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Evaluations Clinical Evaluation Tool Revised June 2017
Evaluations NUR4467L STJ SBN S18 (3/21/2018)
Experience Lai, Hannah (hjlai@health.usf.edu)

Change password Evaluator: Ringewald, Lisa (lringewald@health.usf.edu)

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5-Outstanding: Exceeds Standards
Exhibits above average performance of nursing care for this level student. The
student is proactive, self-directed, and consistently engaged in learning; needs
minimal guidance; is knowledgeable; and appropriately incorporates knowledge with
skills. Student is proactive and self-directed in approach to learning.

4-Satisfactory: Meets Standards

Exhibits average performance of nursing care for this level student. Functions with
minimum guidance. Demonstrates adequate knowledge and requires minimum
assistance in applying knowledge to skills. Recognizes learning opportunities but may
require assistance in utilizing them.

3-Minimal (Consider Level 3 Violation)

Exhibits minimal performance of nursing care for this level student. Functions safely
with moderate guidance. Demonstrates minimal knowledge and requires moderate
assistance in applying knowledge to skills. Requires some direction in recognizing
and utilizing learning opportunities. Often focuses on the task or own behavior, not on
the patient.

2-Unsatisfactory (Consider Level 2 Violation)

Requires intense guidance for the performance of activities at a safe level. Clinical
performance reflects difficulty in the provision of nursing care. Demonstrates gaps in
necessary knowledge and requires frequent or almost constant assistance in
applying knowledge to skills. Requires frequent and detailed instructions regarding
learning opportunities. Focuses primarily on the task or own behavior, not on the
patient.

1-Unsafe to Practice (Consider Level 1 Violation)

Is unsafe to practice without constant, intense guidance. Frequently lacks necessary
knowledge and skills and unable to integrate these into practice. Requires constant
detailed instructions regarding learning opportunities and is often unable to utilize
them. Attempts activity or behavior, yet is unable to complete. Focuses entirely on the
task or own behavior, not the patient.

Standard 1: Patient-Centered Care

1. Performs a comprehensive assessment including patient values,
preferences, and needs.
2. Develops an individualized plan of care with a focus on the nursing process.
3. Provides care with sensitivity and respect for the diversity of the human
experience.
4. Delivers care based on knowledge of pathophysiology and
pharmacotherapy.
5. Identifies potential barriers to active involvement of patients in their own
health care process.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
 3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
Hannah has an outstanding understanding of pathophysiology and 
implements patient care very effectively based on her strong
knowledge and understanding of the patients' conditions,
preferences, and needs. She has an understated approach which
facilitates comfort on the part of the patient, family, and team 
members. She has an insightful nature which helps her deliver
Standard 2: Teamwork and Collaboration
1. Demonstrates awareness of own strengths and limitations as a team
member.
2. Initiates requests for help from other team members as appropriate.
3. Communicates effectively with patients, family members, and other
members of the healthcare team.
4. Identifies potential complications related to handoffs or transitions of care.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
Hannah has a uniquely strong understanding of how to work
effectively as part of a team. Her innate ability to understand
the dynamics of a group, as well as her own strengths and
limitations, make her a very effective patient advocate and member
of the healthcare team.

Standard 3: Evidence-Based Practice and Quality Improvement

1. Utilizes evidence-based literature to support clinical decision making as
demonstrated in written clinical assignments.
2. Differentiates clinical opinion from evidence-based practice to determine
best clinical practice.
3. Promotes and practices quality, cost-effective delivery of care.
4. Identifies potential areas for quality improvement in the clinical setting.
5. Participates in measures to improve patient outcomes as appropriate.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice

Standard 4: Safety
1. Identifies strategies to reduce the risk of harm or poor patient outcomes in
the delivery of care.
2. Delivers medication (as appropriate) in a timely and safe manner including
understanding the specific indications for the medication and potential side
effects.
3. Communicates effectively between team members or to clinical faculty when
giving patient report.
4. Uses appropriate resources to improve organization and/or time
management.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice

Standard 5: Informatics
1. Navigates the electronic health record where appropriate.
2. Documents clearly, concisely, and accurately in the electronic medical
record where appropriate.
3. Protects confidentiality of all protected health information.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice

Standard 6: Professionalism
1. Demonstrates core professional values (caring, altruism, autonomy,
integrity, human dignity, and social justice).
2. Maintains professional behavior and appearance.
3. Demonstrates expected behaviors and completes tasks in a timely manner.
4. Engages in self-evaluation and assumes responsibility for learning.
5. Arrives to clinical setting on time.
6. Demonstrates evidence of preparation for clinical learning experiences.
7. Maintains a positive attitude while interacting with patients, family members,
faculty, peers, or members of the healthcare team.
8. Accepts individual responsibility for actions.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice
 Hannah is extraordinarily altruistic and has deep respect for human
dignity and social justice. She clearly demonstrated this on
multiple occasions as we discussed various patients in post-
conference. She is not afraid to advocate for her patients which
will serve future patients very well.

Levels of Practice Violations

Level 3 Violation
• Potential for unsafe practice
• Typically a single event or occurrence that presents minimal risk for patient
harm
• Examples include but are not limited to being unprepared for clinical or a
perceived disrespectful attitude.
• Intervention: Interaction with clinical instructor. Complete student contact
form. Notify course coordinator.
Level 2 Violation
• Evidence of unsafe practice
• Pattern of behavior
• Examples include but are not limited to pattern of being unprepared for
clinical, unable to organize patient report, continued inability to describe
indications for medications or interventions
• Intervention: Meet with clinical instructor. Notify course coordinator and
program director. Academic Jeopardy Form with clear plan for resolution of
concerning behavior.
Level 1 Violation
• Unsafe practice with unacceptable risk for harm
• Examples include but are not limited to dishonesty, failure to change
behaviors in response to feedback, physical or mental impairment
(intoxication or lack of sleep), violent behavior, breach of confidentiality,
extreme anxiety, angry or unprofessional outburst.
• Intervention: Immediate removal from all clinical, lab, and simulation
activities. Notify course coordinator and program director.
Hannah displayed no evidence of unsafe practice during this
clinical.

Comments:
Outstanding work Hannah

Hannah Lai has reviewed the above evaluation on 3/28/2018 and has provided
the following comment:
Thank you very much for all your comments and feedback throughout this
semester!

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