Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 242 – Nursing Concepts Clinical 4
SUMMATIVE Student Clinical Performance Evaluation

Student My Nguyen Date 03/30/2020 Week # Faculty Professor Rohrbaugh

Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical
(Meets) (Requires assistance) (Unable) applicable behavior
Students who meet any of the following criteria will be given a remediation plan and may be placed on probation.
Failure to progress in these areas may result in failure of the course.
-One unsatisfactory grade in a critical behavior -Two needs improvements in a critical behavior
-Two unsatisfactory grades in a non-critical behavior -Four needs improvements
Instructor
Student Eval of
Course Goal 1 Self-Eval Student
Use the nursing process to optimize client health (PG1) S/N/U S/N/U
1. Prioritizes and completes daily nursing tasks S
2. Completes assessments accurately S
3. Uses EMR/MAR, patient charts, handoff report to provide care S
4. *Establishes appropriate nursing priority list S
5. Creates measurable patient outcomes S
6. Establishes appropriate nursing interventions S
7. Evaluates patient response to care and revises plan as needed S
Instructor
Student Eval of
Course Goal 2 Self-Eval Student
Assimilate into the profession of nursing (PG2) S/N/U S/N/U
8. Adheres to dress code S
9. Seeks input from patient, instructor, and healthcare team when providing care S
10. *Demonstrates accountability and accepts responsibility for own actions and attitudes S
11. Actively participates in all clinical experiences S
12. Communicates learning needs to instructor S
13. Completes assignments/evaluations as required S
14. Demonstrates initiative in assisting peers and healthcare team members S
Instructor
Student Eval of
Course Goal 3 Self-Eval Student
Provide patient-centered care (PG3) S/N/U S/N/U
15. *Implements appropriate infection control precautions S
16. Identifies client’s cultural needs S
17. Accurately documents patient care S
18. Communicates appropriately with patient, family, healthcare team, and instructor S
19. Explains the actions, side effects, and nursing implications of medications S
20. *Administers medication using the six rights S
21. Demonstrates concern, compassion and empathy with patients S
22. *Demonstrates physical and mental competence S
23. *Notifies instructor and appropriate healthcare team members with safety concerns and changes
in the patient’s condition S
24. Identifies patient and family health education needs S
25. Provides nursing care in accordance with the Maryland Nurse Practice Act and the ANA Scope &
Standards of Nursing Practice S
26. *Adheres to HIPAA guidelines S

Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical

(Meets) (Requires assistance) (Unable) applicable behavior

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 242 – Nursing Concepts Clinical 4
SUMMATIVE Student Clinical Performance Evaluation

Instructor
Student Eval of
Course Goal 4 Self-Eval Student
Engage in evidence-based practice (PG4) S/N/U S/N/U
27. Critiques current practice based on evidence S
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.
During this clinical rotation, my instructor put me on many different shoes so I can get familiar with being a nurse. I had my
chances to follow a charge nurse and floor nurses. Thus, I could understand how it was like to manages and prioritizes assigned
tasks on the floor.

Which objective did you accomplish during this rotation? How did you do it?
There were many objectives that I accomplished during this rotation such as: planned and cared for 2 to 3 patients at once;
shadowed a charge nurse; administered medications; attended new procedures/studies such as cardiac catheterization; learned
how to interpret EKG in a more advance level compares to what was being offered in class; etc.

What are your goals for your next clinical rotation?

Be confident and be ready to function as a safe nurse.

Faculty Comments/ Student Learning Goals (Goals must be established even if performance is satisfactory. If an item was
identified as N or U, narrative comments are necessary to clarify student performance along with goals to improve performance).

Student Signature: My Nguyen Date: 03/30/2020

Instructor Signature: Date:

Definitions:
Coaching – Faculty guides student to define objectives, set goals, and develop action plans through collaboration in the decision-making process
Assistance – Student unable to perform task independently; needs some aid or minimal direction from faculty to complete tasks. Not autonomous but does not
require coaching.
Resource - Faculty serves as a facilitator but student is capable of completing self-directed tasks.

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020