CERTIFIED NURSING ASSISTANT
CLIENT NAME: CLINICAL EMPLOYEE NAME:
UNIT: SHIFT: DATE:
Instructions: Use the following key and definitions to evaluate Progressive Nursing Staffers clinical employee’s job
performance.
Key: Does Not Meet job performance standards Circle “1”
Meets job performance standards Circle “2”
Exceeds job performance standards Circle “3
Exceeds highest possible job performance standards Circle “4”
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I. PROFESSIONAL PERFORMANCE EVALUATION:
1. Clinical Ability: Defined as knowledge & skills demonstrated by job performance 1 2 3 4
2. Performance:
a. Quality – Defined as Hospital’s standards for the job 1 2 3 4
b. Productivity – Defined as assigned tasks/duties completed under normal operating conditions 1 2 3 4
c. Communication – Defined to include responses/oral discussions/instructions w/ health care team
Members/patients/families and pertinent written material [i.e. patient records, nursing notes, etc.] 1 2 3 4
3. Clinical Competence: Demonstrates knowledge & practice of basic patient care concepts 1 2 3 4
II. PERSONAL PERFORMANCE EVALUATION:
1. Attitude – Defined as manner of action, feeling or language towards job 1 2 3 4
2. Judgment – Defined as ability to make decisions & utilize working time to best advantage 1 2 3 4
3. Cooperation – Defined as interaction with others in a constructive & harmonious manner 1 2 3 4
4. Reliability – Defined as punctuality, dependability & trustworthiness 1 2 3 4
5. Comprehension – Defined as understanding written &/or oral instructions relating to the job 1 2 3 4
6. Flexibility/Adaptability – Defined as ability to perform effectively a variety of assigned tasks & to quickly
adjust to changes in the work environment 1 2 3 4
III. COMMENTS:
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Evaluator’s Signature & Title Date
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Reviewed with CNA Date
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Reviewed by Progressive RN Representative Date
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