literature regarding the patient’s health history and current medical condition.

Elicits client and family values, preferences and needs when planning and implementing care.

Reports to multidisciplinary team in carrying out nursing care for the client.

Identifies and evaluates strengths and limitations of teamwork in self and other team members.
Draft: Spring 2010 (CA/DT) x x


Begins to practice appropriate delegation to assistive personnel.

Begins to report to multidisciplinary personnel in carrying out nursing care for the client.

Demonstrates increased independence with the use of patient care technologies (e.g. monitors, pumps, medication administration system).
Additional comments:
Educator

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:
 Relates patient education to the patient’s current level of knowledge and motivation to change.

Involves client & family in plan of care including identification of desired outcomes.

Relates to client & family the rationale for interventions, medications and/or treatments.

Incorporates discharge needs into the weekly nursing care plan.
 Evaluates client’s learning needs and selects a health promotional teaching topic.

Presents teaching topic to one or more clients utilizing a variety of teaching methods.
Additional comments:
Effective Communicator

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators

REQUIRED: Meets core clinical competency for communication.
Check all that apply:

Interacts in a professional manner with clients and members of health care team.

Consults multidisciplinary staff when questions arise regarding patient care, including any language and/or cultural barriers identified.

Verbally presents an individual client in a comprehensive and organized fashion to peers in clinical conference in a format similar to medical rounding.

Demonstrates accurate documentation of assessment findings, nursing care and client response to nursing care, medication and treatments using the electronic medical record and/or according to hospital procedure.

Performs shift-to-shift and situational report utilizing SBAR communication format.

Written work exemplifies scholarly, grammatically correct, clear, and organized thought processes.
Additional comments:
Draft: Spring 2010 (CA/DT) x x

Comments:
Ms. Kim’s major strengths are a willingness to function as part of a team, a bright and intellectually curious mind, a compassionate and sensitive bedside manner, and a professional and mature personality. She is sincere in her desire to advocate for her patients.
Ms. Kim struggles with her confidence within the group and will benefit from speaking up- she has much to offer! Communication experience, whether written or oral, will be of great benefit for her professionally. She will continue to work to improve her confidence in multiple assignments, leadership opportunities, time management and organization, and to expand her knowledge base. She has demonstrated tremendous growth over this term.
Grace Kim is a third semester student who is well prepared for her next rotation. She has demonstrated compassionate and developmentally appropriate care to children, incorporating critical thinking, ethical practice, and a growing sense of herself as a nurse. I enjoyed having Grace as my student.
I have reviewed the above evaluation and agree with the clinical performance evaluation.
Student Signature ____met with Ms. Kim____________Date _5-3-2011 Faculty Maeve Howett, PhD, APRN, CPNP-Peds Date_5-3- 2011
Excellent = Consistently exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Exceeds Expectations = Occasionally exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Satisfactory = Meets performance expectations for beginning practitioner, requires minimum guidance
Needs Improvement = Performance adequate but requires guidance
Unsatisfactory = Performance not improved in spite of guidance and feedback
Draft: Spring 2010 (CA/DT)

BSN Outcome Objectives
N460--Psych
AB SN Outcomes: Clinical Performance Evaluation
Excellent
Leader

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Demonstrates understanding of own unique role in the provision of high quality nursing care, aligning self with the patient care initiatives on the clinical unit and the missions/values/philosophy of the institution at large.

Recognizes and seeks to emulate nurses and other staff who provide quality, patient-centered care.

Collaborates with the interdisciplinary health care team in the provision of care to his/her client(s).

Demonstrates initiative by integrating feedback from faculty and staff to improve clinical decision making, collaboration, and communication in the care of his/her client(s).

Presents an evidence-based, nursing research article during clinical conference, including its impact on the care of his/her client(s).

Assumes a leadership role in discussions during clinical conference on more than one occasion.

Applies nursing assessments pertaining to continuous quality improvement initiatives (e.g. fall risk, central line audits, functional assessment) to improve the quality/safety of care given to his/her client(s).
Additional comments:
Ms. Kim was able to articulate the characteristics of quality care, identify role models in the clinical area and apply principles of quality in her interactions with clients and staff.
Scholar

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Identifies sources for current, clinical practice guidelines (e.g. AHRQ, AACN, JCAHO).

Formulates formal questions regarding evidence-based practice.

Performs self-assessment and reflection of clinical practice, identifying areas requiring growth.

Uses appropriate texts, internet sources, and journal articles to find current research relevant to clinical practice setting and population.

Discusses with faculty and peers the applicability of research findings to specific clinical situations.

Prepares a plan of care for his/her client(s) that is evidence-supported, reality-based, and takes into account patient preferences.

Utilizes library and/or internet resources to seek answers to unclear or unknown information regarding patient care.
Draft: Spring 2010 (CA/DT)
Exceeds
Expecta- tions

Satisfactory Needs
Improvement
Unsatisfactory


Additional comments:

Explains rationale for nursing action which demonstrates understanding and application of course content.
Ms. Kim actively contributed to discussions regarding the evidence underlying implementation of the nursing process with her clients.
Socially Responsible Provider

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Observes and constructively evaluates the quality of health care services provided in the clinical practice setting.

Identifies resources available to vulnerable populations (e.g., language interpretation, social workers, clergy, discharge planners, nursing leadership).

Prepares plan of care that is patient/ family-centered and health promotional, taking into account patient’s learning needs, socioeconomic/cultural influences, behavioral patterns, and age.

Demonstrates awareness of cost containment issues in the delivery of nursing care.

Evaluates ways to prevent gaps in care created by transitions between providers, units, levels of care and/or discharge from current care setting.

Demonstrates understanding of how own culture, values and beliefs influence behavior.

Demonstrates respect for client's different cultural values and beliefs and their right to make health
Additional comments: care decisions.

Continues to develop self awareness and uses constructive criticism to improve performance.

Identifies and discusses with faculty individual learning needs and goals.

Actively seeks learning experiences.
Ms. Kim recognized the importance of cultural influences on quality PMHN care and utilized principles of culturally competent care when working with clients.
Ethical Clinician

REQUIRED: Continues to demonstrate Level 1 (NRSG 360) indicators.

REQUIRED: Meets core clinical competencies for Professional Accountability.
Check all that apply:
 Performs nursing care that is respectful of client’s privacy and adherent to ethical/legal requirements for confidentiality.
Draft: Spring 2010 (CA/DT)




Demonstrates awareness of patient goals for health, which are based on the patient’s own values, beliefs and right to participate in their own health care decisions.

Practices in a nondiscriminatory manner, regardless of patient ethnicity, gender, age, wealth, or religious belief.

Reflects on the influence of own values, culture and religion on clinical decision-making.

Reports real and potential clinical practice errors honestly and immediately.

Initiates discussion with appropriate individuals when ethical issues arise.
Additional comments:
Ms. Kim engaged in therapeutic activities with clients based on client needs, including age appropriateness, in a compassionate and ethical manner.
Critical Thinker

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:

Demonstrates beginning use of patient information, standard of practice and evidence-based literature in making decisions for nursing care.

Identifies critical thinking behaviors in self and others.

Asks pertinent questions in clinical to aid understanding.

Demonstrates clinical judgment and questioning of assumptions at a beginning level. (e.g.,— holding medication until appropriate lab results return, prioritizing pain medication over scheduled medications).

Care plans and case presentations demonstrate logical and prioritized thinking.
 Demonstrates analysis of client’s problem list and prioritization of care.
Additional comments:
Ms. Kim incorporated critical thinking into her clinical activities. For instance, she able to identify learning needs and actively sought our clinical experiences to meet those needs.

Draft: Spring 2010 (CA/DT)

Clinician

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators.

REQUIRED: Meets core clinical competencies for safety and universal precautions.
Check all that apply:

Demonstrates increasing independence in the performance of technical skills and documentation.

Demonstrates awareness of limitations and seeks assistance and validation to assure safe practice.

Notifies faculty or RN immediately of any significant change in client’s health status and begins to formulate an appropriate plan.

Arrives for clinical practice promptly, prepared with working knowledge of patient-specific data, unit-specific policies and general literature regarding the patient’s health history and current medical condition.

Elicits client and family values, preferences and needs when planning and implementing care.

Reports to multidisciplinary team in carrying out nursing care for the client.

Identifies and evaluates strengths and limitations of teamwork in self and other team members.

Begins to practice appropriate delegation to assistive personnel.

Begins to report to multidisciplinary personnel in carrying out nursing care for the client.

Demonstrates increased independence with the use of patient care technologies (e.g. monitors, pumps, medication administration system).
Additional comments:
Ms. Kim was able to work in an effective collaborative manner with her peers as well as the professional and paraprofessional staff on the unit.
Educator

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators.
Check all that apply:
 Relates patient education to the patient’s current level of knowledge and motivation to change.

Involves client & family in plan of care including identification of desired outcomes.

Relates to client & family the rationale for interventions, medications and/or treatments.

Incorporates discharge needs into the weekly nursing care plan.
 Evaluates client’s learning needs and selects a health promotional teaching topic.

Presents teaching topic to one or more clients utilizing a variety of teaching methods.
Additional comments:
Ms. Kim successfully incorporated patient education into her implementation of the nursing process in this setting.
Draft: Spring 2010 (CA/DT)



Effective Communicator

REQUIRED : Continues to demonstrate Level 1 (NRSG 360) indicators

REQUIRED: Meets core clinical competency for communication.
Check all that apply:

Interacts in a professional manner with clients and members of health care team.

Consults multidisciplinary staff when questions arise regarding patient care, including any language and/or cultural barriers identified.

Verbally presents an individual client in a comprehensive and organized fashion to peers in clinical conference in a format similar to medical rounding.

Demonstrates accurate documentation of assessment findings, nursing care and client response to nursing care, medication and treatments using the electronic medical record and/or according to hospital procedure.

Performs shift-to-shift and situational report utilizing SBAR communication format.

Written work exemplifies scholarly, grammatically correct, clear, and organized thought processes.
Additional comments:
Ms. Kim demonstrated excellent communication skills with her peers, unit staff and the clinical faculty person!!

Comments:
Ms. Kim demonstrated a high level of professionalism and compassion while working with a difficult patient population.
I have reviewed the above evaluation and agree with the clinical performance evaluation.
William J. Puentes PhD RN 10/27/10
Student Signature _________________________________________Date _______ Faculty____________________________________Date________
Excellent = Consistently exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Exceeds Expectations = Occasionally exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Satisfactory = Meets performance expectations for beginning practitioner, requires minimum guidance
Needs Improvement = Performance adequate but requires guidance
Unsatisfactory = Performance not improved in spite of guidance and feedback
Draft: Spring 2010 (CA/DT)

BSN Outcome Objectives
N460--Hospital
BSN Outcomes: Clinical Performance Evaluation
Excellent
Leader xREQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
Check all that apply:
X Distinguishes breakdowns in the healthcare delivery process which are not line with the institution’s mission, values and philosophy.
X Demonstrates basic knowledge of the effects of healthcare policy, finance and regulatory agencies on the provision of healthcare services in the clinical setting.
X Examines his/her leadership style and assumes ownership for care delivery, in regards to clinical decision making, collaboration and communication.
X Demonstrates appropriate assertiveness in the clinical setting and in post-conference discussions.
X Demonstrates awareness of nurse-sensitive quality measures (e.g. falls, pressure ulcers) in place at the clinical level.
X Leads a discussion in conference regarding an evidence-based patient care practice; analyzes effectiveness as a leader in this discussion.
Additional comments:
Presented patient in conference using SBAR format. Utilized a relevant research article to further understanding of patient care.
Scholar
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
Check all that apply:
X Compares observed clinical practices with published practice standards.
X Identifies and examines ways to strengthen own clinical practice and outcomes.
X Intentionally applies evidence-based research to impact the care of his/her client(s).
X Utilizes scholarly resources in searching for answers to clinical questions and shares findings with healthcare team and peers.
X Collaborates with the healthcare team to provide a plan of care that is evidence-based, reality-based and takes into account patient preferences.
X Evaluates outcomes to plan of care by constructively critiquing patient care and anticipated or actual consequences of that care.
Additional comments:
Discussed a clinical review article pertaining to liver transplant patients with classmates.
Draft: Spring 2010 (CA/DT)
Exceeds
Expecta- tions
X
X
Satisfactory
X
Needs
Improvement
X
Unsatisfactory

Socially Responsible Provider
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
Check all that apply:
X Demonstrates awareness of patient vulnerability and works to promote patient empowerment.
X Acts to prevent gaps in continuum of patient care across care transitions.
X Actively participates in patient advocacy when health disparities identified.
X Practices cost containment measures for cost-effective nursing care, including efficient time management.
X Consistently demonstrates responsibility for own learning and professional growth.
X Assumes accountability for own nursing care as well as care that is delegated.
X Exhibits personal awareness, openness and acceptance of others.
Additional comments:
Ethical Clinician
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
X REQUIRED: Meets core clinical competencies for Professional Accountability.
Check all that apply:
X Promotes the nursing image by modeling altruism, compassion, commitment, integrity, justice and respect for persons in conduct and character.
X Practices information-sharing and patient/family-centered care.
X Acts to prevent unsafe, unethical or harmful care practices.
X Evaluates any clinical practice errors and determines solutions/ prevention strategies.
X Appraises own professional development and creates a plan for continual growth.
X Identifies patient care situations that involve ethical, legal or moral decision making (e.g., sexual assault, abuse, advance directives, spiritual crisis) and involves the healthcare team in formulating a plan to address these situations.

Analyzes actual and potential ethical dilemmas faced by self, health care providers and clients.
Additional comments:
Critical Thinker
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
Draft: Spring 2010 (CA/DT)
X
X
X
X
X
X

Check all that apply:
X Applies previously acquired knowledge, skills, and attitudes to novel clinical microsystem; demonstrates awareness of this thinking process.
X Begins to demonstrate ability to transfer knowledge from one patient scenario to another, similar patient scenario.
X Analyzes relevant client history, etiology of diagnoses, current treatment and barriers to treatment in formulating a plan of care for his/her client.
X Evaluates clinical practice topics by searching nursing and other related databases.
X Examines assumptions and demonstrates perseverance in finding solutions to questions raised in the clinical setting.
X Begins to predict outcomes of nursing interventions.
X Demonstrates ability to modify plans in response to changes in client condition or circumstances.
X Predicts and evaluates consequences of clinical decision making.
Additional comments:
Clinician
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
X REQUIRED: Meets core clinical competencies for safety and universal precautions.
Check all that apply:
X Performs technical skills with minimal assistance while still referring to institutional policies and procedures and nursing personnel to guide interventions.

Performs care for more than one client at a time.
X Identifies and examines unsafe practices such as work-arounds, unapproved abbreviations, and communication failures which contribute to patient harm.

Utilizes error reporting system within organization to report any errors or near miss events.

Analyzes any miss or near miss event by conducting a Root Cause Analysis (RCA).
X Actively consults members of the multidisciplinary health care team to provide care that meets the values, preferences and expressed needs of the client and family.
X Organizes and modifies plan of care based on contributions of other health care team members.
X Assumes role of team member based on clinical situation.
X Solicits and utilizes feedback from team members to improve team performance.
X Initiates and evaluates delegation to assistive personnel.
X Acts as liaison and advocate between patient and the health care system by translating the plan of care to the patient.
X Utilizes patient care technology in a comfortable and knowledgeable way to document and implement patient care.
Draft: Spring 2010 (CA/DT)
X X

Additional comments:
Educator
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
Check all that apply:
X Demonstrates increasing confidence and competence in assessing patient’s learning needs, current practices, beliefs and motivation to change.

Provides creative teaching methodologies that encourage patient/family involvement & learning.
X Adapts teaching strategies to meet client literacy levels, interest, preferences, and specific clinical situation.
X Incorporates client & family education into multiple facets of patient care.
X Participates actively in patient discharge teaching.
X Provides patient with evidence-based health promotion and disease prevention information and resources.
Additional comments:
Effective Communicator
X REQUIRED: Continues to demonstrate Level 1 (NRSG 360) and Level 2 (NRSG 361) indicators.
X REQUIRED: Meets core clinical competency for communication.
Check all that apply:
X Communicates clearly and effectively with clients and family members and partners with them in care delivery.
X Incorporates effective communication techniques, including self-awareness, openness, conflictresolution and negotiation strategies.
X Demonstrates assertiveness in communicating with medical providers and participating with multidisciplinary staff to optimize patient outcomes.
X Utilizes SBAR when reporting a change in client status to client’s provider.
X Presents an individual client in a comprehensive and organized fashion through completion of a comprehensive case study and verbal presentation to peers in clinical group,
X Utilizes information management systems and patient care technology in a comfortable and knowledgeable way to document and implement patient care.
X Written work exemplifies scholarly, grammatically correct, clear, and organized thought processes.
Additional comments:
Draft: Spring 2010 (CA/DT)
X
X X
X

