2014 Performance Evaluation

CreaLed by Shalene 8arrera and !amle Le-Lazar-lease emall correcuons Lo shalene.barrera[uchealLh.org

26008
18717
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
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5
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10
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14
15
16
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
17
18
19
20
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
Manager Comments: Pam exceeded this section, with above
required CE's and obtaining her OCN
Role Model
Commitment to UCH Learning Environment: Demonstrates commitment to service/unit learning
environment by attending required training, staff meetings at 75%, and completing competencies on time
and with positive team attitude. Participates in educational activities offered on service (example: short
CEs). When practice/product changes occur, demonstrates positive response and completes training as
required promptly.
Ethics role: Calls for ethics consults as needed. Advocates for patient and family with team as
appropriate. Acts in an ethical manner with peers and patients. Advocates for equitable healthcare
(Providing culturally sensitive care.)
Employee Comments: I feel that I am a Role Model in this area. I
have over 35 Ces this year and have obtained my OCN! I attend all
staff meetings and have recently created a CNA/ACP council for our
unit. I also have revised and submitted a new Policy for our
BMT/Heme population that was approved by all stakeholders this
year. I started the Policy from scratch and have successfully had it
approved! I feel that I have a strong commitment to the profession
and the culture at UCH as evidenced by my work towards
credentialing to a RN III. PEER: "Pam has recently become a
permanent charge nurse which demonstrates professional growth
and commitment to serving the unit. She is readily accepting of
Evaluation
Evaluates patient changes in condition and modifies plan of care appropriately. Informs and partners
with family as changes occur in plan of care. Communicates with team consistently and clearly as plan
changes, documenting accurately in timely way.
Evaluates patient and family satisfaction daily, making adjustments for improvement. Communicates
across departments as partner to assure patient and family needs and preferences are addressed
across disciplines.
Commitment to Profession/Community: Learns about professional organizations and nursing issues.
Verbalizes why UCH is a magnet hospital and ways to personally contribute to our professional work
environment.
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TRANSFORMATIONAL LEADERSHIP (20%) COMMENTS
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STRUCTURAL EMPOWERMENT (10%) COMMENTS
Professional Development demonstrated by attending CE relevant to clinical area (10/yr). Meets
professional goals from the previous year. Identifies 2 professional goals for next fiscal year.
Nurse practice reflects clinical quality, knowledge/skills, and standards. Minimum 4 record reviews and peer review to document job competency. Care results in optimal patient clinical outcomes.
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EXEMPLARY PROFESSIONAL PRACTICE (10%) COMMENTS
Assessment Role Model Employee Comments: I feel my assessment skills for patients have
become very focused over the past few years. I am able to do
thorough and complete assessments on my patient specific to our
ONC/BMT population. I feel comfortable and confident working with
interdisciplinary teams and UCH and try to always keep patients and
patient family members well informed on their cares. I feel it is
always important to close the loop with patients and their
concerns/questions and follow up accordingly. PEER: "I have worked
with Pam on multiple occasions and witnessed her use her clinical
judgment and experience to address concerns or changing
conditions. I see her constantly advocating for her patients and
creating a positive plan of care with the providers and patients. She
complies with current practice standards and is able to communicate
with families, patients and care team members in a professional
manner. She anticipates needs and potential roadblocks to care and
addresses them quickly to avoid delays in care. She is efficient,
thorough, dedicated and untimately a role model for other RN's. "
Plan constructed from admit to discharge or episode of care, with goals clearly defined.
Plan addresses transitions in care and discharge from one level to another within UCH system or
externally. Placement and progress is identified, communicated, documented clearly. Pt/family is active
participant.
Considers the economic impact of the plan on the patient, family, caregivers, or other affected
parties.
Assessment/intake screening collects data in a systematic and ongoing process. Consistently
completes this using appropriate evidence-based assessment techniques, instruments and tools,
recognizes abnormal, pertinent findings. Initiates referrals/consults to interdisciplinary team promptly.
Assesses patient and family psychosocial, spiritual, emotional, age specific and diversity needs.
Documents and communicates to team assessment results across shifts/episodes of care.
Reassessments recognize potential safety issues. Pain, fall prevention, and changes in patient
condition are reassessed per standards or more frequently to prevent complications. Differentiates
symptoms and changes in condition using critical thinking, reporting to team using SBAR methods.
Plan
Plan of care is developed with interdisciplinary team, based on medical plan and pt/family input.
Individualized plan that considers patient characteristics or situation. Recognizes the patient as the
authority on his or her own health by honoring their care preferences.
Complies with professional practice standards. (e.g., unit specific practice standards)
Implementation
Implements care within policies, procedures and guidelines, integrating data from the team care plan.
Care demonstrates competent clinical skills, using critical thinking and nursing judgment in a safe and
timely manner.
Manager Comments: Pam is an amazing asset to the unit. I have
seen Pam grow tremendously as a leader the last couple of years
and she was promoted to permanent charge nurse this year. Her
calm demeanor nad expert knowledge has shone this year through
all the change and transition. Her peers veiw her as an expert and
she often precepts new graduates sharing her knowledge through
skilled teaching abilities.
Implementation reflects sensitivity to patients comfort, satisfaction, and safety. Recognizes changes in
patient condition. Uses resources and chain of command to prevent adverse events. Care is prioritized
and delegated appropriately. Uses evidence and nurse sensitive indicator data to improve care
interventions.
Safe care delivery shows accurate medication administration using 6 rights and correct use of patient
equipment. Teaches others and models these standards. Documentation is consistently meeting
standards, with no omissions of care.
Communication demonstrates teamwork, safe, accurate handoffs, attention to detail & competent
computer skills.
Patient/ family teaching is complete, including health promotion and discharge instructions to prevent
re-hospitalization. Incorporates core measures targets into teaching. Family included in discharge
planning, instruction.
Employee: Pam Heinke Employee ID:
Evaluator: Jen Zwink Evaluator ID:
Date: 6/30/14
Level II Permanent Charge Registered Nurse Performance Appraisal

2014 Performance Evaluation
CreaLed by Shalene 8arrera and !amle Le-Lazar-lease emall correcuons Lo shalene.barrera[uchealLh.org
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Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
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Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
*I seek to understand and improve core measures, quality metrics, best practices, patient satisfaction
measures and employee engagement measures.
*I respect the confidentiality of patients and colleagues.
*I report concerns and take appropriate actions to eliminate patient, visitor and/or employee safety
hazards.
*I identify opportunities and solutions for service and safety improvements in my work area and assume
accountability for our success.
*I keep the facility and my work area neat, clean, presentable, uncluttered and safe.
*I will take appropriate action when public areas do not meet these standards.
Meets Expectations Employee Comments: I think that I have worked extremely hard to
increase patient satisfaction by working so diligently with the CNA
group. I have educated this group on the importance of LOOK
report, keeping their work environment clean,the 5 P's, throughput
and why this is important, cleaning out rooms on d/c, rounding with
waters during I&Os, and checking in with RNs. I frequently round on
Manager Comments: Everything Pam has stated in her own self
reflection is extremely accurate. She has worked very hard to
educate this CNA/ACP group on importance of look report, hourly
rounding and cleanliness of environment. She also created the unit
specific service excellence contract for the CNA/ACP group.
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Holds staff accountable for safe patient care; is accountable for regulatory compliance. Promotes
Patient Family Centered Care.
Delivers Safe Patient Care w/Team: Uses time constructively to deliver patient care, supports the team.
Consistently flexible with schedule, assignment. Identifies conflict/problems and participates in
resolution. Participates in multidisciplinary rounds, conferences for patient assignment; may act as a
relief charge.
Delegates appropriately per state board nursing R&R. Promotes positive team relations and
communication.
Performance review process participation constructive: open to receiving feedback from peers, patient,
and family. Acts to improve performance. Participates in surveys, patient satisfaction initiatives w/ team,
and unit plans for improvement. Models leadership skills w/ peers, patient care.
Professional Actions: manages conflict constructively and competently, with peers, colleagues and
other disciplines. Acts as a preceptor, with positive responses to assignments responsible actions in role.
Demonstrates a work environment that promotes cooperation, respect and trust.
Attends rounds w/ MDs, others on team. Proactively solves problems.
Reviews acuities, bed control to assure optimum placement per staffing and throughput.
Assesses the practice environment for environmental and safety risks for patients and healthcare
providers. Communicates health risks, environmental hazards and provides appropriate interventions for
exposures or injuries.
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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS (10%) COMMENTS
Evidence-Based Practice/Research: Knowledgeable about Research and Evidence Based Practice
Outcomes Research manual learns how to access on unit/clinic or by Professional Resources website.
Completes annual outcomes competency. Participates in one journal club. Attend one journal club each
year.
Role Model Employee Comments: I feel that my credentialing project to become
a level III RN has allowed me to excel in this category. I have done
a lot of research with EBP practice for the Neutropenic policy that I
have been working on. I have met numerous times with Glen to
make sure that all of the information in the Policy is the most up to
date information. I have also participated in a Journal club this year.
I frequently round on patients when I'm in charge and try to help
increase our scores for pt satisfation by dealing with complaints in
Nurse/Hospital/Unit Indicators: Identifies nurse sensitive NDNQI outcomes for unit/clinic: falls, skin,
pain, other. Verbalizes areas for unit improvement and how own care could improve.
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SERVICE (10%) COMMENTS
1
*I am here to serve my customers. This means prompt, friendly and quality service.
*I promptly respond to patient requests, phone calls and customer needs.
*I communicate in a respectful and professional manner.
Non-verbal communication is as important as what I say.
*I anticipate patients and others needs, working to prevent problems and remove barriers.
*I communicate frequently about how long a patient, visitor or colleague may expect to wait. I provide
regular updates.
*I walk guests to their location and seek out those that look lost.
Role Model Employee Comments: If I see a call light ringing, then I will go into
the patient room to address the problem. I always use my 5 Ps
when rounding to make sure that they are safe and pts needs are
met. I also will round on pts and ask what we are doing well and
things that we could work on. If there is some constructive critism by
the pt, then I will address this with the RN during that shift to make
Manager Comments: Pam has been a true role model for service
excellence, she has mentored new staff and new graduates to be
meticulous with their hourly rounding and ensure they are utilizing
the 5 P's, she also is excellent at communicating pain control options
to indidviduals. Pam's patients adore her and she always gives
them superb care.
Unit Specific Performance Metric: Percent of patients who rate us a 9 or 10 overall Hospital Goal =76%
Overall Pain Management Score- Hospital Goal=74.3% Overal Responsiveness Score- Hospital
Goal=67.1%
QUALITY (10%) COMMENTS
1
Process Improvement: Verbalizes knowledge of FOCUSPDCA and knows unit projects. Oriented to
Little Gold Book, Doing the Right Thing Right. May participate in collecting project data.
Manager Comments: Her revision to the neutropenic policy is
impressive and absolutely crucial to this fragile patient popluation.
This is certainly a common population we treat and it is extremely
important that the staff have the latest info at their fingertips to care
for this very sick population.
Regulatory Standards: Competent in environment of care and unit/department requirements for safety
(temperatures, code cart, mock codes, fire drills, disaster plan). Completes regulatory testing within time
requirements.
Resource Utilization: Assists the healthcare consumer and family in identifying and securing
appropriate services to address needs across the healthcare continuum.
Holds staff accountable for Critical Success standards. Keeps a positive attitude and maintains
effective communication.
Ensures adequate staffing for unit. Reports tardiness, other staff behaviors to manager. Manages
daily flow and function smoothly.
Manager Comments: Pam took on a significant level III project, she
has established a CAN/ACP unit council. With the growing size of
the unit and number constant ACP hires her work with this group has
been tremendous. Many times staff meetings are very RN focused
and this council has allowed the unit to focus on them. She has
completed a significant amount of education with this group, worked
very hard to create an environment of recognition for them and
engage them as part of the team and unit culture. As the manaer I
have been wowed by her work with this group. She soon will also be
taking over the scheduling process for this group which will further
yet enhance their satisfaction. Pam has also completed many yearly
evaluations, she has been well prepared, thorough and made
significant effort to encourage and provide excellent feedback to
staff. I have also witnessed her being an active mentor with new
graduates and those staff assigned under her.
