Nursing Peer/Self Evaluation - Clinical Nurse 2 - Emergency Department

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  1. Please indicate the associate you are providing feedback on.
    Use the full name provided in the invitation e-mail to complete this survey.*


  1. Assessment - Clinical Nurse 2 - Basic
    (Select all that apply)*
    Approaches patients and families with care concern and compassion.
    Performs baseline physical, psychological and spiritual assessments independently.
    Identifies patient and family's expectation of care, goals and basic learning needs with independently.
    None of these apply.


  1. Assessment - Clinical Nurse 2 - Target
    (Select all that apply)*
    Performs physical, psychosocial and spiritual assessments utilizing non-verbal cues and probes or modifies questions to obtain more comprehensive assessments.
    Assesses patient’s and family’s expectation of care, goals and comprehensive learning needs.
    Recognizes early warning signs of changing patient condition based on deviation from baseline.
    None of these apply.


  1. Assessment - Clinical Nurse 2 - Exceptional
    (Select all that apply)*
    Demonstrates advanced assessment skills by gathering data from multiple sources including use of intuition, subtle cues, past experience, and correlates subjective and objective data prior to formulating nursing diagnoses and daily plan of care.
    Assists/coaches peers on unit to identify early warning signs of impending or actual complications.
    None of these apply.


  1. Provide examples for any selected in number 4 above.


  1. Additional comments or examples for numbers 2-4.


  1. Implementation - Clinical Nurse 2
    (Select all that apply)
    Bolded Answers require Examples*
    Demonstrates utilization of basic skills and knowledge to provide education and safe care to meet patient and family individualized needs independently.
    All documentation is clear, legible, concise, accurate and timely and meets regulatory and departmental standards.
    Independently implements the rescuer role for patients whose condition is changing, involves appropriate persons (i.e.RRT, Code team).
    Demonstrates ability to appropriately prioritize patient’s care needs.
    Consistently demonstrates utilization of advanced nursing skill, knowledge and sound judgment to provide education and safe care to meet patients and families individualized needs.
    Demonstrates the rescuer role by identifying changing patient condition modifies interventions and confidently manages emergency situations.
    Recommends changes in documentation to reflect and meet regulatory or practice standard changes.
    Assists/coaches peers on unit in providing safe care for patients and families.
    Coaches/mentors peers in the implementation of the rescuer role.
    None of these apply.


  1. Provide examples for each bold selection above.


  1. Additional comments or examples for number 7.


  1. Planning - Clinical Nurse 2
    (Select all that apply)
    Bolded Answers require Examples*
    Utilizes assessment data to determine basic nursing diagnoses and pathways, protocols and policies to develop initial plan of care independently.
    Communicates all changes in daily plan of care or schedule to patient/family promptly independently.
    Begins to routinely anticipate discharge needs of patients.
    Identifies potential patient problems and individualizes/revises plan of care based on new findings.
    Involves patient and family in planning patient care. Initiates, participates and coordinates patient/family care conferences as appropriate.
    Plans for meeting patient needs for discharge planning at time of admission.
    Develops comprehensive plan of care for the patient/family with complex physical and psychosocial problems.
    Demonstrates awareness of resources in the community and proactively guides patient/family to meet anticipated post-discharge needs.
    None of these apply.


  1. Provide examples for each bold selection above.


  1. Additional comments or examples for number 10.


  1. evaluation - Clinical Nurse 2
    (Select all that apply)
    Bolded Answers require Examples*
    Independently evaluates/re-evaluates patient responses and progress toward expected outcomes and revises plan of care accordingly.
    Seeks advice from an experienced RN before making decisions when intervention does not result in expected outcome.
    Evaluation/re-evaluation is systematic and ongoing and results in up-to-date plan of care.
    Uses both past experience and subtle cues from patient and family to evaluate/re-evaluate patient responses and progress toward expected outcomes.
    None of these apply.


  1. Provide examples for each bold selection above.


  1. Additional comments or examples for number 13.


  1. Critical Success Factor 1 -Quality Performance and Safety - Clinical Nurse 2
    (Select all that apply)
    Bolded Answers require Examples*
    Beginning to incorporate departmental and organizational goals, initiatives and best practice guidelines into own practice.
    Supports a culture of safety by utilizing proper equipment, reporting unsafe conditions and errors.
    Consistently utilizes pathways, toolkits, bundles, etc. in daily practice.
    Seeks out an validates satisfaction with the quality of care received. Takes action to resolve problems.
    Routinely contributes to department goals, initiatives, and best practice guidelines.
    Anticipates/recognizes potential gaps in satifaction and takes action to prevent or resolve concerns/issues.
    Takes a leadership role in identifying, developing and implementing department or organizational goals, initiatives and best practice.
    Creates a culture of safety by participating in the design of new systems that continuallyseeks to prevent patient, self and environmental hazards.


  1. Provide examples for each bold selection above.


  1. Additional comments or examples for number 16.


  1. Critical Success Factor 3 - Develop a consistent approach to improving the patient experience through unit wellness and collaboration - Clinical Nurse 2
    (Select all that apply)
    Bolded Answers require Examples*
    Incorporates service excellence standards demonstratingrespect and appreciation for internal and external customers.
    Demonstartes awareness and adaptability to the changing healthcare environment.
    Manages time efficiently.
    Demonstrates the ability to build relationships with other members of the healthcare team; creating a positive atmosphere on the unit.
    Anticipates increased work activity and initiates strategies to promote teamwork and decrease stress.
    Understands the scope and accountabilities of self and other disciplines and respects teir contribution to patient care.
    Utilizes proactive strategies to anticipate and prevent conflict/stress.
    Sets a positive tone sndshows respect and appreciation for internal and external customers.
    Demonstrates an understanding of the impact of staffing decisions on unit productivity.
    Takes proactive steps to address opportunities to improve collaboration among disciplines.


  1. Provide examples for each bold selection above.


  1. Additional comments or examples for number 19.


  1. Critical Success Factor 5 - Improve strategic alignment of leadership, physicians, and staff related to professional growth and leadership - Clinical Nurse 2
    *
    Seeks experience and knowledge to develop own clinical skills.
    Delegates patient care activities appropriately.
    Willing to ask for, accept and incorporate feedback into nursing practice.
    Participates in educational activities related to practice and professionsal development.
    Recognizes and participates in tests of change. Adapts practice to improve patient outcomes and/or operational efficiencies.
    Achieves and maintains certification in area of practice.
    Participates in unit or organizational committees or initiatives.
    Member or co-chair in UBWT/Collaborative Governance.
    Acts as a catalyst to initiate change or provides support to other staff.




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