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Evaluations > Evaluation Review
Evaluations Clinical Evaluation Tool Revised June 2017
Evaluations NUR 4216L FHT UD Section 101 (11/9/2017)
Experience Butts, Morgan (mbutts@health.usf.edu)
Standard 1: PatientCentered 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 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
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Morgan's ability to critically think is outstanding, and also demonstrates a heightened understanding of
disease processes and patho.
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.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
Standard 3: EvidenceBased Practice and Quality Improvement
1. Utilizes evidencebased literature to support clinical decision making as
demonstrated in written clinical assignments.
2. Differentiates clinical opinion from evidencebased practice to determine best
clinical practice.
3. Promotes and practices quality, costeffective 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 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
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 (Comment Required) Outstanding: Exceeds Standards
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4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
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 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
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 selfevaluation 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 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
At all times, Morgan upheld a professional demeanor and exceeded the norm with regards to
demonstrating core professional values. She possesses a lot of integrity, and she is able to maintain this
professionalism even in high‑intensity patient care situations as I have observed with her.
Levels of Practice Violations
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Level 3 Violation
• Potential for unsafe practice
• Typically a single event or occurrence that presents minimal risk for patient harm
• Examples include but are not limited to being unprepared for clinical or a perceived
disrespectful attitude.
• Intervention: Interaction with clinical instructor. Complete student contact form.
Notify course coordinator.
Level 2 Violation
• Evidence of unsafe practice
• Pattern of behavior
• Examples include but are not limited to pattern of being unprepared for clinical,
unable to organize patient report, continued inability to describe indications for
medications or interventions
• Intervention: Meet with clinical instructor. Notify course coordinator and program
director. Academic Jeopardy Form with clear plan for resolution of concerning
behavior.
Level 1 Violation
• Unsafe practice with unacceptable risk for harm
• Examples include but are not limited to dishonesty, failure to change behaviors in
response to feedback, physical or mental impairment (intoxication or lack of sleep),
violent behavior, breach of confidentiality, extreme anxiety, angry or unprofessional
outburst.
• Intervention: Immediate removal from all clinical, lab, and simulation activities. Notify
course coordinator and program director.
NA
Comments:
Morgan was truly a pleasure to teach in clinical, and she has made excellent growth and progress throughout
the semester. I hope that she continues to consider a career in critical care, as I have told her that "She's got
it." She is able to critically think at an extremely high level, and she maintains a calm and collected demeanor
at all times. She will be an excellent nurse in the future.
Morgan's preceptors have made the following comments on her behalf:
Morgan Butts has reviewed the above evaluation on 3/19/2018 and has provided the
following comment:
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