Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
Faculty
Jane
Schroeder
N = Needs
N/A = Not
S = Satisfactory
U = Unsatisfactory
(*) Critical behavior
Improvement
applicable
Students who meet any of the following criteria will be given a remediation plan and may be placed on probation.
Failure to progress in these areas may result in failure of the course.
-One unsatisfactory grade in a critical behavior
-Two needs improvements in a critical behavior
-Two unsatisfactory grades in a non-critical behavior
-Four needs improvements
Student
Instructor
Outcome 1
SelfEval of
Evaluate the effectiveness of a plan of care using the nursing process to achieve patient
Eval
Student
outcomes.
S/N/U
S/N/U
Collects evidence related to assigned patient(s) from appropriate resources.
S
S
*Demonstrates accurate patient assessment skills.
S
S
Establishes nursing diagnoses based on patient assessment.
S
S
*Prioritizes patient care based on assessment. Jaclyn was able to care for two busy patients
and managed their care and medication administration well. SBARs were well done. They
S
S
were thorough, accurate, and complete.
Identifies measurable patient outcome based on nursing diagnosis. Jaclyn revised and
resubmitted the nursing diagnoses. The revision was accurate and correctly written and
S
S
prioritized. Nice job.
Implements care according to established plan and desired outcomes.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
the nursing process. Jaclyn has an upbeat attitude that puts her patients at ease. She is
S
S
able to establish trust in a short period of time.
*Identifies appropriate interventions based on assessment. When quizzed about the
S
S
connections and things to monitor about the patient Jaclyn was able to answer correctly.
*Demonstrates knowledge of medications for assigned patients.
S
S
*Administers medication safely using six rights of medication administration. Medication
S
S
administration was consistently safe and Jaclyn was fully prepared.
*Implements appropriate infection control precautions.
S
S
Follows through with all patient care.
S
S
*Evaluates patient response to care and revises plan as needed.
S
S
Student
Instructor
Outcome 2
SelfEval of
Assimilate into the profession of nursing with a commitment to lifelong learning and personal
Eval
Student
and professional growth.
S/N/U
S/N/U
Participates actively in all aspects of the clinical experience.
S
S
Discusses patients plan of care with instructor.
S
S
Demonstrates professional behavior and appearance. Jaclyn was consistently neat in
appearance. Her uniform was clean and tidy, hair up, no extra jewelry. She was always on
S
time to clinical and ready for report at 0645.
S
Engages in self-reflection and communicates learning needs to instructor/preceptor.
S
S
Completes assignments as required and submits on time.
N
S
Organizes time efficiently.
S
S
Student
Instructor
Outcome 3
SelfEval of
Provide culturally competent, holistic care using respectful and caring behaviors.
Eval
Student
S/N/U
S/N/U
Demonstrates caring behaviors with the ability to develop and maintain therapeutic
relationships with people from diverse backgrounds. When Jaclyn cared for the same patient 2
S
S
days on a row they were always glad to see her again.
Student

Jaclyn Bossi

Date
10/26/15

Approved 12/41/4. Revised 12/9/2014

Location CHC-IMC

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE

Considers patient values, cultural characteristics and religious differences when planning care.
Outcome 4
Collaborate with healthcare teams to provide patient-centered care.
Identifies patient/family health education needs. Identified and met the patients educational
needs.
Implements patient and family education.
Seeks input from patient, instructor, peers, and healthcare team in the delivery of patient care.
*Updates instructor and healthcare team regarding changes in the patients condition.
*Identifies safety concerns and notifies instructor and appropriate healthcare team members.
Demonstrates initiative in assisting peers and healthcare team members in the clinical setting.
Demonstrates communication skills using SBAR.
Acts as an advocate for patients and families.
Outcome 5
Model a spirit of inquiry that supports evidenced-based practice.
Applies evidenced-based rationale that supports the patients plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Practice within legal and ethical principles to deliver safe and competent care based on current
standards of practice.
Adheres to attendance policy.
*Demonstrates safe clinical practice.
*Provides nursing care based on the policies and procedures of the facility.
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality.
*Provides care according to the ANA Nursing Scope and Standards of Practice.
*Demonstrates accountability and responsibility for own actions and attitudes.

S
Student
SelfEval
S/N/U
S
S
S
S
S
S
S
S
Student
SelfEval
S/N/U
S
S
Student
SelfEval
S/N/U
S
S
S

S
Instructor
Eval of
Student
S/N/U
S
S
S
S
S
S
S
S
Instructor
Eval of
Student
S/N/U
S
S
Instructor
Eval of
Student
S/N/U
S
S
S

S
S
S
S
S
S
S
Student
Instructor
Outcome 7
SelfEval of
Research and communicate information through appropriate technology.
Eval
Student
S/N/U
S/N/U
Gathers data from the electronic medical record to provide patient care.
S
S
Uses electronic medical record to document patient care accurately and in a timely manner.
S
S
Student Learning Goals (List desired learning goals, and your plans to meet them, for the next weeks clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)
I have learned a great deal about time management, medication administration, delegation, and patient care as a whole
during my time at Carroll Hospital Center. I was able to quickly adapt to the use of Paragon to obtain all necessary
information in regards to my patients while communicating with interdisciplinary team members. Interdisciplinary team
members I was able to work with included case management, physicians, charge nurse, dialysis, and physical therapy. I
delegated tasks to the patient care technician when appropriate to ensure timely care. I thoroughly discussed my
patients condition and treatment with the nurses I worked with who were more than willing to educate me. I was also
able to experience and participate in several COTs and a code blue. Lastly, I spent two days shadowing a nurse in
critical care where I got to experience firsthand what its like caring for critically ill patients. This clinical rotation has
taught me a great deal and greatly affected my experience as a student in a positive way. I feel as though I am more
prepared to reach my potential as an entry level nurse after completing my rotation here at Carroll Hospital Center!
Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
Approved 12/41/4. Revised 12/9/2014

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
comments are necessary to clarify student performance**)
Jaclyn,
What a nice reflection. I am glad you have had a positive experience rich with a variety of experiences. I saw you grow
in organization, prioritization, and efficiency of your nursing care and medication administration. The fact that you
already work in patient care has assisted you in the mastery of organization and prioritization. Good plan Jaclyn.
During this clinical rotation I have observed professional growth in your organizational skills and timely delivery of care.
You had the opportunity to insert urinary catheters and you put the patient at ease with your upbeat personality and
approach. When the male catheter did not go in smoothly you exercised correct clinical judgement by paying attention
to the patient.
During this rotation I frequently observed you assisting your team members willing, even under extreme circumstances.
I feel you are ready to care for a full load of patients. You are able to be flexible as the clinical day changes and this is
an important skill to possess in the nursing field.
There is great potential in your abilities as a nurse Jaclyn. Keep up the good work! You are making connections and
acting safely.
Best wishes to you as you progress. It was a pleasure to have you in clinical this rotation.

Student Signature:

Preceptor/Instructor
Signature:

Date:

Jane Schroeder, MSN, RN

Approved 12/41/4. Revised 12/9/2014

11/19/15

Date: