Approved: 2005
Revised: 11/2015
Updated: 1/2019
PENNSYLVANIA STATE UNIVERSITY
C
ollege of Nursing
NURS 2
30 STUDENT CLINICAL PERFORMANCE EVALUATION
Student Name ______________________________ Course Number: NURS 230 Semester _________
Clinical
Site(s)__________________________________________________________________________
Mid-Course Evaluation: Passing____ Failing____ Needs Improvement______ Date: _______________
Final Evaluation: Pass____ Fail____ Date: _____________
F = Fail
*NI – Needs Improvement only
may be used at mid
-course
evaluation
*N.A. – Not applicable
Passing: Clinical performance which consistently demonstrates safe and
adequate application of the clinical course objectives within a defined time
frame with minimal verbal or nonverbal cues or assistance in integrating
knowledge and skills.
Failing: Clinical performance which demonstrates unsafe or inadequate
application of the clinical objectives within a defined time frame; requires
frequent verbal or nonverbal cues or assistance to function on the clinical
area, demonstrates gaps in necessary knowledge or critical thinking and requires
frequent or almost constant assistance in integrating knowledge and skills.
Needs Improvement: Clinical performance which is inconsistent in application
of clinical course objectives within a defined time frame; functions safely and
adequately only with moderate assistance, verbal or nonverbal
cues, integrating knowledge with skills in the clinical area.
Not applicable to students in this course
DO NOT USE N.A. FOR EVALUATION OF ANY CORE COMPETENCY
Criteria for Passing Clinical:
Mid-Course
Passing requires pass (P) in all Core competencies and criteria. “Needs Improvement” (NI) on
any one criteria at mid-course evaluation denotes “Needs Improvement” (NI) for the core
competency and a “Needs Improvement” clinical grade at mid-course. “Fail” (F) on any one
criteria at mid-course evaluation denotes “Fail” (F) for the core competency and a failing clinical
grade at mid-course. The evaluator is expected to comment on ALL items rated: NI or F.
Comments must include a plan for improvement for each criteria evaluated with a Fail (F) or
Needs Improvement (NI).
A Remediation Plan will be written at mid-course if the student is failing and, at the discretion of
the clinical instructor, may be written for a student who needs improvement.
Final: Pass in all elements. A “Fail” (F) on any one element at final evaluation denotes clinical failure
and course failure. The evaluator is expected to comment on all items rated F.
Remediation Plans: will be developed by course faculty for failing grade at mid-course or any time during the
course at the discretion of the clinical instructor. The plan will identify the clinical criteria that are of concern and
will suggest resources and activities designed to assist the student in achieving a passing evaluation for the final
course grade.
Instructions for faculty: Passing (P) for any core competency indicates that all criteria are also passing (P). If the
core competency is graded F or NI, indicate with a check which criteria are F or NI. If even one criterion is F,
the core competency is also F. Unchecked criterions are passing (P).
P=Pass
Definition of Clinical Grades:
Spring
Approved: 2005
Revised: 11/2015
Updated: 1/2019
MID-COURSE
FINAL
Core competency 1
P
F
P
F
Patient Centered Care: Plan and provide competent, compassionate and
coordinated care based on sound judgment and clinical reasoning and
respect for patient’s preferences, values, and need.
Criteria
F
NA
F
NA
1a. Demonstrates accurate, thorough, and systematic clinical assessments
1b. Develops individualized, accurate and complete nursing care plans with
rationales and outcome criteria
1c. Provides patient-centered care compassionately and effectively
1d. Maintains client privacy, confidentiality, and dignity
1e. Identifies the need for the professional nurse to advocate for
clients/families.
1f. Prioritizes patient needs and care accurately.
Core competency 2
P
F
P
F
Safety: Minimizes risk of harm to patients and providers through both
system effectiveness and individual performance.
Criteria
F
NA
F
NA
2a. Performs nursing skills safely, accurately, and without omission
2b. Implements written plans of care safely and effectively
2c. Complies with College of Nursing and clinical site policies for safety,
security, infection control, and patient care
2d. Administers medications safely with an understanding of the purpose,
route, dose range, side effects, and precautions for each medication
2e. Implements strategies to reduce risk of harm to self and others
2f. Recognizes and acts to prevent unsafe, illegal, immoral or unethical
practices by self and others
2g. Monitors patient status and notify assigned nurse promptly of any changes
in condition or concerning findings
2h. Implements strategies related to National Patient Safety Goals that are
appropriate for assigned client(s).
2i. Organizes multiple responsibilities and provides safe client care in a
effective, efficient and timely manner
Core competency 3
P
F
P
F
Evidence based Practice: Integrate best current evidence with clinical
expertise and patient/family preferences and values for delivery of optimal
health care.
Criteria
F
NA
F
NA
3a. Relates theoretical and evidence-based knowledge to practice
3b. Utilizes appropriate resources and references for accurate and complete
data collection
3c. Delivers evidence based care that respects patient and family preferences
✔
✔
✔
Approved: 2005
Revised: 11/2015
Updated: 1/2019
MID-COURSE
FINAL
Core competency 4
F
NI
P
F
Teamwork & Collaboration: Function effectively within nursing and inter-
professional teams, fostering open communication, mutual respect, and
shared decision making to achieve quality patient care.
