Student Name:

Daniel Gaudette

Southwestern Oregon Community College Nursing Program

Nursing 222
Foundations of Nursing: Acute Care II

Clinical Evaluation Tool

The purpose of the weekly clinical performance evaluation tool is to provide feedback about achievement of the course outcomes and
competencies and to assist the student to meet the standards of care for nurses in Oregon as outlined in the Nurse Practice Act.
Explanation of Rating Scale:
(S) Satisfactory = Clinical performance is safe and student adequately demonstrates application of the nursing process/clinical judgment,
required skills, and expected synthesis of learning appropriate to level in the program. Verified by direct instructor observation.
(NI) Needs Improvement = Indicates that additional learning and attention to detail is required for a particular item or that the overall
performance for the week is at a minimum level. The instructor will write an explanation of the rating on the comments page.
(U) Unsatisfactory = Clinical performance is unsafe and inadequately demonstrates application of the nursing process/clinical judgment model,
required skills, and expected synthesis of learning appropriate to level in the program. The instructor will write an explanation of the rating on
the comments page.
(NA) Not applicable = Particular item does not apply to the clinical performance.
(NO) Not observed = Instructor did not observe or has no knowledge of the students performance of the activity.
Students with a grade of NI or U will be required to meet with their advisor and clinical instructor and discuss a plan for change in their behavior
before their next clinical experience.
Safety and legal/ethical concepts are considered critical to the profession and will be graded as NI or U if any violation occurs.
If a student is assigned a U or NI for two weeks, the faculty will review the students clinical performance and consider the options of either
placing the student on probation or dismissing from the program.
In cases of potential failure, notification of the student by the instructor that she/he has been assigned a grade of U or NI for one week
constitutes proper warning of the grade status.
If a student is placed on probation and then receives a grade of U, the faculty will review the students performance and determine whether or
not the student will be dismissed from the program.

Nursing 222 Clinical Evaluation Tool

.
Competency
(C)
Course
Outcomes
(CO)

C9
CO1,2, 5

Student Name:

Daniel Gaudette
Clinical Week
5
6
7

Dates

10/9/
14

10/1
6/14

10/2
3/14

10/3
014

11/6/
14

11/1
3/14

11/2
0/14

Attendance: P=Present, A=Absent, T=Tardy

n/a

Facility/Unit

PSU

n/a

MCU

PSU

MCU

PSU

OR

NI

S
S

S
S

S
U

S
S

S
S

S
S

NI

NI

n/o

n/o

n/o

n/o

n/o

n/o

n/o

n/o

S
S
n/o

S
S
n/o

U
NI
NI

S
S
n/o

S
S
S

S
S
S

NI

NI

NI

Applies concepts and theory to clinical practice in client care and

written assignments:
1. Conducts evidence-based assessment, using age, developmental
and culturally appropriate communication skills
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment findings in
increasing complex acute conditions.
4. Recognizes pathophysiological changes and symptoms
5. Regularly monitors clients level of comfort and ability to
manage symptoms and symptom distress
6. Prioritizes health problems.
7. Develops and uses evidence-based individualized interventions
8. Develops a plan of care that considers the individual, family, age
of client, developmental stage, psycho-socio-cultural issues,
and/or learning needs.
9. Evaluates and reflects on plan of care for clients with acute
conditions.
CO4
Develops discharge plans in collaboration with client, family, and
other members of the health care community.
C8
Uses therapeutic communication with patients and agency staff.
C 6,7,8
Recognize cultural issues and interact with clients in culturally
CO1
sensitive ways.
C5
Collaborates with other members of the health care team to provide
CO3
comfort and symptom management.
C10, CO2 Uses research and evidence to support clinical decision making.
C6, CO
Utilizes resources as needed.
C4
Able to identify/define leadership skills for nurse's role
C9
Exhibits critical thinking skills when prioritizing and delegating
CO1
patient care.

11/2
7/14
holid
ay

12/1
4/14
P

Make-up

1
C9, CO1

C3
C4
C3
C4
C1, 2
C1
C8
C3
C2
C4

Demonstrate responsibility and accountability for professional

behavior:
1. Performs safely in clinical.
2. Prepared for clinical (Appropriate attire, appropriate tools such as
stethoscope, skills list, evaluation tool, assessment tools).
3. Takes initiative in making decisions and assuming responsibility
for decisions.
4. Looks for opportunities for continued learning and selfdevelopment.
5. Identifies behaviors and attitudes influencing professional
behavior.
6. Demonstrates growth in coping with stressful situations in a calm
and dependable manner.
7. Maintains patient confidentiality.
8. Documentation of client care is accurate and relevant and
consistent with agency policy
9. Completes and submits assignments on time.
10. Organizes and manages time effectively.
11. Attends and participates at post-conference.

Instructor Initials
Student Initials
Key: C=Competency, CO=Course Outcome

NI

NI

NI

NI

NI

S
S
S

S
NI
S

S
S
S

S
S
S

S
S
S

S
S
S

TYF
DG

TYF
DG

TYF
DG

TYF
DG

TYF
DG

DG

TYF
DG

TYF
DG

TYF
DG

Make-up

Week

Instructor include comments that are positive, areas that need improvement or are unsatisfactory. Reference the course
outcomes listed in the syllabus and/or the OCNE Competencies from the Nursing Student Handbook (Date/Sign all entries)

Student Initials

10/9/24. PASS. Daniel- For our first day back to clinical after a long break, my expectations for students were to refamilarize themselves
with the environment and passing medications; unfortunately, you had a somewhat challenging experience with your patient due to his
refusal of medication administration. You handled this well and I deemed you to be safe and thorough with how far you did get in the
process. I will still need to view a medication pass with you. In particular, you met competenicies #3, 5, and 9 very nicely. In future clinicals,
I will be observing assessment skills, teaching skills, and critical thinking skills on two assigned patients. At that point, my goal for you is to
meet Level II competency by the time we reach the end of fall or winter term. Please review the OCNE competencies so that you are on
top of what expectations are being measured.
Tracy Fawns, RN, MSN
10/16/14. Clinical canceled by instructor.

DG

10/23/16: Pass. Dan- This was our first clinical week with 2 patients. This added obvious stress to your day and time management and,
unfortunately, caused some late medication administrations, which accounts for the Needs Improvement grading above; this reflects
competencies #2 & #9. I am anticipating that this will improve as you get better with managing care for two patients over the course of the
term. I do see very professional care from you, which reflect competency #9. I would like to see you contemplate your day when you are
doing your care preps in order to help visualize bunching up your med passes with assessments and documentations. Also, I did not pass
you on your IV push, as you did not obtain proper patient identification. This could have very well have been a medication error.
Tracy Fawns, RN, MSN

DG

10/30/14: Unsatisfactory/No pass. Dan- This was a stressful week for you, and we have discussed where things went wrong for you in
clinical this week. With regard to the medication error you made, I do need to document what happened. When assessing a patients pain
level, you deemed a need for a dose of Dilaudid. This med was ordered as IVP by the physician. You texted me (your clinical instructor) for
a check off for the IVP; I replied that I would be 15 minutes with another student, and then replied again with On my way as I began
approaching your clinical area. On my arrival, you stated that you had given the medication via the IV pump with the RN with whom you
were working. A few factors come into play with this: 1) You proceeded to attempt a skill for which you had not been signed off yet
without me present; 2) You went against the physician order for the route intended (IVP) and instead hooked the med to the pump; 3) You
completed a skill in the incorrect manner. An IVP should never be administered via a pump (or any method other than the written order)
for a variety of reasons (i.e., there is medication left in the PG port, the medication takes at least 10 minutes to reach the patient and thus
when it switches back to the main line there is essentially a bolus of medication, etc.). Due to the nature of this error, and the patient
safety factors surrounding this, you were given an unsatisfactory. This issue relates to competencies 4, 6, 9, and 10 (see above). However, I
do appreciate your honesty and your willingness to learn from the situation. This shows professionalism and growth in competency #3
which reflects to using situations as a learning experience.
Tracy Fawns, RN MSN

DG

11/6/14: Dan Unfortunately, I had to give you another NI pertaining to documentation. Please see my notes on your care plan. I am going
to have you talk to your advisor and see if this one-on-one time will help to improve your documentation as far as what you
should/shouldnt write on a patients chart; please make an appointment with her (she is expecting you). Im also concerned that you

DG

DG

didnt know that the surgical process and/or stress therein of a procedure would cause a rise in blood glucose, necessitating the need to go
ahead and give the sliding scale insulin. I am pleased you sought my advice on this, but you didnt practice your SBAR communication with
the physician as I had asked you to do with the RN with whom you were working and you didnt use your own critical thinking to think
through the process on your own to have a solid plan/idea of why/why not to give insulin in this situation. These opportunities for learning
are essential and rich in experience-driving knowledge; this relates to competency #3 (self-development). Dan, your care of your patients is
heart-felt and I do believe you are trying very hard. I would like to see these incidents used as learning experiences and for growth in your
nursing care.
Tracy Fawns, RN MSN

11/13/14: Dan I am still very concerned about your documentation. I gave you another NI for the nurses note that you made. Somehow,
I am not seeing these errors in Soarian within your clinical notes. Are you putting a different note on your care plan versus Soarian? Your
care plan needs to reflect what you chart at the hospital. Your note does not document anything about your patient or patient status; it is
not appropriate to write about an order/intervention that someone else didnt do, and then you came along and implemented. Your
integration in your pathophysiology paper is improved, but was still limited to just 1-2 paragraphs. You need to incorporate your patient in
the entire patho paper, from beginning to end; including, labs, meds, ADLs, developmental level, comorbidities, etc Aside from these
things, as usual I enjoy seeing your interaction with patients. You do have a very caring demeanor about you. Your time management is
also coming along very nicely!
Tracy Fawns, RN MSN

DG

11/20/14: Absent/ill.

DG

11/27/14: Holiday.

DG

12/4/14: PASS. OR observation. Dan, I received very positive feedback about your time in the pre-op area, OR, and PACU.
Tracy Fawns, RN MSN

DG

Clinical
Make-up
9/2/09: revised 5/06/11 sw