Employee Comments: Throughout this year I feel that I have done a
tremendous amount of work developing a CNA/ACP Council for our
unit. I feel that I lead this group by being their advocate making me
a role model. I have helped to make them more engaged by
providing meetings for them, using Sharepoint to get information to
them, and by recognizing them (CNA party in June for recognition,
organized with Mandy). I have taken CEs to help develop my
professional actions including a preceptor classes and leadership
classes. I proactively seek out MDs to round with them or call them
daily to find out the plan of care with my patients. PEER:" Pam is
currently serving in a leadership role as a permanent charge nurse
and as a leader for the CNA/ACP team members. Her work with the
CNA group has increased communication, education and teamwork
among this staff. These efforts serve to improve the quality of care
provided on the unit. Pam is thoughtful and deliberate in her actions
to educate others and resolve concerns. She has been an
enthusiastic and influential preceptor, taking pride in educating and
guiding new staff members. She offers help when able and
delegates appropriately when necessary."
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Definition: Leads group of Patients. Develops ownership of our unit.
Shows growth as a leader.
Leads teams related to patients assigned: CNA, MD team members, by rounding, initiating Pt/Family
conferences.
May participate on unit council/committee
Role Model
Becomes integrated as a member of the unit/clinic leadership team. Supports GN Residents.

2014 Performance Evaluation
CreaLed by Shalene 8arrera and !amle Le-Lazar-lease emall correcuons Lo shalene.barrera[uchealLh.org
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
Unsatisfactory
Growth
Opportunity
Meets
Expectations
Role
Model
2
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COMMUNICATION (10%) COMMENTS
1
*I maintain a positive image and follow the UCHealth dress code. I wear my badge so it is easily read by
patients, visitors and colleagues. Any time I am in uniform or have my badge on, I represent UCHealth in
a positive light.
*I show respect to all members of the UCHealth team: volunteers, employees, managers, medical staff,
students and others.
*Before I speak, I consider who might be listening and what is appropriate in that situation.
*I keep current on organizational information.
Role Model Employee Comments: I check my email daily and frequently. I am
speedy with my responses and feedback. I am also on Sharepoint
daily as this is where I share a lot of information with the CNAs. I try
to always maintain a positive attitude and uplift others. I try to
encourage my peers to excel and to acheive above what is expected
of them. PEER: "Pam meets/exceeds all of the communication
standards. She represents UCH in a positive manner. She is current
and communicative regarding organizational updates"
Manager Comments: Her communication style is personalized,
positive and energectic. In addition she has communicated
consistenly and thoroughly with the CAN/ACP group, via e-mail,
sharepoint, meetings and face to face.
Unit Specific Performance Metric: Expectation is to minimally check E-mail and Sharepoint 3 times per
week.
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PERSONAL (10%) COMMENTS
1
*I seek to understand and improve core measures, quality metrics, best practices, patient satisfaction
measures and employee engagement measures.
*I respect the confidentiality of patients and colleagues.
*I report concerns and take appropriate actions to eliminate patient, visitor and/or employee safety
hazards.
*I identify opportunities and solutions for service and safety improvements in my work area and assume
accountability for our success.
*I keep the facility and my work area neat, clean, presentable, uncluttered and safe.
*I will take appropriate action when public areas do not meet these standards.
Role Model Employee Comments: I feel that I always strive to improve core
measures and patient satisfaction. I work very hard to engage
employees in their current practice. I am an advocate for CNAs and
feel that I'm approachable. I have my OCN and ACLS, both of which
are not required on our unit. I try to get my peers to obtain these
certifications to have our entire unit practice at above average
standards. PEER: "Pam consistently expresses gratitude and
courtesy to others. She is ethical, reliable and responsible. She has
Manager Comments: Pam has sought out the next level of expertise
by obtaining her OCN and ACLS, she is truly an expert for the unit.
Unit Specific Performance Metric:Unit Goal Oncology Certification for eligible RN's to be at 65%. Attend
Oncology M&M rounds 2 times per fiscal year.
Meets Expectations
Manager Comments: Everything Pam has stated in her own self
reflection is extremely accurate. She has worked very hard to
educate this CNA/ACP group on importance of look report, hourly
rounding and cleanliness of environment. She also created the unit
specific service excellence contract for the CNA/ACP group.
