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Evaluations Clinical Evaluation Tool

NUR 4948 L Preceptorship Section 100 S24_Moffitt ()
Experience
Wood, Madison (madisonwood@usf.edu)
Reports
Evaluator: Durosier, Dorothie (dorothie@usf.edu)
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5-Outstanding: Exceeds Standards

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Exhibits above average performance of nursing care for this level student. The student is
proactive, self-directed, and consistently engaged in learning; needs minimal guidance; is
knowledgeable; and appropriately incorporates knowledge with skills. Student is proactive and
self-directed in approach to learning.

4-Satisfactory: Meets Standards

Exhibits average performance of nursing care for this level student. Functions with minimum
guidance. Demonstrates adequate knowledge and requires minimum assistance in applying
knowledge to skills. Recognizes learning opportunities but may require assistance in utilizing
them.

3-Minimal
Exhibits minimal performance of nursing care for this level student. Functions safely with
moderate guidance. Demonstrates minimal knowledge and requires moderate assistance in
applying knowledge to skills. Requires some direction in recognizing and utilizing learning
opportunities. Often focuses on the task or own behavior, not on the patient.

2-Unsatisfactory
Requires intense guidance for the performance of activities at a safe level. Clinical performance
reflects difficulty in the provision of nursing care. Demonstrates gaps in necessary knowledge and
requires frequent or almost constant assistance in applying knowledge to skills. Requires
frequent and detailed instructions regarding learning opportunities. Focuses primarily on the task
or own behavior, not on the patient.

1-Unsafe to Practice
Is unsafe to practice without constant, intense guidance. Frequently lacks necessary knowledge
and skills and unable to integrate these into practice. Requires constant detailed instructions
regarding learning opportunities and is often unable to utilize them. Attempts activity or behavior,
yet is unable to complete. Focuses entirely on the task or own behavior, not the patient.

Course
NUR PATIENT CENTERED CARE: ESSENTIALS OF NURSING PRACTICE
3026L CLINICAL
NUR PATIENT CENTERED CARE: ESSENTIALS OF NURSING PRACTICE LAB
3027L
NUR HEALTH ASSESSMENT, WELLNESS, AND PREVENTION ACROSS THE
3066L LIFE SPAN LAB
NUR COMPLEX HEALTH NURSING I CLINICAL
3225L
NUR COMPLEX HEALTH NURSING II CLINICAL
4227L
NUR NURSING CARE OF WOMEN, CHILDREN, AND FAMILIES CLINICAL
4467L
NUR PSYCHIATRIC/MENTAL HEALTH NURSING CLINICAL
4535L

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NUR PUBLIC HEALTH NURSING CLINICAL

4635L
NUR PRECEPTORSHIP
4948L

Semester
Fall
Spring
Summer

Year
2024

Select Evaluation Type

Formative
Summative

Standard 1: Patient-Centered Care

1. Performs a comprehensive assessment including patient values, preferences, and
needs.
2. Develops an individualized plan of care with a focus on the nursing process.
3. Provides care with sensitivity and respect for the diversity of the human experience.
4. Delivers care based on knowledge of pathophysiology and pharmacotherapy.
5. Identifies potential barriers to active involvement of patients in their own health care
process.
5 Outstanding: Exceeds Standards*
4 Satisfactory: Meets Standards
3 Minimal
2 Unsatisfactory*
1 Unsafe to Practice*
(* Comment Required)

Standard 2: Teamwork and Collaboration

1. Demonstrates awareness of own strengths and limitations as a team member.
2. Initiates requests for help from other team members as appropriate.
3. Communicates effectively with patients, family members, and other members of the
healthcare team.
4. Identifies potential complications related to handoffs or transitions of care.

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5 Outstanding: Exceeds Standards*

4 Satisfactory: Meets Standards
3 Minimal
2 Unsatisfactory*
1 Unsafe to Practice*
(* Comment Required)

Standard 3: Evidence-Based Practice and Quality Improvement

1. Utilizes evidence-based literature to support clinical decision making as
demonstrated in written clinical assignments.
2. Differentiates clinical opinion from evidence-based practice to determine best
clinical practice.
3. Promotes and practices quality, cost-effective delivery of care.
4. Identifies potential areas for quality improvement in the clinical setting.
5. Participates in measures to improve patient outcomes as appropriate.
5 Outstanding: Exceeds Standards*
4 Satisfactory: Meets Standards
3 Minimal
2 Unsatisfactory*
1 Unsafe to Practice*
(* Comment Required)

Standard 4: Safety
1. Identifies strategies to reduce the risk of harm or poor patient outcomes in the
delivery of care.
2. Delivers medication (as appropriate) in a timely and safe manner including
understanding the specific indications for the medication and potential side effects.
3. Communicates effectively between team members or to clinical faculty when giving
patient report.
4. Uses appropriate resources to improve organization and/or time management.
5 Outstanding: Exceeds Standards*
4 Satisfactory: Meets Standards
3 Minimal
2 Unsatisfactory*
1 Unsafe to Practice*
(* Comment Required)

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Standard 5: Informatics
1. Navigates the electronic health record where appropriate.
2. Documents clearly, concisely, and accurately in the electronic medical record where
appropriate.
3. Protects confidentiality of all protected health information.
5 Outstanding: Exceeds Standards*
4 Satisfactory: Meets Standards
3 Minimal
2 Unsatisfactory*
1 Unsafe to Practice*
(* Comment Required)

Standard 6: Professionalism
1. Demonstrates core professional values (caring, altruism, autonomy, integrity, human
dignity, and social justice).
2. Maintains professional behavior and appearance.
3. Demonstrates expected behaviors and completes tasks in a timely manner.
4. Engages in self-evaluation and assumes responsibility for learning.
5. Arrives to clinical setting on time.
6. Demonstrates evidence of preparation for clinical learning experiences.
7. Maintains a positive attitude while interacting with patients, family members, faculty,
peers, or members of the healthcare team.
8. Accepts individual responsibility for actions.
5 Outstanding: Exceeds Standards*
4 Satisfactory: Meets Standards
3 Minimal
2 Unsatisfactory*
1 Unsafe to Practice*
(* Comment Required)
Madison always arrives on time to her preceptorship rotation and
maintains a positive attitude.

Comments:

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Madison is very efficient and precise in assessing her patients. She

is eager to learn, motivated, respectful, caring, compassionate, and
very professional. She also has strong interpersonal skills and works
well with other members of the healthcare team. She will continue to
work on transitioning from the student nurse to the registered nurse
l h d b h h ill l h h d id

Reviewer Review Date

1 Wood, Madison 4/10/2024

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