Criteria
F
NI
NA
F
NA
4a. Develops and maintain constructive and cooperative working relationships
with faculty, staff, peers, and facility employees
4b. Listens carefully and communicate effectively with patients/families,
members of the healthcare team, faculty, and those from diverse
backgrounds, taking the time to understand and ask appropriate questions
without interrupting
4c. Assumes role of team member and functions competently within own scope
of practice providing high quality, safe patient care, as a member of the
healthcare team
4d. Identifies the perspectives, expertise, and limitations of all healthcare team
members including those of diverse background
4e. Reports abnormal findings or changes in patient condition to appropriate
members of the healthcare team in a timely, accurate, and thorough manner
4f. Identifies the need for help, identifies appropriate resources and initiates
requests when appropriate to the situation
4g. Begins to incorporate effective communication techniques, including
negotiation and conflict resolution to produce positive professional working
relationships
4h. Identifies the unique nursing perspective to inter-professional teams to
optimize patient outcomes
Core competency 5
P
F
NI
P
F
Quality Improvement: Monitor the outcomes of care processes and take
steps to continuously improve the quality and safety care delivery.
Criteria
F
NI
NA
F
5a. Accepts guidance, supervision, and constructive criticism
5b. Identifies strengths and weaknesses and uses feedback to formulate goals
for personal and professional growth
5c. Evaluates care based on client response, outcome, scientific knowledge, and
begins to make appropriate revisions, as necessary
5d. Shows a high level of dedication to quality
5e. Promotes achievement of safe, quality outcomes of care for all clients and
families
5f. Realizes that continuous quality improvement is an essential part of the
daily work of all members of the healthcare team.
5g. Realizes that nursing and students of other health professions are part of
systems of care and care processes that affect outcomes for clients and
families.
NA
✔
✔
Approved: 2005
Revised: 11/2015
Updated: 1/2019
MID-COURSE
FINAL
Core competency 6
P
F
NI
P
F
Informatics: Manage data, information, knowledge and technology to
effectively communicate, mitigate error and support decision making.
Criteria
F
NI
NA
F
NA
6a. Maintains accurate & timely medical records and other documentation in
accordance with clinical site & program policy utilizing appropriate
medical terminology and professional communication.
6b. Demonstrates fundamental skills in using patient care technologies,
information & communication systems, that support safe nursing practice.
6c. Recognizes the role of information technology in improving patient care
outcomes and creating a safe care environment.
6d. Upholds ethical standards related to data security, regulatory requirements,
confidentiality, and clients’ right to privacy.
6e. Utilizes and responds appropriately to technologies and alerts that support
clinical decision-making, error prevention, and care coordination.
6f. Utilizes and begin to evaluate patient data and information.
Core competency 7
P
F
NI
P
F
Professionalism and Professional Values: Applies the principles of
altruism, excellence, caring, ethics, respect, communication, civility, and
accountability.
Criteria
F
NI
NA
F
NA
7a. Takes responsibility and accountability for learning, actions and quality of
work without blaming others or making excuses.
7b. Complies with Pennsylvania State University, College of Nursing, program
& course policies, procedures and requirements.
7c. Is honest and trustworthy and demonstrates the professional standards of
moral, ethical, and legal conduct.
7d. Demonstrates flexibility and tolerance for change, ambiguity, and
unpredictability.
7e. Performs effectively and maintains self-control during difficult or
unexpected situations and conditions.
7f. Maintains a culture of civility and kindness treating all individuals with
dignity and respect.
7g. Demonstrates professionalism, including attention to appearance,
demeanor, respect for self and others, and attention to professional
boundaries with patients and families, staff and faculty.
7h. Remains alert and attentive during clinical time.
7i. Performs duties in a reliable, responsible, and dependable manner.
7j. Provides evidence of preparation for clinical experiences
7k. Arrives at clinical experiences and completes work on time.
✔
✔
✔
Approved: 2005
Revised: 11/2015
Updated: 11/2018
Mid-Semester Evaluation
Instructor Comments:
Student Comments:
Student’s Signature: __________________________________________________ Date____________________
Instructor’s Signature: _______________________________________________
_ Date____________________
Final Evaluation
Instructor Comments:
Student Comments:
Student’s Signature: _________________________________________________ Date____________________
Instructor’s Signature: _______________________________________________ Date__________________
___
Approved: 2005;
Revised:11/2015; Fall 2017
Effective: 1/2018
Updated: 10/2018
REMEDIATION PLAN AND OUTCOME
Criteria
Description of unsatisfactory behavior
Please use back of form if necessary for additional detail
PLAN
The SPECIFIC skills, knowledge, and COMPETENCIES that must be demonstrated to meet
course objective(s) including time frame when appropriate:
Suggested resources and activities:
OUTCOME
Follow-up conference (Please check one of the following):
Has overcome deficiencies and now meets objective(s)
Has not overcome deficiencies and does not meet objective(s)
Comments:
Instructor’s Signature:___________________________ Date:____________________
Student’s Signature:_____________________________ Date:____________________
Please type this document
Failure to meet the expectations of the remediation plan and all clinical objectives will result in a
clinical failure for this course.
Instructor’s Signature:_____________________________ Date:____________________
Student’s Signature:_____________________________ Date:____________________
Date of Follow-up Conference:______________________________________________