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Clinical Performance Evaluation Tool Creation Instructions:
Tier 1: ALL tools will utilize the same Texas State School of Nursing Program Student Educational Outcomes. There are 8
outcomes which have been divided (by committee for ease of use) into 3 broad categories (see template below). These
broad categories, based on the program outcomes, will remain the same throughout the curriculum and demonstrate
reliability between tools.
Tier 2: Course Outcomes: Each course coordinator will map individual course outcomes (as identified in the course
syllabus) to the program outcomes and place into one of 3 broad categories depending on which program outcome the
course outcome is mapped to. This will demonstrate progression of course outcomes within the consistent program
outcomes framework.
Tier 3: Using the Nursing Program Student Educational Outcomes as guides, the coordinator will need to review the
behaviors identified in the NCLEX detailed test plan (https://www.ncsbn.org/2010_NCLEX_RN_Detailed_Test_Plan_Candidate.pdf)
that fit the course outcome and are level appropriate based on course. [The NCLEX detailed test plan was chosen by
committee as it was constructed from data collected from a practice analysis of 12,000 newly licensed RNs on the current
practice of the entry-level nurse. This information was then used to guide the development of candidate preparation and
NCLEX examination composition to reflect the knowledge, skills, and abilities essential for the entry-level nurse to
demonstrate] These identified behaviors can then be combined and customized using appropriate taxonomy verbiage (see
blooms taxonomy below) to reflect course level appropriate competencies. These chosen behaviors will then reflect the
level appropriate competencies students are expected to meet for each individual course.
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TEXAS STATE UNIVERSITY ST. DAVID’S SCHOOL OF NURSING (TEMPLATE)
COURSE NAME PRACTICUM
CLINICAL PERFORMANCE EVALUATION TOOL
Student: ______________________________________
S = Self Directed
Semester: __________________
A = Assisted
M = Marginal
Faculty: ____________________________
U = Unsafe
FORMATIVE:
 Students will be evaluated in the setting where clinical activities occur. Clinical activities occur in agencies & in the simulation laboratory
setting. Signature of faculty & student with date is required. The instructor will rate the student’s formative performance for each
Competency using the given indicators: Self-Directed, Assisted, Marginal & Unsafe. The student will have an opportunity for input/feedback
during each evaluation.
 Behaviors evaluated as “Unsafe” or a pattern of “Marginal” ratings may require the student to successfully complete a performance
improvement plan, i.e. a “Learning Contract” with the student’s clinical faculty at the faculty’s discretion.
 Absences are not excused & may result in a U (unsafe) or a Learning Contract at the faculty’s discretion.
SUMMATIVE:
 Final: At the end of the semester, the faculty & student perform a summative evaluation of the student’s performance. The student must
complete the self-evaluation prior to meeting with the faculty. The student will be given an opportunity to respond.
 In addition, 75% of all behaviors must be ‘Self-Directed’ or ‘Assisted’ on the Summative Evaluation.
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DEFINITIONS OF CLINICAL BEHAVIORS:
S: SELF DIRECTED:
 Student practices in a safe, accurate, proficient & self-directed manner.
 Student independently seeks out instructor to provide & validate information for safe care.
 Student independently seeks out appropriate patients correlating to the practicum level.
 Student demonstrates professional behaviors while meeting the objectives for each clinical day.
 Written & verbal communication is clear, professional & therapeutic.
 Clinical assignments are thorough, complete & submitted in a timely manner.
A: ASSISTED:
 Student practices in a safe, accurate, & proficient manner.
 Student appropriately seeks reinforcement & supervision by faculty or nursing personnel.
 Student demonstrates professional behaviors while meeting the objectives for each clinical day with minimal guidance.
 Written & verbal communication is professional & effective.
 Clinical assignments are complete & submitted in a timely manner.
M: MARGINAL:
 Student practices in a safe manner, however requires frequent prompting from faculty or nursing personnel.
 Student demonstrates professional behaviors while meeting the objectives for each clinical day with maximum guidance.
 Written & verbal communication is at times professional, but requires frequent guidance.
 Clinical assignments are partially complete &/or submitted late.
U: UNSAFE:
 Student practices in an unsafe manner requiring frequent prompting from faculty or nursing personnel.
 Student demonstrates unprofessional behaviors
 Does not meet objectives for each clinical day.
 Written & verbal communication is disorganized, incorrect & inaccurate.
 Clinical assignments are incomplete, inaccurate &/or submitted late.
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NURS 3220 ESSENTIALS OF NURSING CARE PRACTICUM
CLINICAL PERFORMANCE EVALUATION TOOL
I. Patient-Centered Care- (Tier 1: REQUIRED FOR ALL TOOLS ACROSS THE CURRICULUM- stays the same, demonstrates
reliability between tools)

Nursing Program Student Educational Outcome (BSN) #1: Facilitate safe, holistic and effective patient/family centered care outcomes
through use of evidence-based research and other science-based frameworks to promote and maintain health, prevent disease, and
manage illness.
 Nursing Program Student Educational Outcome (BSN) #2: Demonstrate professional accountability and responsibility for nursing
judgments and actions within an ethical and legal framework, utilizing the most current knowledge.
 Nursing Program Student Educational Outcome (BSN) #6: Provide entry-level professional nursing care to clients across the lifespan
in a variety of health care settings.
 Nursing Program Student Educational Outcome (BSN) #7: Promote a culture of caring to provide holistic, compassionate, culturally
competent care.
CLINICAL BEHAVIOR
FORMATIVE
SUMMATIVE
Time Period 1
Time Period 2
Time Period 3
Time Period 4
Course Outcome: (Tier 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
1. Tier 3: Behavior based on
NCLEX blueprint- customized
using course level
appropriate taxonomy to
show progression. Include
NCLEX Category and
Subcategory EX: Perform
comprehensive health
assessment NCLEX:Health
Promotion and Maintenance
2. TIER 3: Behavior
Course Outcome: (TIER 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
COURSE TITLE AND YEAR / 5
3. TIER 3: Behavior
4. TIER 3: Behavior
5. TIER 3: Behavior
Course Outcome:
(TIER 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
6. TIER 3: Behavior
II. Professional Nursing Role (Tier 1: REQUIRED FOR ALL TOOLS ACROSS THE CURRICULUM- stays the same,
demonstrates reliability between tools)




Nursing Program Student Education Outcomes #2: Demonstrate professional accountability and responsibility for nursing judgments
and actions within an ethical and legal framework, utilizing the most current knowledge.
Nursing Program Student Education Outcomes #3: Demonstrate leadership in the provision and coordination of safe, cost effective
and high quality nursing care
Nursing Program Student Education Outcomes #4: Advocate for patients, families, communities, and the nursing profession, applying
values and utilizing an ethical framework, critical reasoning, and cultural competence.
Nursing Program Student Education Outcomes #8: Function effectively within nursing and interprofessional teams, fostering open
communication, mutual respect, and shared decision making to achieve quality patient care.
CLINICAL BEHAVIOR
FORMATIVE
Time Period 1
Time Period 2
Time Period 3
SUMMATIVE
Time Period 4
Course Outcome: (TIER 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
1. TIER 3: Behavior based on
NCLEX blueprint- customized
using course level
appropriate taxonomy to
show progression. . Include
NCLEX Category and
Subcategory
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2. TIER 3: Behavior
3. TIER 3: Behavior
Course Outcome: (TIER 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
4. TIER 3: Behavior
5. TIER 3: Behavior
6. TIER 3: Behavior
III. Informatics and Use of Technology (Tier 1: REQUIRED FOR ALL TOOLS ACROSS THE CURRICULUM- stays the same,
demonstrates reliability between tools)


Nursing Program Student Education Outcomes #2: Demonstrate professional accountability and responsibility for nursing judgments
and actions within an ethical and legal framework, utilizing the most current knowledge.
Nursing Program Student Education Outcomes #5: Utilize information and technology to communicate, manage knowledge, educate,
mitigate error and support decision making.
CLINICAL BEHAVIOR
FORMATIVE
Time Period 1
Time Period 2
Time Period 3
SUMMATIVE
Time Period 4
Course Outcome: (TIER 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
1. TIER 3: Behavior based on
NCLEX blueprint- customized
using course level
appropriate taxonomy to
show progression. . Include
NCLEX Category and
Subcategory
COURSE TITLE AND YEAR / 7
2. TIER 3: Behavior
3. TIER 3: Behavior
Course Outcome: (TIER 2: Place Course Outcomes as stated in syllabus-Mapped to Program Outcomes- # and type will vary by course)
4. TIER 3: Behavior
5. TIER 3: Behavior
Faculty Initials
Student Initials
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