2014 Performance Evaluation

25531
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
17
18
19
20
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
21
22
23
24
Employee: Aurora Davis Employee ID:
Evaluator: Evaluator ID:
Ethics role: Calls for ethics consults as needed. Advocates for patient and family with team as
appropriate. Acts in an ethical manner with peers and patients. Advocates for equitable healthcare
(Providing culturally sensitive care.)
Employee Comments: I earned 25.5 CEs this year. I met (or
plan to shortly) all of my goals for last year and have set new
ones. I have completed all my required training and only missed
1 staff meeting in the last year. I provide education for others in
person and via email ("Learning Opportunities", tip sheets). I
created a pain education tool for patients and performed the
staff education for roll-out. I am a member of ONS and MDONS,
and am OCN certified. I am ACLS certified.
Manager Comments:
Assessment/intake screening collects data in a systematic and ongoing process. Consistently
completes this using appropriate evidence-based assessment techniques, instruments and tools,
recognizes abnormal, pertinent findings. Initiates referrals/consults to interdisciplinary team
promptly.
Assesses patient and family psychosocial, spiritual, emotional, age specific and diversity needs.
Documents and communicates to team assessment results across shifts/episodes of care.
Reassessments recognize potential safety issues. Pain, fall prevention, and changes in patient
condition are reassessed per standards or more frequently to prevent complications. Differentiates
symptoms and changes in condition using critical thinking, reporting to team using SBAR methods.
Plan
Considers the economic impact of the plan on the patient, family, caregivers, or other
affected parties.
Date: 6/7/2014
Level II Professional Registered Nurse Performance Appraisal
Nurse practice reflects clinical quality, knowledge/skills, and standards. Minimum 4 record reviews and peer review to document job competency. Care results in optimal patient clinical outcomes.
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EXEMPLARY PROFESSIONAL PRACTICE (35%) COMMENTS
Assessment Role Model Employee Comments: I am able to appropriately care for very ill
patients and coordinate their care, recognize changing patient
conditions, and act appropriately. The complexity of the patients
now assigned to me and comments made by others reflects that
my peers agree that I can handle a very heavy and potentially
tenuous patient load. I act as a resource for others with
potentially unstable patients and am frequently approached with
questions (I was voted "Taber's Medical Dictionary" during our
Nurses Week Celebration). I act as relief charge and assist with
managing patient throughput and capacity. I am able to take a
holistic view of patients and their families and think of their "big
picture" needs. I collaborate effectively with different teams to
meet a wide variety of customer needs. I frequently refer to
policies, procedures, and guidelines to assist my care and also
refer others to them when appropriate. I have particularly
become an advocate of appropriate pain management for
patients and have developed a patient teaching tool, educated
staff, and become a unit resource to assist this goal. I complete
Safety Intelligence Reports when appropriate and also instruct
staff in how to do the same.
Evaluation
Evaluates patient changes in condition and modifies plan of care appropriately. Informs and
partners with family as changes occur in plan of care. Communicates with team consistently and
clearly as plan changes, documenting accurately in timely way.
Evaluates patient and family satisfaction daily, making adjustments for improvement.
Communicates across departments as partner to assure patient and family needs and preferences
are addressed across disciplines.
Complies with professional practice standards. (e.g., unit specific practice standards)
Implementation
Implements care within policies, procedures and guidelines, integrating data from the team care
plan. Care demonstrates competent clinical skills, using critical thinking and nursing judgment in a
safe and timely manner.
Implementation reflects sensitivity to patients comfort, satisfaction, and safety. Recognizes
changes in patient condition. Uses resources and chain of command to prevent adverse events.
Care is prioritized and delegated appropriately. Uses evidence and nurse sensitive indicator data
to improve care interventions.
Safe care delivery shows accurate medication administration using 6 rights and correct use of
patient equipment. Teaches others and models these standards. Documentation is consistently
meeting standards, with no omissions of care.
Communication demonstrates teamwork, safe, accurate handoffs, attention to detail &
competent computer skills.
Patient/ family teaching is complete, including health promotion and discharge instructions to
prevent re-hospitalization. Incorporates core measures targets into teaching. Family included in
discharge planning, instruction.
Commitment to UCH Learning Environment: Demonstrates commitment to service/unit learning
environment by attending required training, staff meetings at 75%, and completing competencies
on time and with positive team attitude. Participates in educational activities offered on service
(example: short CEs). When practice/product changes occur, demonstrates positive response and
completes training as required promptly.
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STRUCTURAL EMPOWERMENT (5%) COMMENTS
Professional Development demonstrated by attending CE relevant to clinical area (10/yr). Meets
professional goals from the previous year. Identifies 2 professional goals for next fiscal year.
Role Model
Manager Comments:
Commitment to Profession/Community: Learns about professional organizations and nursing
issues. Verbalizes why UCH is a magnet hospital and ways to personally contribute to our
professional work environment.
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TRANSFORMATIONAL LEADERSHIP (5%) COMMENTS
Definition: Leads group of Patients. Develops ownership of our unit.
Show growth as a leader.
Leads teams related to patients assigned: CNA, MD team members, by rounding, initiating
Pt/Family conferences.
May participate on unit council/committee.
Role Model Employee Comments: I regularly act as relief charge. I am co-
chair of the Pain Committee (hospital-wide committee). I
perform pain reassessment audits and provide direct feedback
when necessary. I implemented a successful action plan to
improve pain reassessment rates on our unit. I regularly precept
new nurses. I act as a resource to others regarding clinical
questions, both in person and via email. I send out instructive
emails ("Learning Opportunities") and have created/updated
several tip sheets to provide guidance to others. I was voted
"Taber's Medical Dictionary" during our recent Nurse's Week
Celebration. I greatly value feedback and am always seeking to
improve my performance in all ways.
Delivers Safe Patient Care w/Team: Uses time constructively to deliver patient care, supports
the team. Consistently flexible with schedule, assignment. Identifies conflict/problems and
participates in resolution. Participates in multidisciplinary rounds, conferences for patient
assignment; may act as a relief charge.
Delegates appropriately per state board nursing R&R. Promotes positive team relations and
communication.
Performance review process participation constructive: open to receiving feedback from peers,
patient, and family. Acts to improve performance. Participates in surveys, patient satisfaction
initiatives w/ team, and unit plans for improvement. Models leadership skills w/ peers, patient
care.
Manager Comments:
Professional Actions: manages conflict constructively and competently, with peers, colleagues
and other disciplines. Acts as a preceptor, with positive responses to assignments responsible
actions in role. Demonstrates a work environment that promotes cooperation, respect and trust.
Plan of care is developed with interdisciplinary team, based on medical plan and pt/family input.
Individualized plan that considers patient characteristics or situation. Recognizes the patient as
the authority on his or her own health by honoring their care preferences.
Plan constructed from admit to discharge or episode of care, with goals clearly defined.
Plan addresses transitions in care and discharge from one level to another within UCH system or
externally. Placement and progress is identified, communicated, documented clearly. Pt/family is
active participant.
Created by Shalene Barrera and Jamie Le-Lazar-Please email corrections to shalene.barrera@uchealth.org

2014 Performance Evaluation
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
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26
27
28
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Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
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Role Model
Unit Specific Performance Metric: Expectation is to minimally check E-mail and Sharepoint 3 times
per week.
COMMUNICATION (10%) COMMENTS
1
*I maintain a positive image and follow the UCHealth dress code. I wear my badge so it is easily
read by patients, visitors and colleagues. Any time I am in uniform or have my badge on, I
represent UCHealth in a positive light.
*I show respect to all members of the UCHealth team: volunteers, employees, managers, medical
staff, students and others.
*Before I speak, I consider who might be listening and what is appropriate in that situation.
*I keep current on organizational information.
Employee Comments: I always follow dress code. I check email
frequently and am an active participant (asking and answering
questions where appropriate). I disseminate information through
email and Sharepoint from my Committee and from my own
Manager Comments:
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PERSONAL (10%) COMMENTS
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*I take responsibility for my attitude and actions. I treat others with dignity and respect; rudeness is
not acceptable.
