Registered Nurse Performance Evaluation Appraisal Score

Name: Job Title: Department: Appraisal Date: Review Period: Appraised by: From: To: Employee ID: Hire Date: Overall Score:

/ 5.0

Key Responsibilities
Works under the direction of the physician and the applicable State Acts to provide nursing care to patients, assessing, monitoring and evaluating the patients response to nursing interventions. Qualifications: Holds a current, valid state license or compact state license. Education: A graduate of an accredited school / college of nursing. Unit Specific: OB / NSY: Recent acute OB and newborn experience. NRP certified within one year. ACLS preferred. Pass Fetal Monitor test within one year. PEDS: One year acute M/S experience preferred. PALS required within one year. ER: ACLS required. ATCN / Trauma nurse course within one year. One year acute med/surg nursing preferred. PALS required within one year. CCRN or CEN encouraged. ACUTE REHAB: 1 year Rehabilitation experience preferred. FIMs certified within 6 months. PCU: Two years acute care experience preferred. ACLS within six months. Basic EKG course, or equivalent, within one year. CCRN encouraged. ICU: ACLS within six months. CCRN encouraged. Two years acute med / surg experience preferred. Basic EKG course, or equivalent, within one year. PACU: Critical Care experience preferred. ACLS required. OR: One year experience circulating / scrub preferred. ACLS required. CORN encouraged. Physical Requirements: Demonstrates good oral and written communication skills. Demonstrates basic computer knowledge. Must be able to assist with the movement of an adult patient weighing up to 300 pounds. Must be able to stand and walk for extended periods of time. Must be able to distinguish colors. Able to care for patients with infectious diseases. Exposure Categories: None

Definition of Ratings
5.0 Outstanding (exceptional; consistently exceeds expectations) 4.0 Exceeds Expectations (consistently meets, and frequently exceeds expectations) 3.0 Competent (conforms to standards, meets expectations) 2.0 Needs Improvement (does not consistently meet expectations) 1.0 Unacceptable (significantly below standard and unsatisfactory)

Hospital Behavioral Expectations

Performance Level Competency

Score: / 5.0 (10%) 5 Outstanding; 4 Exceeds Expectations; 3 Competent; 2 Needs Improvement; 1 Unacceptable. Performance Comments Score Level /5.0
(4%)

1.1 Courtesy: A. Acknowledge a customer's presence immediately by making eye contact, smiling and using their names whenever possible. B. Warmly greet and respond to others in the hallways, elevators and in other areas. C. Provide directions. If it involves more than two turns, escort them. D. Answer the telephone with a smile, identifying your department and yourself and speaking in a professional, friendly tone. 1.2 Respect/Privacy: A. Knock or announce your arrival before entering private patient areas. B. Close curtains or doors during exams and procedures. C. Discuss confidential or sensitive information only with appropriate parties, privately never in public places. D. Respect cultural and religious differences. 1.3 Communication: A. Keep patients and their families informed about their care in a timely manner. Keep customers up-to-date concerning any delay in care and provide a timeframe for addressing concerns. B. Listen with your full attention. Speak in a manner that is appropriate for the customer. C. Use scripting as required for your position. 1.4 Comfort: A. To the extent possible, ensure that patients pain is controlled. 1.5 Responsiveness: A. Anticipate patients needs to minimize the use of call lights. B. Acknowledge call lights within one minute. All employees are responsible for answering patient call lights. Respond to requests and concerns quickly. 1.6 Teamwork: A. Cooperate and perform duties in a way that helps your co-workers throughout the hospital perform their duties. B. Take ownership and responsibility for addressing problems.

(4%) (4%) (4%)

(4%) (4%) (4%)

(4%)

(4%)

(4%)

(4%)

(4%)

(4%) (4%)

(4%)

(4%)

C. When necessary, communicate concerns and suggestions to the appropriate supervisor. D. Recognize and praise others whenever possible. E. Do not participate in gossip or rumors. F. Address concerns with co-workers professionally and privately. 1.7 Professionalism: A. Follow dress code policies. B. Wear your ID badge with your name clearly visible. C. Limit eating and drinking in designated areas. D. Avoid personal conversations with coworkers that can be overheard by patients or the public. E. Limit personal calls and cell phone use so as not to interfere with work duties. Measure: Based on supervisory observation.

(4%)

(4%) (4%) (4%)

(4%) (4%) (4%) (4%)

(4%)

Nursing Process
Performance Level Competency

Score: / 5.0 (25%) 5 Outstanding; 4 Exceeds Expectations; 3 Competent; 2 Needs Improvement; 1 Unacceptable. Performance Comments Score Level /5.0
(6%)

2.1 Assessment: The nurse collects patient health data. A. Nursing assessments are completed according to hospital and unit specific policies, procedures, and standards of nursing care. B. Pertinent data are collected from the patient, significant others, and health care providers. C. A comprehensive patient history and physical is completed in a timely manner and includes: biophysical, psychosocial, environmental, self care abilities, educational, age specific, cultural, and discharge planning needs. 2.2 Diagnosis /Care Needs: The nurse analyzes the assessment data to identify care needs A. Nursing diagnoses / care needs are derived from the assessment data. B. Involving the patient and significant other as appropriate, the nurse formulates a plan to provide appropriate care based on identified patient needs.

(6%)

(6%)

(6%) (6%)

2.3 Implementation: The patients nursing care is based on identified nursing diagnoses / care needs and patient care standards and is consistent with the therapies of other disciplines. A. Nursing care is based on identified nursing diagnoses / care needs. B. Nursing care is based on a standards of patient care. C. Nursing care is prioritized based on assessment of patients immediate condition or needs. D. The patient and/or significant other(s) is involved in the patients care as appropriate. E. The nurse collaborates with the patient, family, physician and other clinical disciplines in making decisions regarding each patients need for nursing care. F. The nurse implements patient education and involves the patient, family and/or significant other(s) as appropriate. 2.4 Evaluation: The nurse evaluates the patients progress towards attainment of desired outcomes. A. Evaluation of the patients response to nursing car is evident in the ongoing assessment data. B. Nursing diagnoses / care needs are revised based on reassessment data. 2.5 Documentation: Documents patient care management in clear, concise manner. A. Completes nursing admission and assessment form. All blanks completely filled in or N/A. B. Initiates the Nursing Care Plan with identified patient problems (utilizing nursing diagnosis), expected outcomes and nursing intervention. C. Records patient's response to hospitalization, treatments, and nursing intervention on the patient care record. D. Documents medications, treatments, and nursing intervention on appropriate chart forms. E. Completes Discharge Instruction Sheet as appropriate. Measure: Based on chart review of 6 charts.

(5%) (5%) (5%)

(5%)

(5%)

(5%)

(5%)

(5%)

(6%)

(6%)

(6%)

(6%)

(6%)

Quality of Care
Performance Level Competency

Score: / 5.0 (30%) 5 Outstanding; 4 Exceeds Expectations; 3 Competent; 2 Needs Improvement; 1 Unacceptable.
Performance Comments Score

Level

/5.0

3.1 The nurse works to reduce the risk of health care acquired infections through compliance with current CDC hand hygiene guidelines. Standard Precautions are utilized during patient contact and when handling contaminated materials. 3.2 The nurse is knowledgeable of and demonstrates compliance with all National Patient Safety Goals. 3.3 The nurse demonstrates an awareness of Appropriate Care Measures that are fitting for his/her area of nursing practice and incorporates standards for appropriate care into his/her practice. Appropriate Care Measures include Acute Myocardial Infarction, Heart Failure, and Pneumonia Measure: Based on chart review of 6 charts consider the following: Does the nurse properly identify the patient using two unique identifiers prior to any procedure or medication administration? Does the nurse accurately and completely reconcile medications across the continuum of care? When receiving telephone orders or critical test results, does the nurse read-back the complete order or test result? Does the nurse utilize unapproved abbreviations? Is the Universal Protocol policy practiced? Are appropriate interventions in place for patients at risk for fall? Does the nurse document appropriate care for the patient with myocardial infarction? Does the nurse document appropriate care for the patient with heart failure? Does the nurse document appropriate care for the patient with pneumonia?

(33%)

(33%)

(34%)

Education
Performance Level Competency

Score: / 5.0 (15%) 5 Outstanding; 4 Exceeds Expectations; 3 Competent; 2 Needs Improvement; 1 Unacceptable.
Performance Level Comments Score /5.0

4.1 The nurse acquires and maintains current knowledge in nursing practice. Maintains NRP, PALS, ACLS, ATCN and

(25%)

BLS as required by units. 4.2 Provides documentation for in-service attendance required by Nursing Division. 4.3 Keeps abreast of happenings on assigned nursing unit as documented by attendance at 75% of staff meetings or initialing meeting minutes and demonstrating knowledge and understanding of current information. 4.4 Completes Annual Mandatory Hospital Program update. Measure: Employee Education Record.
(25%)

(25%)

(25%)

Patient Satisfaction
Performance Level Competency

Score: / 5.0 (20%) 5 Outstanding; 4 Exceeds Expectations; 3 Competent; 2 Needs Improvement; 1 Unacceptable.
Performance Level Comments Score /5.0

5.1 Unit goal for Patient Satisfaction has been met. 5.2 RN has contributed to the Nursing Unit reaching the 90th percentile goal for Patient Satisfaction. Measure: Director interview with patients and/or families utilizing questions pulled from Press Ganey patient satisfaction tool in areas of Nurses Rating and Personal Issues.

(50%)

(50%)

Goal Results
Objectives Title: Accomplishments

Objectives Title:

Accomplishments

Objectives Title:

Accomplishments

Next Years Goals

Goals for the upcoming year should be established by the manager and employee. SMART goals will help to focus efforts and clearly define objectives. SMART goals should be: S Specific M Measurable A Attainable R Realistic T Time-bound Objectives Weight Title:

Development Plan
Development Objectives Title:

Managers Comments

Employees Comments

I have met with my manager to discuss this evaluation. I have not met with my manager to discuss this evaluation.