Student Clinical Evaluation

GNUR 383L
Student Information:
Name: _____________________________________________ Email: ____________________________
Semester and Year: ___Fall ___Spring ___Summer Year: ________
Program of Study: ___Traditional BSN ___ ABSN
Total Number of Days Absent: ____ Midterm ____Final
Total Number of Days Tardy:

____Midterm ____Final

Site Information:
Institution: ___________________________________________________________________________
Unit: ___________________________ Shift: _____________________
Faculty Information:
Clinical Faculty: ______________________________________ Email: ___________________________
Preceptor Information:
Preceptor: __________________________________________ Email: ___________________________

1. Demonstrates novice clinical competence and judgment in professional nursing practice:

(Must achieve Met in each category to successfully complete rotation)
Sample behaviors for each category:
Assessment: Involves patients, families, significant others, and healthcare providers in data collection; Collects data in a
systematic and ongoing manner; Prioritizes data collection based on patient condition; Identifies patterns and trends in
assessment data; Documents assessment clearly and completely.
Problem Identification: Identifies nursing problems from assessment data; Prioritizes nursing problems.
Outcomes Identification: Involves patient, family, significant others and healthcare providers in identifying expected
outcomes; Identifies measurable and time delimited outcomes; modifies outcomes based on changes in patient condition and
evaluation.
Planning: Develops an individualized plan of care, considerate of patient characteristics, needs, and preferences; Involves
the patient, family, significant others, and healthcare providers in planning care; Identifies nursing care interventions that are
specific, time bound, and evidence based; Incorporates interventions related to health promotion, health restoration, and
prevention, as appropriate to the specific problem.
Implementation: Implements the plan of care; Documents modification and implementation of the plan of care; Coordinates
implementation of the plan of care with other health care providers; Provides health teaching; Incorporates health promotion
and teaching methods that are consistent with the patients situation, developmental state, culture and preferences.
Evaluation: Conducts systematic and ongoing evaluation of attainment of outcomes; Includes patient, family, significant
others and healthcare providers in the evaluation process as appropriate; Uses data from ongoing assessment to revise the
plan of care as needed; Documents the results of evaluation.
Communicates evaluation data to patient and others involved in care, as appropriate and consistent with standards and
regulations.
Preceptor Comments:

Faculty Comments:
Expectations:
Unmet
Met
Midterm

Exceeds

Final

2. Use evidencebased strategies in providing patient and family centered care.

Sample behaviors.
Demonstrates competency in locating evidence to support practice; Uses best available evidence, including research findings,
to guide nursing practice.
Effectively communicates with others who differ by gender, ethnicity, race or nationality.
Preceptor Comments:

Faculty Comments:
Expectations:
Unmet
Met
Midterm
Final

Exceeds

3. Incorporate economic and regulatory considerations in managing patient care.

Sample behaviors.
Evaluates safety, effectiveness, cost, availability and efficiency in selecting practice interventions that produce comparable
outcomes; Assists patient, family, and significant others in the identification and securing of appropriate and available
resources to address healthrelated needs; Delegates tasks based on the needs and condition of the patient, and consistent
with standards of practice and regulatory guidelines; Assists the patient, family and significant others in becoming informed
consumers of health care.
Preceptor Comments:

Faculty Comments:
Expectations:
Unmet
Met
Midterm
Final

Exceeds

4. Conduct an inter-professional patient and family centered care conference for a selected patient and pursue
followup as indicated.
Sample behaviors:
Communicates with patient, family, significant others and healthcare providers regarding the overall plan of care; Collaborates
with patient, family, significant others and healthcare providers in decisions related to the plan of care; Partners with others in
the generation of positive outcomes for a patient care situation; Identifies resources necessary for the provision of continuity
of care across care settings.

Preceptor Comments:

Faculty Comments:
Expectations:
Unmet
Met
Midterm
Final

Exceeds

5. Identify elements in the clinical practice environment that enhance or threaten quality and safety in the
provision of patient care.
Sample behaviors.
Documents the application of the nursing process; Identifies areas for the focus of quality improvement in the clinical setting.
Incorporates contemporary knowledge in evidencebased planning and implementation of care; Protects patient from physical
and emotional harm.
Maintains a safe and effective environment for care; Uses the Code of Ethics for Nurses with Interpretive Statements to guide
practice.
Respects patient autonomy and preferences in the delivery of nursing care; Maintains confidentiality; Maintains a therapeutic
and professional nursepatient relationship; Reports illegal, incompetent, or impaired practice; Negotiates adeptly with
individuals and groups over roles and resources
Handles conflict effectively
Preceptor Comments:

Faculty Comments:
Expectations:
Unmet
Met
Midterm
Final

Exceeds

6. Recognize personal characteristics that contribute to effective leadership in the clinical practice environment.
Sample behaviors.
Contributes as a productive member of the patient care team; Delegates effectively to unlicensed personnel, consistent with
regulatory and professional
guidelines; Contributes to resolving ethical issues in the practice setting; Partners with others to effect positive change in
patient outcomes; Engages in selfevaluation; Solicits feedback on performance; Takes actions to achieve goals and rectify
deficiencies identified through evaluation; Provides evidence to support judgments; Participates in educational activities that
enhance knowledge base and professional practice; Seeks out experiences that augment skills and competence; Adheres to
standards of professional accountability, including but not limited to dress code, preparation, attendance, appearance, and
mannerisms.
Preceptor Comments:

Faculty Comments:
Expectations:
Unmet
Met
Midterm
Final

Exceeds

Midterm Evaluation:
Student Comments:

Faculty Summary and Comments:

Final Evaluation:
Student Comments:

Faculty Summary and Comments:

Evaluation Signatures
Midterm Evaluation:
Student:
I have read, reviewed, and discussed this evaluation and my performance, with my clinical instructor and preceptor.
_____________________________________________
Student Signature/ Date
_____________________________________________
Student Print Name
Faculty and Preceptor:
The undersigned have reviewed and discussed this evaluation, and the students performance with the above mentioned
student.
_____________________________________________
Faculty Evaluator Signature/ Date
_____________________________________________
Faculty Evaluator Print Name
_____________________________________________
Preceptor Signature/ Date
_____________________________________________
Preceptor Print Name
Final Evaluation:
Student:
I have read, reviewed, and discussed this evaluation and my performance, with my clinical instructor and preceptor.
_____________________________________________
Student Signature Date
____________________________________________
Student Print Name

Faculty and Preceptor:

The undersigned have reviewed and discussed this evaluation, and the students performance with the above mentioned
student.
_____________________________________________
Faculty Evaluator Signature Date
_____________________________________________
Faculty Evaluator Print Name
_____________________________________________
Preceptor Signature Date
_____________________________________________
Preceptor Print Name