KYULH - Clinical Rotation Student Evaluation Question Title * 1. Student Information Name School Name Instructor Name Unit of Clinical Rotation Weekday of Clinical Rotation Time of Clinical Rotation Question Title * 2. Where your course objectives for clinical application met in the patient care setting (Please chose the best response) None where met Most were not met Some were met, some were not Most were met All were met None where met Most were not met Some were met, some were not Most were met All were met If you rated 1-3, please provide comments Question Title * 3. Were you given opportunities to implement nursing care in your daily assignments (i.e., at the bedside, participating at report or conferences, nursing rounds, patient teaching, and documentation on the chart) I had no variety of opportunities I had few variety of opportunities I had some variety of opportunities I had a fair variety of opportunities I had a wide variety of opportunities I had no variety of opportunities I had few variety of opportunities I had some variety of opportunities I had a fair variety of opportunities I had a wide variety of opportunities If you rated this 1-3, please provide comments Question Title * 4. Did you have a chance to meet and interact with any of the following? (Please check all that apply) Clinical Manager Unit Charge RN Care Coordinators/Social Workers Physical, Occupational, or Speech Therapists Pharmacists Respiratory Therapists Radiology List any other field not identified Question Title * 5. What types of patients did you most care for in your clinical rotation? (Please rank the following options) 1 2 3 4 Acuity level 1: Independent care patients who were up ad lib, took oral medications, and required minimal nursing care. 1 2 3 4 Acuity level 2: Patients who completed activities with assistance, took oral medications, some IV medications, some simple dressings. 1 2 3 4 Acuity level 3: Patients who required complete care,oral and IV medications, indwelling tubes and catheters, multiple dressings. 1 2 3 4 Acuity level 4: Patient who required complete care, NPO, Feeding tubes, Central lines, indwelling catheters, complex dressings, mostly IV medications or medications provided through a tube. Question Title * 6. Are the clinical resources at the University of Louisville Hospital adequate and appropriate for meeting your course objectives?(please circle)? Not at all Somewhat Fair To a great degree Very good Not at all Somewhat Fair To a great degree Very good If you rated this a 1-3, please provide comments Question Title * 7. Did the staff nurses reflect a role model for you to emulate? (Please choose the best response) None did Most did not Some did, some did not Most did All did None did Most did not Some did, some did not Most did All did If you rated this a 1-3, please provide comments Question Title * 8. Would you like to recognize any staff members for making your clinical rotation a positive learning experience. Question Title * 9. Please choose the best response for each of the following statements Most nursing staff exhibited this behavior Most nursing staff DID NOT exhibit this behavior The nursing staff provided good customer service The nursing staff provided good customer service Most nursing staff exhibited this behavior The nursing staff provided good customer service Most nursing staff DID NOT exhibit this behavior The nursing staff provided good organizational/prioritization skills The nursing staff provided good organizational/prioritization skills Most nursing staff exhibited this behavior The nursing staff provided good organizational/prioritization skills Most nursing staff DID NOT exhibit this behavior The nursing staff used collaboration and teamwork The nursing staff used collaboration and teamwork Most nursing staff exhibited this behavior The nursing staff used collaboration and teamwork Most nursing staff DID NOT exhibit this behavior The nursing staff displaced personal responsibility and accountability The nursing staff displaced personal responsibility and accountability Most nursing staff exhibited this behavior The nursing staff displaced personal responsibility and accountability Most nursing staff DID NOT exhibit this behavior The nursing staff provided respect for patients and staff The nursing staff provided respect for patients and staff Most nursing staff exhibited this behavior The nursing staff provided respect for patients and staff Most nursing staff DID NOT exhibit this behavior The nursing staff provided leadership qualities The nursing staff provided leadership qualities Most nursing staff exhibited this behavior The nursing staff provided leadership qualities Most nursing staff DID NOT exhibit this behavior The nursing staff were willing to provide a variety of useful clinical learning experiences The nursing staff were willing to provide a variety of useful clinical learning experiences Most nursing staff exhibited this behavior The nursing staff were willing to provide a variety of useful clinical learning experiences Most nursing staff DID NOT exhibit this behavior The nursing staff were supportive of your deliver of patient care The nursing staff were supportive of your deliver of patient care Most nursing staff exhibited this behavior The nursing staff were supportive of your deliver of patient care Most nursing staff DID NOT exhibit this behavior Please leave any comments Question Title * 10. Please provide the best experience during the clinical rotation Question Title * 11. Please provide areas/items that could improve the clinical rotation Question Title * 12. Would you consider employment at University of Louisville Hospital Yes No If no, Why? Question Title * 13. Would you like a nurse recruiter to contact you about employment and scholarship opportunities? Yes No If Yes, please remember to write name and contact information on this form. Done