Performance Evaluation


Date:
Evaluator's First Name:
Evaluator's Last Name:
Evaluator's Email:
Name of Nurse:
Specialty:
Employment Dates:
Shift:
Facility
Unit:

Quality of Work Unsatisfactory Needs Improvement Fully Competent Exceeds Expectations N/A
Adheres to hospital policy & procedures
Demonstrates accuracy
Performs & completes assigned tasks
Accepts & follows directions
Uses & maintains equipment properly
Observes safety rules to prevent accidents
Demonstrates effective communication for patient care
Patient satisfaction with care provided
Documentation Unsatisfactory Needs Improvement Fully Competent Exceeds Expectations N/A
Initiates and/or updates care plans
Documentation is accurate, appropriate, and completed in a timely manner
Attention to detail
Personal Unsatisfactory Needs Improvement Fully Competent Exceeds Expectations N/A
Dress & appearance is in accordance with dress policy
Punctuality, dependability, and attendance
Attitude
Initiative
Treats patients & families with respect and courtesy
Exhibits teamwork & cooperation with work group and hospital staff
Flexibe with schedule
Photo ID worn at all times
Clinical Processes - Licensed Personnel Unsatisfactory Needs Improvement Fully Competent Exceeds Expectations N/A
Completes accurate patient assessments and treatments, reports findings
Administers medication & treatment as ordered
Evaluates patient response to medications & treatments
Evaluate patient care through systematic assessment of patient outcomes
Provides nursing interventions appropriate to patient assessment
Delivery of care is developed appropriately
Completes accurate intakes with correct traige
High quality information intake
Communicates effectively with Regional Offices according to policy
Participates in on-call schedule as assigned

Additional Comments:

Signature: Date:

Agency Signature: __________________________________