Manager Performance Evaluation

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					                                                                         MERCY HOSPITAL
                                                                          1031 Seventh Street
                                                                       Devils Lake, ND 58301-2798
                                                                         Phone (701) 662-2131

                                                                      Job Performance Standards

Employee Name                         Berg, Jessica                         Department              Respiratory Therapy     Job Title  Certified Respiratory Care
Evaluation Period                           2009                      Evaluation Conducted On:                              By:   Rick Morse
                                                                                                    Self Eval.   Manager
Responsibilities and Duties:                                                                                                  Comments/Development Plan
                                                                                                    Yes   No     Yes   No

Mission and Core Values
   Complies with CHI Standards of Conduct
   Follows all Expected Behaviors as established by Mercy Hospital
        1. We will treat all information that we have about patients and co-workers with
            strict confidentiality.
        2. We will show kindness and gentleness in manners, speech, attitudes and actions
           while at work.
        3. We will demonstrate acceptance of every person, regardless of race,
           socioeconomic status and religion, by attitude shown through tone of voice,
           facial expression, and body language.
        4. We will inform patients honestly in regard to all exams and procedures they will be
           given, e.g., if there will be discomfort, etc.
        5. We will perform our job accurately for the safety and well-being of our patients.
        6. We will be professional at all times.
        7. We will show courtesy, such as by saying "Please" and "Thank you" in
           conversations with patients and co-workers.
        8. We will demonstrate our dependability by completing tasks that are assigned.
        9. We will recognize/compliment others when they have done a good job.
       10. We will cooperate with patients, families and co-workers to create the optimum
           atmosphere for healing.
       11. We will respect the privacy of patients by knocking on closed doors before entering.
       12. We will meet patient and co-workers with a smile and cordial greeting.

  Attends all mandatory in-services
  Participates in educational programs to enhance skills and maintain licensure requirements.
  Assumes responsibility for maintaining personal education records.
  Demonstrates knowledge of location and appropriate use of manuals (Infection Control
      Emergency Preparedness, Administrative, Hazard Communication, Policy & Procedure)
Employee Name                        Berg, Jessica                        Department          Respiratory Therapy      Job Title   Certified Respiratory Care

                                                                                              Self Eval.    Manager
Responsibilities and Duties                                                                                              Comments/Development Plan
                                                                                              Yes   No      Yes   No

   Analyzes and identifies ergonomic issues
   Utilizes proper body mechanics
   Utilizes sufficient and proper assistance when transporting or lifting.
   Uses personal protective equipment appropriately
   Uses appropriate electrical safety precautions
   Reports safety and security concerns through proper channels (occurrence reports, safety
        concerns report, variance reports)
   Identifies appropriate departmental response to emergency procedures (Code Red,
        Code Pink, Adam 12, Code T, Code Blue, Code Green)

Infection Control
   Uses standard precautions
   Uses transmission based precautions when appropriate
   Utilizes appropriate management of non-regulated and regulated waste
   Reports infectious diseases appropriately
   Utilizes proper hand hygiene

Record Maintenance:
  Follows departmental policies and procedures for documentation
  Maintains appropriate logs
  Follows procedures for filing and record keeping

Professionalism and Customer Service
   Uses proper telephone etiquette
   Dresses neatly and appropriately
   Uses break times appropriately
   Has less than four episodes of absenteeism per year
   Notifies appropriate individual in a timely manner of absenteeism due to illness
   Arrives to work on time
   Limits overtime to justifiable reasons
   Communicates within department and between departments in a timely and appropriate
   Applies good judgment in situations not covered by written or verbal instructions
   Acts as mentor for new employees or students as assigned
Employee Name                        Berg, Jessica                        Department           Respiratory Therapy    Job Title   Certified Respiratory Care

                                                                                               Self Eval.   Manager
Job Specific Responsibilities and Duties                                                                        Not     Comments/Development Plan
                                                                                               Yes   No     Met

  Assesses patients objectively and subjectively as appropriate to procedure being
     performed according to policies and procedures.

  Provides patient education on procedures being performed, medications being
     administered, and self care aspects as appropriate to respiratory health.

  Correctly performs respiratory care procedures including:
     Hand held nebulizers
     Intermittent Positive Pressure Breathing
     Postural drainage and percussion
     Incentive spirometry
     Ultrasonic nebulizers
     Croup tents
     Pulse oximetry
     Heated aerosol oxygen therapy
     Use of Spag II
     Mechanical ventilation
     Arterial blood gases
     Pulmonary function studies
     Methacholine studies
     Obtaining sputum specimens
     Use of BiPap

  Correctly performs other procedures assigned to the Respiratory Care department including:
     Electroencephalograms (EEGs)
     Electrocardiograms (EKGs)

  Demonstrates knowledge of the principles of growth and development over the life
    span and skills necessary to provide age appropriate care to the patients served.

  Evaluates patient response to procedures and medications administered

  Communicates patient assessment and response according to policies and

  Prepares or directs the preparation and maintenance of equipment and supplies
     necessary for treatments or procedures.
Employee Name                      Berg, Jessica                       Department             Respiratory Therapy      Job Title   Certified Respiratory Care
         Employee demonstrates competency to fulfill job responsibilities and duties
         Employee consistently and correctly performs job responsibilities and duties
         Employee requires further education/training to fulfill job responsibilities and duties

         Next evaluation date

         Additional Comments

         Employee Comments

Employee Signature                                                                                                  Date

Manager/Director Signature                                                                                          Date
                                                 JOB DESCRIPTION/PERFORMANCE EVALUATION

POSITION:                                       Certified Respiratory Care Technician/Practitioner                                               FLSA: NON-EXEMPT
JOB SUMMARY                                     Performs all duties and procedures of respiratory care as provided by Mercy Hospital for patients of all ages
                                                (neonates/infants, pediatric, adolescent, adult, geriatric).

SECURITY ACCESS                                 High Security Access - User has ability to access restricted or confidential information, or
                                                network infrastructre information, server configuration, or other user account information.

         Reports to:                            Respiratory Care Manager
         Supervisory Responsibility             Works independently within the department

         Training and Experience:               Graduate of an AMA approved school of respiratory therapy with minimum of one year clinical experience
                                                and meets position description requirements.

         Licenses, Registrations and Certifications:
                                         Licensed by the North Dakota State Board of Respiratory Care, certified in CPR

         Working Conditions:                    Works in a typical hospital environment subject to the hazards associated with such a facility, including
                                                exposure to blood and body fluids, infectious diseases, hazardous materials and emergency or crisis situations.
                                                Requires shift rotation and "on call" status.

         Physical Requirements:                 Requires frequent walking, reaching and lifting of patients and equipment. Visual acuityand hearing ability
                                                necessary to fulfill job responsibilities.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to
be construed as an exhaustive list of all duties performed by the personnel so classified.
                                                              COMPETENCY ASSESSMENT
Position                    Certified Resp. Care Technician                           Self Evaluation              Patient Population                  Verification Method
                                                                                 1 Never done; no                   N     Neonate/Infant          O     Direct observation
Department                  Respiratory Therapy                                    knowledge                              0-1 year                 D    Return demonstration
                                                                                 2 Never done; under-               P     Pediatric 1-17                in actual practice
Name                        Berg, Jessica                                          stand theory                     A     Adult 18-60              S    Skills station/simulation
                                                                                 3 Limited experience               G     Geriatric >60            V    Verbalization
Eval. Date                  2009                                                 4 Can perform independently                                      NA Not applicable

 Certifications: CPR________ Other________
 Numbr of years experience in Pediatrics__________ Adults__________ Geriatrics__________

                                               Self    Verification method for         Competent                Needs
               Competency                     Eval.    Each Patient Population      Date    Validator           Add'l                      Comments/Action Plan
                                            *See Key    N      P     A     G                                   Training

 Postural drainage & percussion
 Arterial Blood Gases
   Specimen Collection
   Instrument function cks & callibration
   Quality Cont./Proficiency testing
   Preventive maintenance
 Pulmonary function studies
 Methacholine studies
 Initiating mech. ventilation
 Weaning off mech.ventilation
 Reporting and recording test results

 Mechanical ventilators
 Croup tents
 Spag II
 Apnea monitors

Critical Thinking Skills
 Pain assessment
 Adverse Drug Reactions
 Signs of abuse/neglect
 Pt. receiving sedation
 Pt. in restraints
 Problem Solving Skills

Description: Manager Performance Evaluation document sample