Beruflich Dokumente
Kultur Dokumente
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
Assessment.
1
Excellent
2
Competent
3
Requires
Improvement
4
Developmental
5
Not Applicable
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.
Not applicable to
current role and
responsibility.
Competency
Number
Rating
(1-5)
A: Nursing Knowledge
A-1
A-2
A-3
A-4-4
Year
20
Year
20
Year
20
Year
20
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
4
3
Page 1
nd
Competency
Number
A-8-2
B-2-2
B-2-3
B-3
B-3-2
B-4
C-5-1
C-6-1
C-7-1
C-12
D-2
D-3
D-3-7
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)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
Rating
(1-5)
4
5
5
5
4
3
4
5
5
Year
20
C: Safety
C-1 to
C-4
Year
20
B: Nursing Process
B-1
Year
20 16
4
4
4
4
Competency
Number
D-4
D-5
D-7
D-8-1
D-8-2
W-2-3
W-3
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)
Rating
(1-5)
Rating
(1-5)
W-4-5
W-5-1
W-6
W-7
W-9
W-9-4
W-11
5
4
4
5
4
4
5
X-3-5
Year
20
W-4
X-1-5
Year
20
W: Professionalism
W-1-3
Year
20 16
Year
20 16
Competency
Number
X-4
X-7-1
X-7-3
X-7-4
Year
20
Year
20
Year
20
Year
20
5
5
SELF-ASSESSMENT SUMMARY
Competency
Number
Year
2016
20
Describe the competency areas you want to improve or develop. List all items rated 2
(Competent), 3 (Requires Improvement), 4 (Developmental) in Step 1.
Category:
_ M-1
20
Competency
Number
20
20
20
20
Rating
(1-5)
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 2016
Learning Objectives
1;Efficient Time
management
Evaluation
Target Date
(Realistic time
frame for
achievement)
Name:
1
2months after
commening
work
Speak to families
affected by mental
illness and offer my
knowledge and request
feedback.
CLPNA Registration #:
Professional Activity
Summary of Learning
December
2014
OctMedical and surgical care Caring for patients in an acute care setting
december for two moths (clinical)
2015
Name:
CLPNA Registration #:
Professional Activity
Summary of Learning
Name: Pn student
CLPNA Registration #: