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Complete nursing evaluation 

G:\Compensation\Performance Evaluations\Blank Self Evaluation BH 2008-7-22 draft.doc

8/22/2023

Evaluation

Employee Name:

Employee ID Number:

DEVELOPMENT/ TRAINING REQUESTS :

EVALUATION AREA

MAJOR ACCOMPLISHMENT:

Provide a summary of accomplishments which demonstrate your level of achievement above & beyond your job requirements for each evaluation area.

  1. Exceptional Servic e
  2. Collaborative Team
  3. Accountability for Positive Outcomes
  4. Fostering Innovation
  5. Valuing Employee Family
  6. ASSESSMENT, PLANNING, INTERVENTION AND EDUCATION: Assesses each patient in accordance with established org and dept standards & formulates an individualized plan of care in collaboration w/ interdisciplinary team.
  7. PATIENT SAFETY: Proactively assures safe practice, reports safety concerns and complies with all national and organizational patient safety and environment of care safety standards.
  8. DELIVERY OF CARE AND EVALUATION: Delivers care in accordance with the nurse practice act and organizational policies and procedures.
  9. DEMONSTRATES THE PROFESSIONAL ROLE OF THE REGISTERED NURSE: Represents the department on committees, work groups, and as a part of daily practice.
  10. MEDICATION ADMINISTRATION: Accountable for safe and standard practice medication administration.

Employee Name:

Employee ID Number: