PERFORMANCE APPRAISAL

REGISTERED NURSE

 

Employee Name:                                                    

               

Date:                                                                                      

 

Evaluator's Name :                                                              

 

Title:                                                                                      

 

For each area of performance evaluate the level of achievement demonstrated during the past year.

 

AREAS OF PERFORMANCE

 

Autonomy and Accountability

Patient Care Management

Professionalism

 

LEVEL OF ACHIEVEMENT

 

5  -   Outstanding

4  -   Highly Effective

3  -   Effective

2  -   Improvement Needed

1  -   Unacceptable

NA-  Not Applicable

 

Areas of Performance                        Level of Achievement

 

A.  Autonomy and Accountability

 

      1.   Functions within legal framework of the                                                                                                                              

            Nurse Practice Act of the state currently

            employed.                                                                                                 

      2.   Performs work assignment with

            minimum need for supervision and

            guidance.                                                                                                                                                                                                                                                                                                                                                                                                                       

     3.   Demonstrates reliability in meeting

            deadlines and completing

            responsibilities.                                                                                                                                                                                                                                                                                                                                                                                      

     4.   Possesses skills and technical

            competence to execute work

            responsibilities.                                                                                       

     5.   Demonstrates responsibility and

            reliability in meeting scheduled

 

 

 

 

 

 

 

Areas of Performance                        Level of Achievement

 

 6.  Operates within the established

      company guidelines                                      ______

     

7.   Complies with hospital policies

      and procedures.                                                           

               

8.  Assists with training/education of

     staff, contributes to an open learning

     environment.                                                                                   

9.  Displays ability to utilize appropriate

     channel(s) for communication and/or

     problem solving.                                                                                                            

10.  Adheres to Hospital and Company

     health and safety standards.                                                                        

 

B.  Patient Care Management

 

1.   Utilizes established Nursing

      Department Standards in the

      delivery of patient care.                                                               

2.   Utilizes clinical knowledge and skills

      to assess the needs of assigned

      patients.                                                                                          

3.   Completes and documents initial and

      ongoing assessments as per policy.

      Written communication is clear, legible

      and objective.                                                                                

4.   Prioritizes care based on medical and

      nursing diagnosis, nursing history, DRG

      and expected patient outcomes.                                                                                                                 

5.   Demonstrates ability to set goals, assign

      priorities, anticipate problems, establish

      limits and achieve quality results.                              

 

6.   Completes tasks with timeliness,

      schedules and uses time efficiently.                                                                   

 

7.   Develops comprehensive plan of care

      from admission to discharge for

      assigned patients based on patient

      needs, standards of care, DRG and

      expected patient outcomes.                                        

 

Areas of Performance                        Level of Achievement

 

8.   Functions as a patient advocate

      assuring patient's right to information,

      providing patient safety at all times, and

      maintaining confidentiality.                                                         

 C.   Professionalism                                                                         

 

1.   Promotes good public relations for

     CCMS and Hospital.                                                                    

2.   Communicates accurately/appropriately

      with patients, family and other personnel.

      Establishes and maintains therapeutic

      and supportive relationship.                                                       

3.   Adheres to Company/Hospital dress

      code policy.                                                                                                                                                                                                   

4.   Reports to work in a timely manner.                                                                                                                                           

5.   Effectively expresses self. Listens

      attentively and creates a climate of open

      communication. Respects confidentiality

      and privacy.                                                                                                   

6.  Accepts constructive comments from

     hospital/contracting company as a

     mechanism for improvement.                                                                                

7. Maintains credentials and education

    files as per JCAHO standards and

    Department of Health Regulations.                                                                                              

8. Functions as an integral part of the

    health care delivery team and participates

    in the maintenance of a cohesive work                                                  

    environment.                                                                                                                    

                                                                               

Signature of Clinical Nurse                                                                                                Date                                       __________

 

 

                                                                                                                                                                              Signature of  Branch/ Nurse Manager                                                      

 

Date                                                                                                       

 

 

                                                                               

Signature of  Division Officer/Designee

 

Date                                                                       

 

 

COMMENTS: Areas of performance marked Level 1 or Level 2 must be accompanied by comments.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GOALS: