Name…
Date…
Evaluation period…
| Objectives | Weight | Score and comments |
| Job-related skills | 25% | |
| Self-development | 20% | |
| Custom service and teamwork | 30% | |
| Knowledge, skills, and ability | 25% | |
| Overall evaluation |
Job-related skills
| Objectives | Criteria |
|
This section tests the ability to offer various forms of care on request, such as diagnostic, therapeutic, or surgical procedures. The appraisal is based on technical, professional, initiative, communication, problem-solving, interpersonal, and cooperation skills. The evaluation is based on the following items viz. chart audits, supervisor observations, and written and oral communication. |
Exceeds expectations: A score of 3 items in the following: Assumes leadership when offering care especially in emergency cases Teaches members of the nursing team Exceeds the basic clinical competencies Has shown advanced clinical competences Meets expectations A score of 2 or more in the following Maintaining practice standards Managing all aspects of care when offering clinical care Accurate documentation Transferring and referring complicated cases to competent providers Does not meet the expectation in the following cases Wrong or poor documentation No clinical competency Wrong diagnosis No clinical leadership |
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Comments: …………………………………………………………………………
Self-development
| Objective | Criteria |
| The objective of this self-evaluation is to assess commitment to professional self-development, job skills, and competencies. |
Exceeds expectations: A score of three or more in the following Regular attendance of development courses Completes mandatory courses Volunteering to lead Coordinating special projects Publishing in professional journals Active participation in professionals associations Meets expectations: A score of 2 or more in the following Maintaining licensure and certification Excellent communication and professional skills Regular meeting attendance Willing to cooperate with others to address clinical matters Does not meet expectations if the following exists: Written warning in the file Noncooperation with the others in the department |
Comments…
Customer service and teamwork
| Objectives | Criteria |
|
This section assesses the ability of the nurse to meet the primary responsibilities of serving customers according to customer policy. The nurses are expected to show a positive attitude and work spirit. Evaluations are based on the observations of the supervisor, written documentation and as well as oral communication on file. |
Exceeds expectations if the nurse meets one or more of the following: Enrolled and have completed advanced customer service skills Taken duties in the various clinical situations Proper documentation Meets expectation if the following cases: Demonstrable interpersonal skills when dealing with others Communication through proper channels Proper handling of patients Ethical conduct Problem-solving skills Does not meet expectations in the following situations: Warning in file Corrective action plan On counseling plan |
Comments: …………………………………………………………………………..
Knowledge, skills, and ability
The assessment will measure the following elements to assess whether the nurse the knowledge, skills, and ability required for work performance.
| Assessment area | Exceeds expectations | Meets expectations | Fails to meet expectations |
| Good clinical judgment | |||
| Excellent clinical knowledge | |||
| Excellent communication skills | |||
| Ability to establish rapport with patients | |||
| The quality of relationship with colleagues at the workplace | |||
| General appearance and grooming | |||
| Punctuality in attending patients and meetings | |||
| Ethical and professional conduct based on the professional code of conduct | |||
| Ability to inspire followers through leadership qualities | |||
| Proper recording and documentation | |||
| Ability to adhere to the guidelines and protocols relating to treating patients, reviewing their cases, and referring them | |||
Comments…
