HOSPITAL SKILLS AND COMPETENCY EVALUATION TOOL

(Head Nursing)

Name:______________________________________ Area:____________________________ Rating:________________________________

Clinical Instructor:____________________________ Hospital:_________________________ Inclusive Dates:_________________________

DIRECTION: Listed below are skills based on the eleven Key areas of Competency expected of the student head nurse. Put the level number based on the legend on the space
provided.
0 = No experience/lesser extent
1 = Needs supervision/moderate extent
2 = Competent to perform independently & safely/greatest extent
3 = Expert, able to act as resource to others/fullest extent

11 KEY AREAS CORE COMPETENCY PERFORMANCE INDICATORS EVALUATION

OF
RESPONSIBILITY Clinical Student Staff REMARKS
Instructor Nurse/Peer

A. Planning

Management of Core Competency 1 Decides in advance what is to be done in the

Resources and Organize workload to facilitate patient care unit to reach the goals effectively
Environment
2. Utilizes techniques to accomplish tasks
accordingly to priority.

Legal Responsibility Core Competency 2 3. Interpret the mission, vision, philosophy, and
Adheres to organizational policies and procedures local and objectives of the hospital to the student staff
national nurses

4. Conforms to the policies of the college and

the institution regarding the R.L.E. program

5. Understands the requirements and grading

system.

6. Orients the student staff nurses to the

physical setup and routine activities in the
Pediatric ward

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 Core Competency 1 7. Establish nursing standards, policies and
Adheres to practice in accordance with the nursing law and procedures involving patient care
other legislation including contracts, informed consent

TOTAL SCORE =

EVALUATION
11 KEY AREAS OF
CORE COMPETENCY PERFORMANCE INDICATORS
RESPONSIBILITY Clinical Student Staff REMARKS
Instructor Nurse/Peer

B. Organizing

Management of Resources Core Competency 1 1.Explains the organizational structure to the

and Environment Organize workload to facilitate patient care student staff nurses emphasizing lines of authority
and responsibility

2.Make sure that the staffing pattern and the

patient care model is observed

Ethico-Moral Core Competency 2 3.Makes sure that the work hours in the unit are
Responsibility Accepts responsibility and accountability for followed
own decisions and actions

4.Reviews job description of the student staff

nurses.

TOTAL SCORE =

C. Directing

Ethico-Moral Core Competency 2 1.Delegate to student staff nurses portion of her

Responsibility Accepts responsibility and accountability for work to be done with corresponding authority,
own decisions and actions responsibility and accountability.

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 2.Supervises the performance of attendant and
orderlies

3.Supervises all nursing activities in the ward.

4.Acts as supervising nurse when so delegated.

5.Assists the clinical instructor and student staff

nurses in their learning experience

Legal Responsibilities Core Competency 1 6.Implements hospital philosophy, objectives and

Adheres to practice in accordance with the policies to student staff nurses, patients and
nursing law and other legislation including significant others.
contracts, informed consent

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 11 KEY AREAS OF CORE COMPETENCY PERFORMANCE INDICATORS EVALUATION
RESPONSIBILITY

Clinical Student REMARKS

Instructor Staff
s Nurse/Peer

Manage of Resources and Core Competency 2 7. Supervises the maintenance of cleanliness and
Environment Maintains safe environment orderliness of the unit

Personal and Professional Core Competency 6 8.Implements student development plan to help
Development Performs function according professional students perform effectively, and to enrich their
standards. competence in practice, education, administration,
and research.

Core Competency 3 9. Participates in the orientation of other student

Gets involved in professional organizations nurses.
and civic activities

Collaborative Teamwork Core Competency 2 10. Coordinates and collaborates ward activities in
Collaborates plan of care with other members the administration of nursing care with all other
of the health team hospital services.

11. Coordinates as liaison between patient and

members of the health team.

12. Represents the unit in the nursing service

meetings and other hospital meetings when
necessary.

Core Competency 1 13.Establishes, promotes and maintains good

Establishes collaborative relationship with interpersonal relationships in the unit.
colleagues & other members with the team and
public in general

Communication Core Competency 1 14. Resolves any conflict in the unit.

Utilizes effective communication in relating
with clients, members with the team and the
public in general.

Records Manager Core Competency 1 15.Checks and evaluates documentation done by

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 Maintains accurate and updated documentation the students staff nurse
of patient care.

TOTAL SCORE =

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 EVALUATION
11 KEY AREAS OF
CORE COMPETENCY PERFORMANCE INDICATORS
RESPONSIBILITY Clinical Student Staff
REMARKS
Instructor Nurse/Peer

D. Controlling

Quality Improvement Core Competency 2 1.Pays attention to issues of patient care and nursing
Participates in nursing audits and rounds practice by listening during endorsement and
participating in the nursing rounds.

2. Evaluates performance of the student staff nurses

Safe and Quality Core Competency 11 3. Sees to it that doctors’ orders are carried out
Improvement Administers medications and other health properly and accurately by the student staff nurses
therapeutics

Core Competency 10 4.Monitors performances of nursing care against the

Evaluates progress toward expected standards through records, reports and observations
outcomes

Management of Resources Core Competency 5 5.Determines safe, clean, secure environment for
and Environment Maintain a safe and therapeutic environment patients, visitors and personnel

Core Competency 2 6.Maintains adequate facilities, equipment and

Utilizes resources to support patient care supplies necessary for quality patient care in the unit

Core Competency 6 7.Determines cost-effectiveness of supplies,

Practices stewardship in the management of equipment and other resources in the care of patient.
resources

Personal and Professional Core Competency 6 8.Guides student staff nurses on ward objectives to
Development Performs function according to professional enhance nursing knowledge and skills
standards.

Core Competency 5 9.Values the importance of action, reaction, action

Possesses positive attitude towards change synthesis (ARAS) at the end of every shift.
and criticism
10.Recognizes desired qualities of a Vincentian
nurse

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 TOTAL SCORE =

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FORMULA:

A. Clinical Instructor
Total number of scores x 100 x .60 = 60% of total grade
108
B. Students Staff Nurse/Peer
Total number of scores x 100 x .10 = 10% of final grade
108
C. Add the grades of A and B=total grade of skills competency

Comments/Suggestions/Recommendations:
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________.

Evaluated by: Conforme:

___________________________________ _____________________________________
___________________________________
Signature over Printed Name Signature over Printed Name Signature over Printed Name
(Clinical Instructor) (Student Staff Nurse/Peer) (Ratee)

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