*I am supportive and flexible when change occurs.
*I consistently carry out my work duties to the best of my ability, skills and training; understanding
that my work makes a difference in the care of our patients.
*I deal with conflict in a constructive manner and welcome personal feedback to improve
performance and relationships.
*I look for opportunities to further my learning.
*I do the right thing because it is the right thing to do, whether anyone is watching or not.
Role Model Employee Comments: I have greatly exceeded the required
amount of CEs for each of the last 3 years. I am OCN certified. I
work hard to accept criticism in the spirit in which it is given and
view it as an opportunity for personal growth. I try to tackle
conflict in a direct manner by going to the source. I value
personal relationships on my unit and strive to maintain them.
Manager Comments:
Unit Specific Performance Metric: Unit Goal Oncology Certification for eligible RN's to be at 65%.
Attend Oncology M&M rounds 2 times per fiscal year.
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TEAM (10%) COMMENTS
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*I listen to understand and respond in a compassionate manner.
*I encourage my colleagues and offer words of praise for excellent work.
*I partner with my colleagues to manage the workflow of my team and willingly pitch in to help
others.
*I help new or less experienced colleagues feel welcome.
*I thank others for their time and efforts.
Role Model Employee Comments: I precept new nurses frequently. I act as
relief charge and try to mentor and support new staff members.
I always thank others for their hard work, particularly my
CNAs/ACPs. I act as a role model for LOOK report and I
encourage participation in shift huddles.
Manager Comments:
Unit Specific Performance Metric: 100% Compliance with LOOK Report and Shift Huddles.
QUALITY (10%) COMMENTS
1
*I seek to understand and improve core measures, quality metrics, best practices, patient
satisfaction measures and employee engagement measures.
*I respect the confidentiality of patients and colleagues.
*I report concerns and take appropriate actions to eliminate patient, visitor and/or employee safety
hazards.
*I identify opportunities and solutions for service and safety improvements in my work area and
assume accountability for our success.
*I keep the facility and my work area neat, clean, presentable, uncluttered and safe.
*I will take appropriate action when public areas do not meet these standards.
Role Model Employee Comments: I educate others on ways to improve
safety through my "Learning Opportunities" emails. I am working
to improve our HCAPS for pain. I was an ambassador for this
year's EES. I am 100% compliant with critical results. I tidy work
areas and patient rooms. I use the discharge lounge frequently.
Manager Comments:
Unit Specific Performance Metric:Meet Current Hospital Wide Benchmark for CLABSI. Meet
hospital goal of 90% of accurate documentation for critical test results. Meet Fall Benchmark of
2.79/1000 patient days. I will consistently utilize the discharge lounge for patients.
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SERVICE (10%) COMMENTS
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*I am here to serve my customers. This means prompt, friendly and quality service.
*I promptly respond to patient requests, phone calls and customer needs.
*I communicate in a respectful and professional manner.
Non-verbal communication is as important as what I say.
*I anticipate patients and others needs, working to prevent problems and remove barriers.
*I communicate frequently about how long a patient, visitor or colleague may expect to wait. I
provide regular updates.
*I walk guests to their location and seek out those that look lost.
Role Model Employee Comments: I am working to improve our HCAPS for
pain. The quality of my service is very important to me. I
recognize the value of nonverbal communication and work hard
to be an active listener. I use AIDET and try to be specific when
telling customers when I will return. I walk guests to their
destination or provide a map for them.
Manager Comments:
Unit Specific Performance Metric: Percent of patients who rate us a 9 or 10 overall Hospital Goal
=76% Overall Pain Management Score- Hospital Goal=74.3% Overal Responsiveness Score-
Hospital Goal=67.1%
Regulatory Standards: Competent in environment of care and unit/department requirements for
safety (temperatures, code cart, mock codes, fire drills, disaster plan). Completes regulatory
testing within time requirements.
Evidence-Based Practice/Research: Knowledgeable about Research and Evidence Based
Practice Outcomes Research manual learns how to access on unit/clinic or by Professional
Resources website. Completes annual outcomes competency. Participates in one journal club.
Attend one journal club each year.
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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS (5%) COMMENTS
Role Model Employee Comments: I am near completion of a FOCUS-PDCA
project to improve HCAPS for pain (awaiting post-data). I am co-
chair of the Pain Committee and regularly perform pain
reassessment audits. I am a leader and resource on the unit for
pain management, particularly PCA and epidural use. I regularly
provide safety and improvement education to the unit through
my "Learning Opportunities." I act as relief charge and assist
with fulfilling regulatory standards.
Nurse/Hospital/Unit Indicators: Identifies nurse sensitive NDNQI outcomes for unit/clinic: falls,
skin, pain, other. Verbalizes areas for unit improvement and how own care could improve.
Process Improvement: Verbalizes knowledge of FOCUSPDCA and knows unit projects.
Oriented to Little Gold Book, Doing the Right Thing Right. May participate in collecting project
data.
Manager Comments:
Resource Utilization: Assists the healthcare consumer and family in identifying and securing
appropriate services to address needs across the healthcare continuum.
Created by Shalene Barrera and Jamie Le-Lazar-Please email corrections to shalene.barrera@uchealth.org

2014 Performance Evaluation
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Overall Score UEXCEL Score Individual Performance Goal
Goals
for
FY14
List your FY2014 Goals (last year) Comments
Goals
for
FY15
Specific: List specifically what
goals you will accomplish.
Measurement: How will you
and your evaluator know the
goals are completed?
Realistic: What support or resources
do you need to accomplish the goals?
Timeline: Dates the goals
will be completed.
Join a Hospital-Wide Committee
Role Model
I joined the Pain Champions of Change (hospital-wide committee)
in Oct. 2014. I have never missed a meeting. I implemented a
successful action plan to improve pain reassessment rates on the
unit. I was approached by the co-chairs and asked to replace one of
them, and became Co-Chair of the Committee as of May, 2014.
Patient Satisfaction
Role Model
My credentialing project ties directly into improving patient
satisfaction, as I am working to improve the unit's HCAHP scores
for Pain Management. The Education Tool I developed has been
rolled out house-wide in an effort to improve patient satisfaction
throughout the hospital.
Completed?
Become a Level III Clinical RN
Role Model
I am currently in the process of credentialing to a Level III Clinical
RN. My unit project and portfolio are well underway and I anticipate
turning in my supporting documentation by the August 22nd, 2014
deadline.
Below Threshold Threshold Target Max
Individual Performance Goal
Rating
Strategic: What strategic
objective do your goals
support?
Attainable: Can the goals be
completed within the next year?
Critically think through each
patients individual fall risk score
each shift and as needed
throughout the shift, guided by
the fall assessment tool.
Implement and utilize
appropriate fall interventions
(bed and chair alarm, gait belt
use, correct number of side
rails, yellow socks, assistance
to the bathroom) as needed.
Educate each patient on what
interventions are in place for
their safety and what makes
them a high fall risk utilizing the
fall teaching tool. Coordinate
purposeful hourly rounding on
your patients with your
CNA/ACP, and document
rounding in real time. Respond
to all bed alarms in an urgent
manner, even when it is not
your patient. Participate in the
fall huddle when a fall does
occur on the unit. Aim for a goal
of being below the benchmark
of 2.79 falls per thousand
patient days for each unit
monthly
Quality and Patient
Expericnce
The Oncology/BMT units will
meet the HCAHPS benchmark
as set per hospital FY 15 goals
Note to Evaluators: You must transfer the above three ratings into the system evaluation tool.
Role Model 4.00 Target
Growth
Become BMT certified,
maintain my Level 3 status
(hold a Journal Club, mentor
another credentialing RN, etc.),
ensure the Pain Education Tool
Quality and Patient
Expericnce
Created by Shalene Barrera and Jamie Le-Lazar-Please email corrections to shalene.barrera@uchealth.org