Evaluation
The College of St. Benedict/St. John’s University is requesting that all preceptors complete the following evaluation form for the students you have worked with in clinical. It may be helpful to review this form with the students approximately half way through the clinical hours to determine areas of strengths and weakness for the student and to focus on learning needs of the student. The final evaluation form is due at the end of the student’s clinical experience.
Evaluation of students is likely one of the most challenging responsibilities for the preceptor. There are no hard and fast rules for determining student performance, in most instances preceptors use their judgment to determine the student’s ability to meet the course objectives and ultimately the needs of the patients they care for. Excellent performance, a rating of 5 or 6 on the rating scale, is characterized by considerable proficiency, confidence, initiative, consistent preparation, and a high level of inquiry. Limited performance, a rating of 2 or 1 on the rating scale, is characterized by decreased proficiency, lack of confidence, inability to take the initiative, lack of preparation or organization and a lack of inquiry. Faculty instructors should be notified immediately if student performance falls below the satisfactory level or the student does not provide safe care.
Preceptors should review the course evaluation form before beginning work with the student and notify the clinical faculty with any questions or concerns regarding either the evaluation form or the evaluation process.
The student, the preceptor and the clinical faculty will all complete this evaluation form. The preceptor WILL NOT need to complete the grey shaded portion of the evaluation form, these sections are completed by the faculty and student. The preceptor’s evaluation of the student will account for 20% of the student’s grade in this course.
COLLEGE OF SAINT BENEDICT/SAINT JOHN’S UNIVERSITY
Faculty: |
Student |
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Nursing Department |
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College of St. Benedict |
Preceptor/Mentor |
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37 College Ave. S. |
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St. Joseph, MN 56374 |
Agency/Organization |
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Preceptor/Mentor: Please complete this form, make a copy for the student and then forward the original form to the faculty member at the above address. The grey areas will be evaluated by the site faculty and students. You will not need to evaluate these areas. Thank you very much for taking the time and energy to serve as a preceptor/mentor! |
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Please rate the Student’s performance in the following areas: |
Very Satis- Needs |
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Good factory Improvement |
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1. Synthesize knowledge from undergraduate liberal arts and nursing courses in full implementation of both provider and coordinator of care roles |
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· Consistently demonstrates professional behavior |
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o Exhibits responsibility for care assignments & own learning |
6 5 4 3 2 1 NA |
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o Able to accept constructive criticism |
6 5 4 3 2 1 NA |
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o Functions at a high level of productivity |
6 5 4 3 2 1 NA |
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o Adapts to changing circumstances |
6 5 4 3 2 1 NA |
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o Displays a spirit of cooperation |
6 5 4 3 2 1 NA |
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o Shows ability to work independently |
6 5 4 3 2 1 NA |
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o Is punctual |
6 5 4 3 2 1 NA |
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o Presents an appropriate personal appearance |
6 5 4 3 2 1 NA |
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o Demonstrates self-confidence appropriate to the situation |
6 5 4 3 2 1 NA |
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o Participate actively in the unit/agency activities |
6 5 4 3 2 1 NA |
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· Plan, implement, & evaluate holistic care consistent with professional values & practice standards and agency mission, structure, goals and policies. |
6 5 4 3 2 1 NA |
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· Admit clients to agency/unit including initiating the plan of care and the discharge plan |
6 5 4 3 2 1 NA |
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· Discharge clients from the agency/unit including discharge client/family teaching and making and following-up referrals |
6 5 4 3 2 1 NA |
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· Contributes to plan of care |
6 5 4 3 2 1 NA |
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· Applies principles of patient safety in assignments |
6 5 4 3 2 1 NA |
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2. Evaluate the quality of nursing practice using appropriate methodologies |
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· Evaluate own nursing practice including strengths and areas for improvement |
6 5 4 3 2 1 NA |
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· Participate in quality improvement activities (data collection, analysis, recommendations for improvement, reporting) |
6 5 4 3 2 1 NA |
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· Provide informal evaluative feedback to unlicensed assistive personnel on the health care team. |
6 5 4 3 2 1 NA |
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· Identify an aspect of nursing practice that could be improved by utilizing research findings. |
6 5 4 3 2 1 NA |
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3. Evaluate utilization of information technology in the clinical setting |
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· Describe information and health care technology used in the care setting |
6 5 4 3 2 1 NA |
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· Assess staff satisfaction with existing information and health care technology |
6 5 4 3 2 1 NA |
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· Project different or additional technologies that are likely to impact health outcomes |
6 5 4 3 2 1 NA |
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4. Use oral, written and electronic communication strategies to provide efficient and effective continuity of services across health care agencies |
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· Communicates in a clear and explicit way with preceptor, physicians and other care providers |
6 5 4 3 2 1 NA |
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· Accurately documents assessment findings and the provision of care |
6 5 4 3 2 1 NA |
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· Conducts a client care conference |
6 5 4 3 2 1 NA |
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· Makes thorough referrals in verbal and written form; evaluates the effectiveness of referral |
6 5 4 3 2 1 NA |
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5. Analyze evidence that evaluates the success of the nursing profession in improving health outcomes of individuals and populations |
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· Identify best practices that are relevant to the assigned care setting |
6 5 4 3 2 1 NA |
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· Analyze progress of a group of clients toward achieving health outcomes, identifying successful nursing strategies. |
6 5 4 3 2 1 NA |
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6. Apply leadership and management concepts and principles in providing and coordinating nursing care for groups of clients |
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· Assign, delegate, and supervise care provided by unlicensed nursing personnel |
6 5 4 3 2 1 NA |
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· Describe existing and potential cost containment strategies |
6 5 4 3 2 1 NA |
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· Identify leadership behaviors manifested by professional staff nurses and appointed leaders. |
6 5 4 3 2 1 NA |
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· Work collaboratively with others |
6 5 4 3 2 1 NA |
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· Contribute to a positive work environment |
6 5 4 3 2 1 NA |
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· Demonstrate a stewardship of resources (time, personnel, supplies) |
6 5 4 3 2 1 NA |
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7. Provide nursing care for groups of clients that manifests sensitivity to cultural, racial, socioeconomic, religious, and lifestyle differences affecting health status and response to health care. |
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· Integrate clients’ cultural, racial, socioeconomic, religious, and lifestyle preferences into nursing assessments, interventions (including teaching), and referrals |
6 5 4 3 2 1 NA |
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· Interact with clients and their families with sensitivity to their culture, socioeconomic status, religious beliefs, and lifestyle preferences |
6 5 4 3 2 1 NA |
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Overall assessment of the Student |
6 5 4 3 2 1 NA |
Identify the areas of professional growth that you have noticed in the student over the course of the immersion experience.
What recommendations would you have for the student’s professional development plan?
Preceptor/Mentor Signature Date
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Student Signature (indicates the evaluation was discussed with the student)
___________________________________________________ ________________________________