Appendix E: Clinical Practice Evaluation Rubric

Instructions for Learner and Clinical Instructor:

It is expected that the clinical instructor will work in consultation with the learner to complete the
following evaluation. Please indicate the level that best describes the learner’s performance based
on the following Rating Scale, by placing an "x" in the column against each indicator. Provide
comments where prompted and include examples of how the learner has/has not demonstrated
competency.

Rating Scale:
Self-Directed (SD): Demonstrates understanding of the competency, working mostly independently, seeking
information and consultation only when required.
Meets Expectations (ME): Demonstrates understanding of the competency most of the time, requiring
occasional direction and information.
Unable to Meet Expectations (UE): Unable to meet competency, requires frequent clarification, direction
and information.
No Opportunity (NO): There is no opportunity.

NOTE: The performance expectations upon which this clinical evaluation is based, are taken directly from the College of Nurses of
Ontario. (2014a). Competencies for Entry-Level Registered Nurse Practice; and College of Nurses of Ontario. (2014b). Entry-to-
Practice Competencies for Ontario Registered Practical Nurses.

Clinical Practice Evaluation Form

Name of Learner:
Date of Evaluation: Mid-Course / Final Evaluation:
Clinical Site: Clinical Dates:

Competency Indicator #1: Professional Responsibility and Accountability Score

SD ME UE NO
a] Demonstrates professional presence by adhering to policies and standards of the clinical facility, George
Brown College and the College of Nurses of Ontario.
b] Demonstrates accountability for own actions and decisions.
c] Recognizes own competence within legislated scope of practice, seeking support and assistance when
necessary.
d] Displays initiative, confidence and self-awareness to encourage collaborative interactions within the
nursing and health care team.
e] Responds to own learning needs through critical inquiry, and proactively seeking information, knowledge
and best practice.
f] Organizes own workload using time-management skills.
Comments and Rationale:

NURS 1051, Clinical Practice Course Outline 31

Competency Indicator #2: Knowledge-Based Practice Score
SD ME UE NO
a] Demonstrates knowledge in health, nursing and social sciences, including anatomy, physiology,
pathophysiology, pharmacology, nutrition, communication, learning, leadership, conflict resolution, health care
issues, and cultural safety.
b] Uses relational skills such as listening, questioning, empathy and reflection to promote development of
relationships with patients and health care providers.
c] Conducts a comprehensive assessment of physical, emotional, spiritual, cognitive, social and learning needs in
collaboration with the patient.
d] Interprets assessment data to draw conclusions about patient health status.
e] Facilitates patient involvement in planning and implementation of the health care plan.
f] Collaborates with health team members to develop and deliver comprehensive care.
g] Provides comprehensive nursing care to multiple patients within scope of practice based on critical inquiry and
evidence-informed decision making.
h] Recognizes the need for immediate assistance in rapidly changing patient conditions.
i] Performs therapeutic interventions safely within scope of practice.
j] Implements evidence-informed medication practices.
k] Applies principles of health promotion to prevent illness, assisting patients to understand and support healthy
lifestyle choices.
l] Implements preventive and therapeutic strategies to ensure the safety of patients, self and colleagues.
m] Uses critical inquiry to evaluate effectiveness of care and modifies care as needed.
n] Records assessment data, nursing care, and its evaluation as per the policies of the clinical facility and
Standards of Practice.
Comments and Rationale:

Competency Indicator #3: Ethical Practice Score

SD ME UE NO
a] Identifies the effect of own values, beliefs and experiences in relationships with patients and health care
providers.
b] Maintains professional boundaries.
c] Supports patients in making informed decisions.
d] Ensures that informed consent is provided.
e] Demonstrates ethical responsibilities and legal obligations related to maintaining patient privacy, confidentiality
and security in all forms of communication.
Comments and Rationale:

NURS 1051, Clinical Practice Course Outline 32

Competency Indicator #4: Service to the Public Score
SD ME UE NO
a] Demonstrates leadership in the coordination of health care by advocating for and facilitating patient care.
b] Contributes to nursing and health care team development by promoting interprofessional collaboration and
providing and encouraging constructive feedback.
Comments and Rationale:

Competency Indicator #5: Self Regulation Score

SD ME UE NO
a] Practices within defined scope of nursing practice.
b] Reflects critically on own practice and competence to identify learning needs.
c] Implements a Personal Learning Plan to maintain and enhance competence.
Comments and Rationale:

Summary of Strengths and Areas for Development

Comments:

Final Course Mark: Pass (P) Not Pass (NP)

Signatures Date: (yyyy/mm/dd)

Learner:

Clinical Instructor:

NURS 1051, Clinical Practice Course Outline 33

NURS 1051, Clinical Practice Course Outline 34