XYZ School Clinical Evaluation tool

Clinical Performance Evaluation Tool

Student
Name:

Student

Faculty
Name:

Jennifer Dougherty

Semest Fall
er:

Student must obtain a 3 (75%) and a yes (Y) in all competencies at the final
evaluation for the course.
Core Competencies

Scor
e
Students will begin to develop critical thinking abilities utilizing the nursing process in the roles
of communicator and caregiver. Students will learn principles of professional nursing practice
and provide direct care to individuals in a variety of settings while recognizing the diverse
uniqueness of individuals with health alterations.
I. Patient-Centered Care
a. Begin to develop an individualized plan of care with a focus on assessment and
planning utilizing the nursing process. Begin to Interpret and utilize patient
assessment data to modify patient care.
b. Demonstrate caring behaviors. Communicate effectively with client.
c. Conduct a basic assessment while eliciting patient values, preferences, needs, with
respect for diversity.
d. Deliver care based on beginning knowledge of pathophysiology with respect for
individual values, preferences, needs, and diversity.
e. Assess the presence and extent of pain and suffering.
f. Demonstrate beginning competency in skills.
II. Teamwork and Collaboration
a. Develop effective communication skills with all appropriate members of the
healthcare team
b. Begin to develop collaboration skills in working with the inter-disciplinary team
members to address client care needs
c. Participate in pre and post conferences to identify patient needs and methods to
deliver care more effectively for the next interaction.
d. Demonstrate awareness of own strengths and limitations as a team member.
e. Initiate requests for help when appropriate to situation.
III. Evidence-Based Practice
a. Begin to understand the concept of evidence-based practice in determining best
clinical practice
b. Begins to utilize evidenced-based resources for clinical learning and practice
IV. Quality Improvement
Begin to deliver care in a timely and efficient manner.
Begin to identify areas and information in the health care setting about
processes/projects to improve care (QI).
Begin to understand the importance of variance reporting in how it impacts patient care
protocols and risk prevention. For example: Fall Risk
V. Safety
*Content based upon QSEN Competencies and KSAs.
Developed 6/2016

3
2
3
3
3
2
2
2
2
2
3
3
1
4
1

a.
b.
c.
d.

Integrate effective use of technology and standardized practices that support safety.
Implement strategies to reduce risk of harm to self or others.
Begin to recognize and report abnormal findings
Recognize and adhere to national patient safety guidelines that affect outcomes for
patients and families.
e. Perform clinical procedures demonstrating appropriate knowledge and skill.
f. Examine the healthcare environment to determine patient and family safety needs
g. Develop the awareness of the impact of unsafe practices by self and others and
communicate findings to appropriate healthcare providers.
h. Organize client care in a timely, effective, and safe manner
VI. Informatics
a. Navigate the patient written/electronic health record to plan patient care and
monitor changes in patient status.
b. Begin to document clear and concise responses to care in the patient
written/electronic health record as appropriate to the clinical setting.
c. Manage data, information, and knowledge of technology in an ethical manner.
Protect confidentiality of electronic health records.
VII.
Professionalism
a. Recognize and begin to demonstrate core professional values (caring, altruism,
autonomy, integrity, human dignity, and social justice).
b. Maintain professional behavior and appearance.

3
2
3
1

c. Provide evidence of preparation for clinical learning experiences.

d. Comply with the Code of Ethics, Standards of Practice, and policies and procedures
of XYZ University,
School of Nursing and clinical agencies.
e. Accept constructive criticism and participate in plan of action for improvement.
f. Maintain a professional attitude when interacting with inter-disciplinary team
members, faculty, and fellow students.
g. Arrive to clinical experiences at assigned times.
h. Demonstrate professional behaviors
i. Accept individual responsibility and accountability for nursing interventions,
outcomes, and other actions.
j. Engage in constructive self-evaluation.
k. Assume responsibility for learning.
TOTAL SCORE ( of 128 points possible)

2
3

3
2
2
2
3
3
3

3
2

2
3
1
2
2
2
3
88

*See clinical evaluation tool guidelines for full descriptions of grades 1-4
(Exemplar must include correlating core numbers I-VII and knowledge, skills, and attitude letter
(KSA))
4-exceeds
expectations

3-meets
expectations

2-below
expectations

1-does not meet

expectations

Faculty Comments:
Although you have made some progress since the midterm evaluation I feel that there are key
areas that need to be improved upon before being able to advance to the next clinical phase.
The areas that need to be focused on is number one your assessment skills, it is easy to miss
*Content based upon QSEN Competencies and KSAs.
Developed 6/2016

things when not going head to toe in an organized manner. Although you are able to
communicate any abnormal finding to your preceptor and myself, you really need improvement
in the communication skills area as a whole to also include your nurses notes which often times
dont paint an appropriate picture of the patient. Without communication patient safety will be
put in jeopardy. Your preparedness for clinical needs much improvement. Being punctual, and
exhibiting efficient time management in nursing is important, not only because your co-workers
want to get off shift on time, but your patient also has medications that are on a certain schedule
that need to be maintained. Although you are good with hourly rounding for patient safety, as
far as adhering to patient safety guidelines and fall precautions you fall short and I know we have
spoken about this. I know you have been working hard, and you do have a kind and caring
heart, this is why I know you have the capabilities to improve and accomplish the tasks that are
needed to continue and meet expectations next year. One comment I will leave you with is
asking for help does not mean you are incapable of doing it yourself, but that you need further
understanding or a hand to make the patients experience exceptional, as well as safe.

* Please note there is usually a signature page for faculty in addition to student comments and
signature

*Content based upon QSEN Competencies and KSAs.

Developed 6/2016

*Content based upon QSEN Competencies and KSAs.

Developed 6/2016