Appendix F - Nurse Manager Evaluation of Clinical Experience/Rotation. Nursing Division

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1 Appendix F - Nurse Manager Evaluation of Clinical Experience/Rotation Nursing Division Directions. This evaluation form is to be completed by the faculty member and Nurse Manager/Assistant Head Nurse at a joint conference. The faculty member will provide the program s department chair/course lead instructor and the Director of Student Programs with a completed copy of the evaluation. Please respond to the following questions. A no response should be followed with an explanation. Thank-you. 1. Before the clinical rotation began, did the faculty member and Nurse Manager/Clinical Shift Manager review policies, expectations, and clinical outcomes? 2. Was the faculty member competent to perform expected unit-specific clinical skills? 3. Were students introduced to the Nurse Manager/ Clinical Shift Manager and were specific recommendations/ expectations shared? 4. Were assignments planned with the Nurse Manager/ Clinical Shift Manager? Were assignments posted in advance? 5. Were any issues encountered with planning and implementing assignments? 6. Were periodic conferences held between the faculty member and Nurse Manager/ Clinical Shift Manager to identify concerns and review expectations regarding the staff and/or students? 7. Were staff and nursing students professional and courteous? 8. Was faculty member on unit at all times to monitor students, when doing new procedures, giving medications, etc.? 9. Were team leaders kept informed of patient changes and was pertinent data reported before students left unit? 10. Did nursing students give all medications correctly? 11. Did nursing students correctly document pertinent information? 12. Were on-unit classes made available to students and/or faculty members? Yes No NA Revised , , , , , , , , , Page 29 of 31 Created by Novant Health Corporate Education and Training in collaboration with Forsyth Medical Center Department of Nursing Revised in collaboration of the Manager of Patient and Staff Education & CNO of Thomasville Medical Center

2 Nurse Manager s/ Clinical Shift Manager summary of rotation: Faculty member s summary of rotation: Revised , , , , , , , , , Page 30 of 31 Created by Novant Health Corporate Education and Training in collaboration with Forsyth Medical Center Department of Nursing Revised in collaboration of the Manager of Patient and Staff Education & CNO of Thomasville Medical Center

3 Educational Institution Faculty Evaluation of Clinical Experience/Rotation Directions. This evaluation form is to be completed Educational Institution Faculty. Please respond to the following questions. A no response should be followed with an explanation. Thank-you. Before the clinical rotation began, did the faculty member and Manager/Supervisor/Preceptor review policies, expectations, and clinical outcomes? Yes No NA 1. Were students introduced to the Manager/Supervisor/Preceptor and were specific recommendations/ expectations shared? 2. Were assignments planned with the Manager/Supervisor/Preceptor? 3. Were assignments posted in advance? 4. Were any issues encountered with planning and implementing assignments? 5. Were periodic conferences held between the faculty member and Manager/Supervisor/Preceptor to identify concerns and review expectations regarding the students? 6. Were team members professional and courteous to faculty and students? 7. Were the team members supportive in helping identifying opportunities for students to perform expected unit-specific clinical skills? 8. Were team leaders kept informed of patient changes and were pertinent data reported before students left unit? (Please share any areas where we did well as well as any areas where we could improve. Please elaborate on any disagree or strongly disagree responses on the back of this sheet. Facility: Date: Educational Institution/Program / Signature (opt): Please send completed forms to: Glenda Livengood Director of Student Programs Fax: studentprograms@novanthealth.org Additional Comments should be entered on the following page:

4 Educational Institution summary of rotation and comments: Faculty member s summary of rotation: Reviewed by Director of Student Programs.

5 Student Clinical Experience/Rotation Evaluation Guidelines. This evaluation form is to be completed by the nursing student. Please forward completed evaluations to the Director of Student Programs via interoffice mail (the unit staff will be happy to show you where you can place the mail for interoffice mail distribution). Please respond to the following statements by placing a check ( ) in the appropriate box. For disagree and strongly disagree responses, please add comments to the end or back of this form. We thank-you in advance for sharing your feedback with us. This will help us make improvements to your clinical experiences. Strongly Agree Agree Disagree Strongly Disagree NA A. Student Orientation 1. The clinical orientation process was informative and helpful. 2. I was introduced to unit staff and specific recommendations/expectations were shared with me. B. Staff Role Modeling (if not marked Strongly Agree, please state why on the back of this form). 1. Staff members were professional. 2. Staff members were friendly, warm, open and courteous. 3. Staff members were helpful in identifying learning experiences. 4. Staff members demonstrated respect for the patients and their rights. 5. Staff members were committed to giving high quality patient care. 6. I was actively involved with the primary team member and other team members when implementing my patient s plan of care. 7. I discussed my patient s progress with the primary team members prior to leaving. C. Environment 1. The unit setting was pleasant and a comfortable place to work. 2. I would recommend this organization as a great place to work. 3. Conference space was available. D. Resources 1. Supplies were available to meet clinical objectives. 2. Up-to-date unit specific policies and procedures intranet access were available. 3. Treatment/practice standards were up-to-date and relevant to my patient(s). 4. Current reference materials (journals, texts, PDR, etc.) were available. Student s summary of rotation (Please share any areas where we did well as well as any areas where we could improve. Please elaborate on any disagree or strongly disagree responses on the back of this sheet. Facility: Unit(s) School/Program Signature (opt): Date: Please forward completed forms to: studentprograms@novanthealth.org

IN-TRAINING ASSESSMENT REPORT (ITAR)

IN-TRAINING ASSESSMENT REPORT (ITAR) Trainee Name: Rotation: Neonatology Trainee Level: Start Date: End Date: Block(s): Goals & Objectives: Considering the present level of training and, on review of training milestones, assess the resident