Aultman College of Nursing and Health Sciences Nursing 250 by xuh86054


									                      Aultman College of Nursing and Health Sciences
                          Nursing 250: Nursing Management IV
                               Preceptor Evaluation Tool

Student Name: __________________________________ Dates: _______________

Key: 1 = No knowledge/Experience                3 = Knowledge/ Done with assistance
     2 = Knowledge/ No Experience               4 = Knowledge/ Done Independently

                                              Student           Preceptor
Clinical Behavior Outcomes        1 2 3 4    Met     Not          Comments
Demonstrates an awareness of
significant blood work (K+,
H/H, APTT, blood sugar),
specimens, diets, and
procedures scheduled.
Communicates to team
members necessary
information in a professional
Makes early and periodic
rounds on all assigned patients
to do brief and continuous
assessments as needed.
Completes assigned patient
assessments within a timely
Administers all medications
according to hospital policy
and procedure (MARS at
bedside, 6 rights of
medication administration,
checks 2 patient identifiers).
Completes all treatments and
procedures on assigned
patients in a timely manner.
Covers IV’s, medications, and
treatments as indicated.
Continually demonstrates
safety and aseptic
principles while providing
nursing care.
Documents all nursing care
given in a timely and concise
manner according to policy
and procedure.
Checks on other team
members frequently and
assists with other patient care
as indicated.
Identifies learning needs and
provides incidental teaching to
patients/families daily.
Demonstrates problem-
solving and decision-making
ability when confronted with
various nursing care
Informs charge nurse and/or
physician of changes in a
patient’s condition
Utilizes the skill of delegation
in organization and time-
management practices
(identify specifics under
Communicates effectively
with RN preceptor regarding
goals, needs, strengths,
weaknesses, patient care
issues, etc.
Demonstrates initiative in
seeking out own learning
Demonstrates flexibility and
adaptability of changing

* If “Not Met, the course coordinator must be contacted for follow-up.

Nursing Student: Please list below any procedures or special experiences that he/she participated
in and any comments related to this experience.
RN Preceptor: Please constructively list strengths and weaknesses of the student in the patient
care management role for this clinical experience. (This item should guide the student in setting
goals for the next clinical experience.)

RN Preceptor Signature and Date: _______________________________

Student Signature and Date: ____________________________________

Clinical Instructor Signature and Date: ____________________________

Thank-you for your help in assisting with an Aultman College of Nursing and Health Sciences
nursing student. Your time that you have invested is greatly appreciated by faculty and the future
of nursing. Please have the student read, sign and forward this form to the Nursing Clinical

If you have any problems, questions, or concerns please contact:

Jo Ann Weinland, MSN, RN, ACNS-BC (ext. 34129, pager 330-588-1627)

Kelly Carmany, BSN, RN (ext. 31163, pager 330-430-8940)

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