Unit Specific Performance Metric: Meet Current Hospital Wide Benchmark for CLABSI. Meet hospital
goal of 90% of accurate documentation for critical test results. Meet Fall Benchmark of 2.79/1000
patient days. I will consistently utilize the discharge lounge for patients.
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CTEAM (10%) COMMENTS
1
*I listen to understand and respond in a compassionate manner.
*I encourage my colleagues and offer words of praise for excellent work.
*I partner with my colleagues to manage the workflow of my team and willingly pitch in to help others.
*I help new or less experienced colleagues feel welcome.
*I thank others for their time and efforts.
Role Model Employee Comments: I feel that I always thank my co-workers for
their time. I have tried to make the CNA group feel more
appreciated by sending out thank you emails to staff about great
service, giftcards, a recognition party, being their unit leader, and
making them feel welcome. I think I have done a lot for this group
and promoting a well rounded team. PEER: "Pam has always been Manager Comments: She has worked extremely hard to incorporate
CAN/ACP has part of the team, the feedback from this group has
been overwhelming positive toward the changes she has
implemented.
Unit Specific Performance Metric: 100% Compliance with LOOK Report and Shift Huddles

2014 Performance Evaluation
CreaLed by Shalene 8arrera and !amle Le-Lazar-lease emall correcuons Lo shalene.barrera[uchealLh.org
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3
Target
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FY15 Performance reviews
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FY15 Performance reviews
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FY15 Performance reviews
Overall Score UEXCEL Score Individual Performance Goal
Goals
for
FY14
List your FY2014 Goals (last year) Comments
Goals
for
FY15
Specific: List specifically what
goals you will accomplish.
Measurement: How will you
and your evaluator know the
goals are completed?
Realistic: What support or resources
do you need to accomplish the goals?
Timeline: Dates the goals will
be completed.
Below Threshold Threshold Target Max
Individual Performance Goal Rating
Strategic: What strategic
objective do your goals
support?
Attainable: Can the goals be completed
within the next year?
Falls: unit goal of being <3.17 patient falls per thousand patient
days each month
Growth Opportunity
While our Fall rates are below the unit goal, I think we continue to
work on ways to prevent patient falls. The new chair alarms overhead
should help to decrease our falls, hourly rounding, and educating staff
on the importance of frequent Fall checks.
Credential to Level III RN
Meets Expectations
Hopefully I will be done in the next few months!
Role Model 3.90 Target
Growth Complete my Level III project and
consider a Level IV project BMT
Certifidcation
Successful completion of
portfolio.
Yes
A mentor, time, and strength
Quality and Patient
Expericnce
Critically think through each
patients individual fall risk score
each shift and as needed
throughout the shift, guided by the
fall assessment tool. Implement
and utilize appropriate fall
interventions (bed and chair
alarm, gait belt use, correct
number of side rails, yellow
socks, assistance to the
bathroom) as needed. Educate
each patient on what
interventions are in place for their
safety and what makes them a
high fall risk utilizing the fall
teaching tool. Coordinate
purposeful hourly rounding on
your patients with your CNA/ACP,
and document rounding in real
time. Respond to all bed alarms
in an urgent manner, even when it
is not your patient. Participate in
the fall huddle when a fall does
occur on the unit. Aim for a goal
of being below the benchmark of
2.79 falls per thousand patient
days for each unit monthly Improvement in pt falls
Yes
Teamwork, communication between
staff members, and utilizing resources.
Quality and Patient
Expericnce
The Oncology/BMT units will
meet HCAHPS benchmarks as
set per hospital FY 15 goals
Improvement in HCAHP
scores
Yes
Training staff and enforcing the training
that we have been taught.
Completed?
Customer Service: Encorporate AIDET training, implement and
document on hourly rounding, increase communication with
patients, address 5 P's when doing rounding, and use
appropriate verbage to maintain consistency about expectations
of patient car
Meets Expectations
I feel that I use AIDET and implement hourly rounding. I use the
verbage that we were trained to use during our AIDET training and
also teach others how to use it.

2014 Performance Evaluation
CreaLed by Shalene 8arrera and !amle Le-Lazar-lease emall correcuons Lo shalene.barrera[uchealLh.org
Note to Evaluators: You must transfer the above three ratings into the system evaluation tool.