Hondros College School of Nursing Nursing 299 Guide to Role Transition

Preceptor Form To Evaluate Student Performance Student Name: ________________________________ Preceptor Name:_______________________________ Clinical setting:____________________ Date:__________
KEY: The purpose of this tool is to demonstrate student progress and achievement in

their role transition. The goal is that the student performs skills safely and accurately, maintains confidentiality, manages a client load efficiently, and acts in a professional manner. Students must achieve a satisfactory rating in role transition to pass the course. This feedback will be shared with the faculty member and the faculty member will conduct a final course evaluation clinical tool utilizing preceptor feedback. Rating Designation 4 Exemplary Description Performs specified function safely and accurately, achieving desired effect and with appropriate affect each time. Performs efficiently and capably. Functions with minimal supporting cues. Performs specified function safely and accurately, achieving desired effect and with appropriate affect most of the time. Occasionally functions inefficiently within a delayed time period. Required occasional directive and/or frequent supporting cues. Requires direct supervision to ensure specified function is performed safely and accurately. Demonstrates considerable expenditure of excess energy in performance behaviors. Requires frequent directive and supportive cues. Lacks knowledge about application of nursing principles. Unsafe or unable to demonstrate behaviors. Lacks coordination and efficiency. Requires constant directive cues.

Satisfactory

Needs Improvement

Unsatisfactory

Hondros College School of Nursing Nursing 299 Guide to Role Transition

Preceptor Form To Evaluate Student Performance Student Name: ________________________________ Preceptor Name:_______________________________ Clinical setting:____________________ Date:__________
4 3 2 1
1. Student asks pertinent questions relevant to patient care 2. Organizes assignments 3. Demonstrates understanding of responsibilities 4. Demonstrates understanding of patient needs for assignments 5. Has problem solving and decision making ability 6. Asks for assistance appropriately 7. Practices in a safe manner for patients, self, and other staff 8. Interacts well with staff, patients, and physicians 9. Completes assignments in a timely manner 10. Utilizes resources well 11. Identifies own learning needs 12. Non-judgmental, on time, prepared, and displays professional appearance 13. Honest, dependable and follows agency policies 14. Seeks out additional learning experiences, motivated to learn 15. Keeps client information confidential in accordance with HIPAA

Comments and suggestions for improvement:

_____________________________ Preceptors Signature & Date: