Beruflich Dokumente
Kultur Dokumente
Page 1
2nd Edition - Revised October 2008
TABLE OF CONTENTS
Page 2
2nd Edition - Revised October 2008
SELF-ASSESSMENT TOOL
The Self-Assessment Tool is used to assess your professional practice using the LPN Standards of
Practice and Competency Profile as a guide. Focus your assessment on your practice as a whole and
then those Specific Competencies which are directly related to your role and responsibilities.
RATING SCALE Use the following rating scale to complete your Self-Assessment.
1
Excellent
2
Competent
3
Requires
Improvement
4
Developmental
Demonstrates
excellence in the
expectations and /
or requirements of
the competency.
Meets the
expectations and /
or requirements of
the competency.
Has identified
weakness in
areas of
knowledge, skills,
attitudes, or
clinical judgment.
Requires
education and/or
orientation to
meet the
expectations and /
or requirements of
the competency.
5
Not Applicable
Not applicable to
current role and
responsibility.
A: Nursing Knowledge
Year
2015
Year
20__
Year
20__
Year
20__
Year
20__
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
A-1
A-2
A-3
A-4-4
A-5-9
A-6
A-7
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2nd Edition - Revised October 2008
Year
2015
Competency
Number
A-8-2
B: Nursing Process
Rating
(1-5)
B-2-2
B-2-3
B-3
B-3-2
B-4
Year
20__
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
C-1 to
C-4
C-5-1
C-6-1
C-7-1
C-12
1
Rating
(1-5)
D-1
D-2
D-3
D-3-7
Year
20__
Rating
(1-5)
Year
20__
B-1
C: Safety
Year
20__
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2nd Edition - Revised October 2008
Year
2015
Competency
Number
D-4
D-5
D-7
D-8-1
D-8-2
W: Professionalism
Rating
(1-5)
W-1-3
W-2-3
W-3
W-4
W-4-5
W-5-1
W-6
W-7
W-9
W-9-4
W-11
Rating
(1-5)
X-1-5
X-3-5
Year
20__
Year
20__
Year
20__
Year
20__
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Page 5
2nd Edition - Revised October 2008
Year
2015
Competency
Number
X-4
X-7-1
X-7-3
X-7-4
Year
20__
Year
20__
Year
20__
Year
20__
SELF-ASSESSMENT SUMMARY
Year
Competency
Number
Describe the competency areas you want to improve or develop. List all items rated 2
(Competent), 3 (Requires Improvement), 4 (Developmental) in Step 1.
2015
Nursing Knowledge
A-2
A-3
A-4-4
A-6
A-7
A-8-2
B
2015
B-2-2
B-2-3
B-3
B-3-2
B-4
C
2015
Safety
C-1 to
C-4
C-7-1
D
2015
Nursing Process
D-1
D-2
D-3
D-3-7
D-5
D-7
W
Self-Assessment Tool CCP
College of LPNs of Alberta
Professionalism
Page 6
2nd Edition - Revised October 2008
2015
W-1-3
W-2-3
W-3
W-9
W-9-4
W-11
2015
X-1-5
X-3-5
Competency
Number
L-3-2
2015
G-2-4
20___
Rating
(1-5)
20___
Page 7
2nd Edition - Revised October 2008
Your Learning Plan must consist of at least TWO objectives for each year. You are required to fill out
all FOUR columns for each objective. Transfer your Learning Plan onto your Annual CLPNA
Registration Renewal Form. Please refer to the Guidelines at www.clpna.com for more information.
YEAR 2015
Learning Objectives
Target Date
Evaluation
(Realistic time
frame for
achievement)
March 25,
2015
Page 8
2nd Edition - Revised October 2008
Professional Activity
(include course,
seminar, research,
hours, details)
Summary of Learning
May 4-28,
2015
October 26
November
20, 2015
Medicine Clinical
145hrs
November
23December
18, 2015
Surgery Clinical
145hrs
February 12,
2015
CPR course
October
2014
Page 9
2nd Edition - Revised October 2008