PERFORMANCE EVALUATION SHEET

MEASUREMENT CRITERIA 1 2 3 4 5
I. QUALITY OF CARE
1. Participates in quality-of-care activities.

2. Practice changes are a result of quality-of-care

activities.

3. Quality-of-care activities are used to initiate

changes throughout the health care delivery
system
II. PERFORMANCE APPRAISAL
1. Engages in performances appraisal on a regular
basis.

2. Seeks constructive feedback regarding one’s

own practice.

3. Takes action to achieve goals identified during

the performance appraisal.

4. Participates in peer view as appropriate.

5. Practice reflects knowledge of current

professional practice standards, laws, and
regulations.

III. EDUCATION
1. Participates in ongoing educational activities
related to clinical knowledge and professional
issues.

2. Seeks experiences to maintain clinical skills.

3. Seeks knowledge and skills appropriate to the

practice setting.

IV. COLLEGIABILITY
1. Shares knowledge and skills to the colleagues.

2. Provides peers with constructive feedback

regarding their practice.
 3. Interacts with their colleagues to enhance one’s
own professional nursing practice.

4. Contributes to an environment tat is conducive

to clinical education of nursing students as
appropriate.

5. Contributes to a supportive and healthy work

environment.

V. ETHICS

1. Practice is guided by the Code of Nurses.

2. Maintains patient confidentiality.

3. Acts as a patient advocate

4. Delivers care in nonjudgmental and

nondiscriminatory manner that is sensitive to
patient diversity.

5. Delivers care in a manner that preserves patient

autonomy, dignity, and rights.

6. Seek available resources in formulating ethical

decisions.

VI. COLLABORATION
1. Communicates with the patient, significant
others, and health care providers regarding
patient care and nursing’s role in the provision of
care.

2. The nurse collaborates with the patient, family

and other health care providers in the
formulation of overall goals and the plan of care
and in the decisions related to care and delivery
of services.

3. Consults with health care providers for patient

care as needed.

4. Make referrals, including provisions for

continuity of care, as needed.
 I. RESEARCH
1. Utilizes best available evidence, preferable
research data, to develop the plan of care and
intervention.

2. Participates in research activities as appropriate

to the nurse’s education and position.

3. Using research findings in the development of

policies, procedures, and practice guidelines for
patient care.

II. RESOURCE UTILIZATION

1. Evaluates factors related to safety, effectiveness,
availability, and cost when practice options
would result in the expected patient outcomes.

2. Assists the patients and family in identifying and

securing appropriate and available services to
address health related needs.

3. Assigns or delegates the task as defined by the

state nurse practice acts and according the
knowledge and skills of the designated nursing
attendant.

4. Assigns or delegates tasks based on the needs

and condition of the patient, the potential for
harm, the stability of the patient’s condition, the
complexity of the task, and the predictability of
the outcome.

5. Assists the patient and family in becoming

informed consumers about the cost, risks, and
benefits of treatment and care.