Comments:
NOTE: THIS IS AN EVALUATION FOR N 361: It was a pleasure being Grace’s clinical instructor. She is an avid learner and pays attention to detail.. Although quieter in personality, she actively engages in every facet of patient care. Her communication with the nursing staff and level of organization /efficiency were much higher than expected at this level. She consistently monitored her patient for response to care measures and reported these to the nurse. She responded well to instruction and feedback on her weekly assignment and showed improvement with each clinical day. Her psychomotor skills were solid as was her confidence and safety in performing them. At the end of her second clinical day on 7G, her nurse took me aside and said, “Grace is the best student yet”. This nurse complimented
Grace on her ability to initiate and evaluate care. I have no doubt that Grace will be a very strong clinician. My one piece of advice would be for her to “speak up” and share what she has learned with her classmates, so as to develop her leadership potential. DBT
MATERNITY N460: Grace is a kind and engaged student, consistently arriving prepared to give care to the wide variety of patients encountered in this rotation. She applies classroom content to the clinical setting with appropriate assistance. She manages time and prioritizes her care plans well. She remains quiet in post-conference but she is actively engaged and shares important points throughout discussions. I would encourage more active engagement with her patients’ care as occasionally she needs encouragement to act rather than to simply observe. She was a pleasure to teach Grace and I wish her well in her bright future in nursing. Sara Edwards CNM
I have reviewed the above evaluation and agree with the clinical performance evaluation.
Student Signature _________________________________________Date _______ Faculty__Deborah B. Thomas, RN, MSN, ANP-BC___Date__12/2/10____
Excellent = Consistently exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Exceeds Expectations = Occasionally exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Satisfactory = Meets performance expectations for beginning practitioner, requires minimum guidance
Needs Improvement = Performance adequate but requires guidance
Unsatisfactory = Performance not improved in spite of guidance and feedback
Draft: Spring 2010 (CA/DT)

BSN Outcomes: Clinical Performance Evaluation
Excellent BSN Outcome Objectives
N461/462
Leader

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.
Check all that apply:

Evaluates strengths & weaknesses in the healthcare delivery process related to quality, safety and cost-effectiveness of care.

Examines own unique leadership style that could positively impact care delivery processes in clinical setting
 Identifies the professional nurse’s role in advocating for safe and effective workplace environments.

Attends meetings where quality, safety and/or evidence-based initiatives are discussed.

Exemplifies appropriate assertiveness with providers and peers in advocating for his/her client.

Works cooperatively & collaboratively with population, peers and team to identify health needs.

Prepares a group discussion/ seminar with peers regarding a clinical case study, vulnerable population or significant social issue.

Designs a quality improvement intervention based on a problem encountered in the clinical setting.

Demonstrates an ability to consider improvements in patient care that may be originated at the hospital system and/or public policy levels.
Additional comments:
Scholar

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.
Check all that apply:

Compares observed clinical practices with published practice standards.

Identifies and examines ways to strengthen own clinical practice and outcomes.

Intentionally applies evidence-based research to impact the care of the client and/or target population.

Utilizes scholarly resources in searching for answers to clinical questions and shares findings with healthcare team and peers.

Collaborates with the healthcare team to provide a plan of care that is evidence-based, reality-based
Draft: Spring 2010 (CA/DT)
Exceeds
Expecta- tions
Satisfactory Needs
Improvement
Unsatisfactory

and takes into account client preferences.

Engages with the healthcare team in discussing obstacles/possible solutions to effective patient outcomes.
Additional comments:
Socially Responsible Provider

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.
Check all that apply:

Evaluates outcomes of nursing care given in the clinical setting, whether his/her care promoted health, empowered the client, contained cost, and addressed the characteristics that make a client or population vulnerable.

Acts to prevent gaps in continuum of patient care across care transitions.

Reflects on the social, economic, political & power structures that impede the fulfillment of health.

Shares power with population in determining the course of care & responds to the needs & desires of the population.

Prepares for and attends a meeting related to health care policy reform and/or politics.

Consistently demonstrates responsibility for own learning and professional growth.

Assumes accountability for own nursing care as well as care that is delegated.

Exhibits personal awareness, openness and acceptance of others.
Additional comments:
Ethical Clinician

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.

REQUIRED: Meets core clinical competency for Professional Accountability.
Check all that apply:

Promotes the nursing image by modeling altruism, compassion, commitment, integrity, justice and respect for persons in conduct and character.

Practices information-sharing and patient/family-centered care.

Acts to prevent unsafe, unethical or harmful care practices.

Evaluates any clinical practice errors and determines solutions/ prevention strategies.
Draft: Spring 2010 (CA/DT)


Appraises own professional development and creates a plan for continual growth.

Identifies patient care situations that involve ethical, legal or moral decision making (e.g., sexual assault, abuse, advance directives, spiritual crisis) and involves the healthcare team in formulating a plan to address these situations.
Additional comments:
Critical Thinker

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.
Check all that apply:

Synthesizes data across care settings and populations to support clinical decisions

Provides care to clients that is evidence-based, realistic, organized and prioritized.

Examines assumptions and demonstrates perseverance in finding solutions to questions raised in clinical.

Provides reasoning for application of knowledge, skills, and attitudes in particular clinical decisions.

Integrates and applies scientific knowledge base, nursing process, and clinical judgment to improve clinical outcomes.

Applies theoretical and epidemiological concepts and strategies to deliver population-focused care.

Demonstrates ability to modify plans in response to changes in condition or circumstances, predict consequences of decisions and make appropriate adjustments in interventions.
Additional comments:
Clinician

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.

REQUIRED: Meets core clinical competencies for safety and universal precautions.
Check all that apply:

Performs tasks with minimal assistance while still referring to institutional policies and procedures and nursing personnel to guide interventions.

Identifies and examines unsafe practices such as work-arounds, unapproved abbreviations, and communication failures which contribute to patient harm.

Utilizes error reporting system within organization to report any errors or near miss events.
Draft: Spring 2010 (CA/DT)


Analyzes any miss or near miss event by conducting a Root Cause Analysis (RCA).

Provides patient-centered care with sensitivity to client’s diverse cultural, ethnic and social background and the values and preferences associated with these.

Assesses target population; plans, implements, and evaluates evidence-based health promotion strategies to meet the needs of a target population.

Collaborates with patient, family, and/or population in determining strategies to promote health.

Functions competently as a member of the health care team in delivery of patient care while staying within scope of practice as a student.

Selects a plan of care that is in the best interest of the patient / population and advocates for this.

Evaluates completion and effectiveness of delegated tasks/ interventions.

Utilizes patient care technology in a comfortable and knowledgeable way to document and implement patient care.
Additional comments:
Educator

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.
Check all that apply:
 Demonstrates confidence and competence in assessing patient’s learning needs, current practices, beliefs and motivation to change.

Provides creative teaching methodologies that encourage patient/family involvement & learning.

Adapts teaching strategies to meet client literacy levels, interest, preferences, and specific clinical situation.

Incorporates client & family education into multiple facets of patient care.

Participates actively in patient discharge teaching.

Provides patient with evidence-based health promotion and disease prevention information and resources.

Assesses patient / target population’s educational needs and readiness to change.

Implements and evaluates an educational intervention.
Additional comments:
Effective Communicator

REQUIRED: Continues to demonstrate Level 1 (NRSG 360), Level 2 (NRSG 361), and Level 3
(NRSG 460) indicators.
Draft: Spring 2010 (CA/DT)

Check all that apply:

Actively partners with clients, family members, peers, faculty and health care team utilizing effective communication strategies and culturally appropriate language.

Evaluates the effectiveness of communication among team members and discusses strategies for improving team dynamics.

Actively participates in multidisciplinary patient rounds.

Proposes change in plan of care and/or recommendations for care to client’s providers.

Exhibits competent communication techniques, including self-evaluation, openness, conflict resolution and negotiation strategies that lead to a win-win situation.

Discusses clinical decisions & actions in an organized and comprehensive manner.

Demonstrates competency with electronic medical records, informatics, formal and technical writing and computer literacy in the clinical setting.

Presents a clinical case study to faculty and peers.

Presents a culturally appropriate, evidence-based, health intervention to a target population, followed by an evaluation of this intervention to faculty and peers in a media format.

Prepares a written abstract and poster display to communicate the health intervention plan.
Additional comments:
Comments:
I have reviewed the above evaluation and agree with the clinical performance evaluation.
Student Signature _________________________________________Date _______ Faculty____________________________________Date________
Excellent = Consistently exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Exceeds Expectations = Occasionally exceeds performance expectations for beginning practitioner, independent thinker, takes initiative
Satisfactory = Meets performance expectations for beginning practitioner, requires minimum guidance
Needs Improvement = Performance adequate but requires guidance
Unsatisfactory = Performance not improved in spite of guidance and feedback
Draft: Spring 2010 (CA/DT)