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EMPLOYER EVALUATION-CCCTC PN Full Time 2013 GRADUATE

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* Please evaluate your satisfaction with the graduate employee from the CCCTC Practical Nursing Program:

Name of Graduate:

Job Title/Position:

Date of Employment:

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* Employee Status:

	Full Time	Part Time	Casual	Per Diem
Status:	Status: Full Time	Status: Part Time	Status: Casual	Status: Per Diem

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* PROVIDER OF CARE: APPLIES NURSING PROCESS IN CARING FOR PATIENTS.

	Excellent	Above Average	Satisfactory	Needs Improvement	Un-Satisfactory
1. Collects and records objective and subjective data.	1. Collects and records objective and subjective data. Excellent	1. Collects and records objective and subjective data. Above Average	1. Collects and records objective and subjective data. Satisfactory	1. Collects and records objective and subjective data. Needs Improvement	1. Collects and records objective and subjective data. Un-Satisfactory
2. Determines priority problems and organizes care accordingly.	2. Determines priority problems and organizes care accordingly. Excellent	2. Determines priority problems and organizes care accordingly. Above Average	2. Determines priority problems and organizes care accordingly. Satisfactory	2. Determines priority problems and organizes care accordingly. Needs Improvement	2. Determines priority problems and organizes care accordingly. Un-Satisfactory
3. Provides appropriate nursing care.	3. Provides appropriate nursing care. Excellent	3. Provides appropriate nursing care. Above Average	3. Provides appropriate nursing care. Satisfactory	3. Provides appropriate nursing care. Needs Improvement	3. Provides appropriate nursing care. Un-Satisfactory
4. Evaluates nursing care provided.	4. Evaluates nursing care provided. Excellent	4. Evaluates nursing care provided. Above Average	4. Evaluates nursing care provided. Satisfactory	4. Evaluates nursing care provided. Needs Improvement	4. Evaluates nursing care provided. Un-Satisfactory
5. Maintains safety and asepsis.	5. Maintains safety and asepsis. Excellent	5. Maintains safety and asepsis. Above Average	5. Maintains safety and asepsis. Satisfactory	5. Maintains safety and asepsis. Needs Improvement	5. Maintains safety and asepsis. Un-Satisfactory
6. Performs technical skills and administers meds safely.	6. Performs technical skills and administers meds safely. Excellent	6. Performs technical skills and administers meds safely. Above Average	6. Performs technical skills and administers meds safely. Satisfactory	6. Performs technical skills and administers meds safely. Needs Improvement	6. Performs technical skills and administers meds safely. Un-Satisfactory
7. Demonstrates critical thinking and problem solving skills in clinical practice.	7. Demonstrates critical thinking and problem solving skills in clinical practice. Excellent	7. Demonstrates critical thinking and problem solving skills in clinical practice. Above Average	7. Demonstrates critical thinking and problem solving skills in clinical practice. Satisfactory	7. Demonstrates critical thinking and problem solving skills in clinical practice. Needs Improvement	7. Demonstrates critical thinking and problem solving skills in clinical practice. Un-Satisfactory

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* COMMUNICATION: UTILIZES PRINCIPLES OF EFFECTIVE COMMUNICATION.

	Excellent	Above Average	Satisfactory	Needs Improvement	Un-Satisfactory
1. Uses appropriate verbal and nonverbal communication.	1. Uses appropriate verbal and nonverbal communication. Excellent	1. Uses appropriate verbal and nonverbal communication. Above Average	1. Uses appropriate verbal and nonverbal communication. Satisfactory	1. Uses appropriate verbal and nonverbal communication. Needs Improvement	1. Uses appropriate verbal and nonverbal communication. Un-Satisfactory
2. Responds appropriately and professionally.	2. Responds appropriately and professionally. Excellent	2. Responds appropriately and professionally. Above Average	2. Responds appropriately and professionally. Satisfactory	2. Responds appropriately and professionally. Needs Improvement	2. Responds appropriately and professionally. Un-Satisfactory
3. Uses therapeutic communications.	3. Uses therapeutic communications. Excellent	3. Uses therapeutic communications. Above Average	3. Uses therapeutic communications. Satisfactory	3. Uses therapeutic communications. Needs Improvement	3. Uses therapeutic communications. Un-Satisfactory
4. Displays caring non-judgmental attitude.	4. Displays caring non-judgmental attitude. Excellent	4. Displays caring non-judgmental attitude. Above Average	4. Displays caring non-judgmental attitude. Satisfactory	4. Displays caring non-judgmental attitude. Needs Improvement	4. Displays caring non-judgmental attitude. Un-Satisfactory
5. Informs responsible staff of patient status and reports timely.	5. Informs responsible staff of patient status and reports timely. Excellent	5. Informs responsible staff of patient status and reports timely. Above Average	5. Informs responsible staff of patient status and reports timely. Satisfactory	5. Informs responsible staff of patient status and reports timely. Needs Improvement	5. Informs responsible staff of patient status and reports timely. Un-Satisfactory
6. Informs staff of learning progress.	6. Informs staff of learning progress. Excellent	6. Informs staff of learning progress. Above Average	6. Informs staff of learning progress. Satisfactory	6. Informs staff of learning progress. Needs Improvement	6. Informs staff of learning progress. Un-Satisfactory
7. Demonstrates critical thinking and problem solving skills in written care planning.	7. Demonstrates critical thinking and problem solving skills in written care planning. Excellent	7. Demonstrates critical thinking and problem solving skills in written care planning. Above Average	7. Demonstrates critical thinking and problem solving skills in written care planning. Satisfactory	7. Demonstrates critical thinking and problem solving skills in written care planning. Needs Improvement	7. Demonstrates critical thinking and problem solving skills in written care planning. Un-Satisfactory
8. Determines clients learning needs	8. Determines clients learning needs Excellent	8. Determines clients learning needs Above Average	8. Determines clients learning needs Satisfactory	8. Determines clients learning needs Needs Improvement	8. Determines clients learning needs Un-Satisfactory
9. Teaches clients according to client needs.	9. Teaches clients according to client needs. Excellent	9. Teaches clients according to client needs. Above Average	9. Teaches clients according to client needs. Satisfactory	9. Teaches clients according to client needs. Needs Improvement	9. Teaches clients according to client needs. Un-Satisfactory

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* MANAGER OF CARE: MANAGES OWN ACTIONS AND IS ACCOUNTABLE FOR NURSING CARE.

