PERFORMANCE APPRAISAL FOR
REGISTERED NURSE
Employee Name:
Date:
Evaluator's Name:
Title:
For each area of performance evaluate the level of achievement demonstrated
during the past year.
AREAS OF PERFORMANCE
Autonomy and Accountability
Patient Care Management
Professionalism
LEVEL OF ACHIEVEMENT
5 - Outstanding
4 - Highly Effective
3 - Effective
2 - Improvement Needed
1 - Unacceptable
NA- Not Applicable
Areas of Performance
Level of Achievement
A. Autonomy and Accountability
1. Functions within legal framework
of the Nurse Practice Act of the state
currently employed
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2. Performs work assignment with minimum
need for supervision and guidance.
3. Demonstrates reliability in meeting
deadlines and completing
responsibilities.
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4. Possesses skills and technical
competence to execute work
responsibilities.
-------------5. Demonstrates responsibility and
reliability in meeting scheduled
Areas of Performance
---------------
Level of Achievement
6. Operates within the established
company guidelines
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7. Complies with hospital policies
and procedures.
----------------
8. Assists with training/education of
staff, contributes to an open learning
environment.
----------------
9. Displays ability to utilize appropriate
channel(s) for communication and/or
problem solving.
---------------
10. Adheres to Hospital and Company
health and safety standards.
-----------------
B. Patient Care Management
1. Utilizes established Nursing
Department Standards in the
delivery of patient care.
-----------------
2. Utilizes clinical knowledge and skills
to assess the needs of assigned
patients.
-----------------
3. Completes and documents initial and
ongoing assessments as per policy.
Written communication is clear, legible
and objective.
-----------------
4. Prioritizes care based on medical and
nursing diagnosis, nursing history, DRG
and expected patient outcomes.
----------------
5. Demonstrates ability to set goals, assign
priorities, anticipate problems, establish
limits and achieve quality results.
-----------------
6. Completes tasks with timeliness,
schedules and uses time efficiently.
-----------------
7. Develops comprehensive plan of care
from admission to discharge for
assigned patients based on patient
needs, standards of care, DRG and
expected patient outcomes.
-----------------
Areas of Performance
8. Functions as a patient advocate
assuring patient's right to information,
providing patient safety at all times, and
Level of Achievement
--------------------
maintaining confidentiality.
C. Professionalism
1. Promotes good public relations for
CCMS and Hospital.
2. Communicates accurately/appropriately
with patients, family and other personnel.
Establishes and maintains therapeutic
and supportive relationship.
---------------------
-----------------------
3. Adheres to Company/Hospital dress
code policy.
---------------------
4. Reports to work in a timely manner.
------------------------
5. Effectively expresses self. Listens
attentively and creates a climate of open
communication. Respects confidentiality
and privacy.
6. Accepts constructive comments from
hospital/contracting company as a
mechanism for improvement.
7. Maintains credentials and education
files as per JCAHO standards and
Department of Health Regulations.
8. Functions as an integral part of the
health care delivery team and participates
in the maintenance of a cohesive work
environment.
Signature of Clinical Nurse
Date
__________
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Signature of Branch/ Nurse
Manager : --------------------------- Date:
Signature of Division Officer/Designee:----------------------------Date
COMMENTS: Areas of performance marked Level 1 or Level 2 must be
accompanied by comments.
