Clinical Evaluation Tool Revised
Evaluator: Wing, Rebecca
Evaluatee: Morais, Carolina
Completed: 4/23/24
5-Outstanding: Exceeds Standards
Exhibits above average performance of nursing care for this level student. The student is proactive, self-
directed, and consistently engaged in learning; needs minimal guidance; is knowledgeable; and
appropriately incorporates knowledge with skills. Student is proactive and self-directed in approach to
learning.
4-Satisfactory: Meets Standards
Exhibits average performance of nursing care for this level student. Functions with minimum guidance.
Demonstrates adequate knowledge and requires minimum assistance in applying knowledge to skills.
Recognizes learning opportunities but may require assistance in utilizing them.
3-Minimal (Consider Level 3 violation)
Exhibits minimal performance of nursing care for this level student. Functions safely with moderate
guidance. Demonstrates minimal knowledge and requires moderate assistance in applying knowledge to
skills. Requires some direction in recognizing and utilizing learning opportunities. Often focuses on the
task or own behavior, not on the patient.
2-Unsatisfactory (Consider Level 2 violation)
Requires intense guidance for the performance of activities at a safe level. Clinical performance reflects
difficulty in the provision of nursing care. Demonstrates gaps in necessary knowledge and requires
frequent or almost constant assistance in applying knowledge to skills. Requires frequent and detailed
instructions regarding learning opportunities. Focuses primarily on the task or own behavior, not on the
patient.
1-Unsafe to Practice (Consider Level 1 violation)
Is unsafe to practice without constant, intense guidance. Frequently lacks necessary knowledge and
skills and unable to integrate these into practice. Requires constant detailed instructions regarding
learning opportunities and is often unable to utilize them. Attempts activity or behavior, yet is unable to
complete. Focuses entirely on the task or own behavior, not the patient.
Created June 2017
Clinical Evaluation Tool Revised
Standard 1: Patient-Centered 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.
Score: 5
Clinical Faculty Feedback: Carolina continued to develop and strengthen her assessment skills, and
her ability to develop a thorough care plan for her patients. She really stepped for up the challenge
of completing her preceptorship hours in the MSICU. She asked appropriate questions throughout to
ensure she fully understood the care was executed safely.
Areas for improvement:
n/a
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.
Score: 5
Clinical Faculty Feedback: Carolina worked well with her preceptor and the other members of the
healthcare team. She is eager to help when able. Her preceptor expressed positive feedback about
her ability to integrate herself into the unit and be engaged with everyone, and helping when able.
Areas for improvement:
n/a
Created June 2017
Clinical Evaluation Tool Revised
Standard 3: Evidence-Based Practice and Quality Improvement
1. Utilizes evidence-based literature to support clinical decision making as demonstrated in written
clinical assignments.
2. Differentiates clinical opinion from evidence-based practice to determine best clinical practice.
3. Promotes and practices quality, cost-effective delivery of care.
4. Identifies potential areas for quality improvement in the clinical setting.
5. Participates in measures to improve patient outcomes as appropriate.
Score: 5
Clinical Faculty Feedback: Carolina continued to learn and ask questions pertaining to evidence-
based practice and quality improvement. She has a solid foundation of knowledge and was able to
critically think and integrate her knowledge into practice.
Areas for improvement:
n/a
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.
Score: 5
Clinical Faculty Feedback: Provides safe and effective care. Follows the protocols set forth by the
hospital. Carolina continued to strengthen her organization and time management skills. She made
great strides to learn as much as possible about the ICU, along with the ICU drips, and integrating
into practice alongside her preceptor.
Areas for improvement:
n/a
Created June 2017
Clinical Evaluation Tool Revised
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.
Score: 5
Clinical Faculty Feedback: Carolina does well navigate the EMR to locate information needed to care
for the patient. She maintains confidentiality and ensures to log off when walking away from
computer to protect patient’s HIPPA.
Areas for improvement:
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 self-evaluation 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.
Score: 5
Clinical Faculty Feedback: Carolina was a ray of positivity, maintaining a high level of professionalism.
Her engagement and willingness to soak up every bit of the last semester truly afforded her a solid
foundation for her transition from student nurse to a licensed nurse. She made a lasting impression
on the unit she completed her preceptorship hours. Her passion for caring for others is evident, and
know she will continue to soar throughout her nursing career.
Areas for improvement:
Created June 2017
Clinical Evaluation Tool Revised
Levels of Practice Violations
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.
Created June 2017