	Excellent	Above Average	Satisfactory	Needs Improvement	Un-Satisfactory
1. Demonstrates responsibility for client assignments and provides caring interventions timely.	1. Demonstrates responsibility for client assignments and provides caring interventions timely. Excellent	1. Demonstrates responsibility for client assignments and provides caring interventions timely. Above Average	1. Demonstrates responsibility for client assignments and provides caring interventions timely. Satisfactory	1. Demonstrates responsibility for client assignments and provides caring interventions timely. Needs Improvement	1. Demonstrates responsibility for client assignments and provides caring interventions timely. Un-Satisfactory
2. Reports changes timely in client condition or needs and intervenes accordingly.	2. Reports changes timely in client condition or needs and intervenes accordingly. Excellent	2. Reports changes timely in client condition or needs and intervenes accordingly. Above Average	2. Reports changes timely in client condition or needs and intervenes accordingly. Satisfactory	2. Reports changes timely in client condition or needs and intervenes accordingly. Needs Improvement	2. Reports changes timely in client condition or needs and intervenes accordingly. Un-Satisfactory
3. Completes data collections and care including assignments within acceptable timeframe.	3. Completes data collections and care including assignments within acceptable timeframe. Excellent	3. Completes data collections and care including assignments within acceptable timeframe. Above Average	3. Completes data collections and care including assignments within acceptable timeframe. Satisfactory	3. Completes data collections and care including assignments within acceptable timeframe. Needs Improvement	3. Completes data collections and care including assignments within acceptable timeframe. Un-Satisfactory
4. Prepared for clinical experience.	4. Prepared for clinical experience. Excellent	4. Prepared for clinical experience. Above Average	4. Prepared for clinical experience. Satisfactory	4. Prepared for clinical experience. Needs Improvement	4. Prepared for clinical experience. Un-Satisfactory
5. Participation in multidisciplinary teams.	5. Participation in multidisciplinary teams. Excellent	5. Participation in multidisciplinary teams. Above Average	5. Participation in multidisciplinary teams. Satisfactory	5. Participation in multidisciplinary teams. Needs Improvement	5. Participation in multidisciplinary teams. Un-Satisfactory

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* MEMBER WITHIN THE DISCIPLINE OF NURSING: PRACTICES WITHIN ETHICAL AND LEGAL LIMITS OF NURSING PRACTICE IN PENNSYLVANIA.

	Excellent	Above Average	Satisfactory	Needs Improvement	Un-Satisfactory
1. Demonstrates responsibility for own actions.	1. Demonstrates responsibility for own actions. Excellent	1. Demonstrates responsibility for own actions. Above Average	1. Demonstrates responsibility for own actions. Satisfactory	1. Demonstrates responsibility for own actions. Needs Improvement	1. Demonstrates responsibility for own actions. Un-Satisfactory
2. Complies with state board law, regulations, CCCTC and agency policies and procedures.	2. Complies with state board law, regulations, CCCTC and agency policies and procedures. Excellent	2. Complies with state board law, regulations, CCCTC and agency policies and procedures. Above Average	2. Complies with state board law, regulations, CCCTC and agency policies and procedures. Satisfactory	2. Complies with state board law, regulations, CCCTC and agency policies and procedures. Needs Improvement	2. Complies with state board law, regulations, CCCTC and agency policies and procedures. Un-Satisfactory
3. Reports and records thoroughly, concisely and timely.	3. Reports and records thoroughly, concisely and timely. Excellent	3. Reports and records thoroughly, concisely and timely. Above Average	3. Reports and records thoroughly, concisely and timely. Satisfactory	3. Reports and records thoroughly, concisely and timely. Needs Improvement	3. Reports and records thoroughly, concisely and timely. Un-Satisfactory
4. Demonstrates ethical and caring behaviors.	4. Demonstrates ethical and caring behaviors. Excellent	4. Demonstrates ethical and caring behaviors. Above Average	4. Demonstrates ethical and caring behaviors. Satisfactory	4. Demonstrates ethical and caring behaviors. Needs Improvement	4. Demonstrates ethical and caring behaviors. Un-Satisfactory
5. Demonstrates dignity and respect of others.	5. Demonstrates dignity and respect of others. Excellent	5. Demonstrates dignity and respect of others. Above Average	5. Demonstrates dignity and respect of others. Satisfactory	5. Demonstrates dignity and respect of others. Needs Improvement	5. Demonstrates dignity and respect of others. Un-Satisfactory
6. Adheres to school and agency dress code and attendance policy.	6. Adheres to school and agency dress code and attendance policy. Excellent	6. Adheres to school and agency dress code and attendance policy. Above Average	6. Adheres to school and agency dress code and attendance policy. Satisfactory	6. Adheres to school and agency dress code and attendance policy. Needs Improvement	6. Adheres to school and agency dress code and attendance policy. Un-Satisfactory

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* Please comment on any answers that were "Needs Improvement" or Un-satisfactory".

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* Please comment on any strengths or areas of concern:

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* Please list any suggestions you may have regarding our program.

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* EMPLOYER INFORMATION

Name:

Title:

Agency:

Date: