2017 Annual Performance Appraisal (Staff Level TV & MC)

Employee Information Overall Score: 3.1 /  5.0

Appraisal Due 8/12/2017

Employee ID: 215378 Date:
    Last Appraisal
Date:

Supervisor's HURZELER,JACKIE
Employee Name: MELISSA WAITE SAMSON
Name:
Job Title: RN Department: Clinical Support

Welcome to the Performance Appraisal Process!

Click HERE to access the SLHS performance management webpage for additional support resources (toolkits,
step-by-step user guides, FAQ's, etc.).

JOB REQUIREMENTS  
 

Response
Employee has reviewed his/her current job description(s).  Yes 
Employee has read and agrees to abide by the St. Luke's Employee Handbook.  Yes 
Employee has read and agrees to abide by St. Luke's Confidentiality and Network  Yes 
Access Agreement.
Employee is aware of where St. Luke's Policies and Procedures are located.  Yes 
Employee has met the education requirements for his/her position(s).  Yes 
The licensure and/or certification requirements for the employee's position(s) are  Yes 
current.

 
 ST. LUKE'S VALUES

These descriptions are general and flexible. Competencies should be rated in a way that is appropriate for
the expectations of the job and the work environment.
*REQUIRED: Add supporting performance comments about contributions, professional strengths and/or
development opportunities.

Rating Assessment Comments:

Integrity  Successful Self: N/A
High and consistent ethical standards of self and Performer 
Supervisor: Melissa takes
others in regards to the St. Luke's Code of pride in the reputation and
Ethics/General Conduct. public perception of the
Key Performance Behaviors: organization. She follows
+ Demonstrates unwavering and superior through on promises and
professionalism. commitments to
+ Takes responsibility of his/her own actions. patients/customers & co-
+ Exhibits truthful interactions with others. workers.
+ Maintains appropriate confidentiality.
+ Owns up to mistakes and finds ways to correct them. Peers: Very professional.
On the rare occasion they
occur, Melissa always
acknowledges any errors
and never tries to hide her
mistakes. She is honest with
others and respectful of any
confidential information.

Compassion  Consistently Self: N/A

Genuine consideration and desire to help others by Exceeds
Expectations  Supervisor: Melissa
valuing individual differences. considers
Key Performance Behaviors patients/customers to be a
+ Believes and assumes the best in others. priority, and attempts to
+ Commits to be fully present in relationships with ensure that their needs and
patients, families and colleagues. expectations are met.
+ Takes time to listen and demonstrates patience even Melissa's peers rated her
when there is no extra time. consistently exceeds
+ Able to recognize when help is needed and responds expectations and exemplary
in a caring manner. performer in this category.
+ Models collaborative attitude and behavior when
interacting with others. Peers: Melissa makes the
time to help others.

Accountability  Successful Self: N/A

Accepts full responsibility for self and contributions Performer 
Supervisor: Melissa's work
as a team member of St. Luke’s. quantity in team situations
Key Performance Behaviors meets job expectations. She
+ Keeps commitments. is willing to accept
+ Assesses multiple demands and competing priorities accountability for her actions
and identifies necessary resources to handle critical and decisions. She meets
work demands. the expected attendance
+ Assumes responsibility for the organization and requirements. Needs to
accuracy of work and flow of multiple tasks. improve in accountability for
+ Accepts and provides constructive performance tasks and deadlines. Her
feedback. SUM Total account is 87%
+ Demonstrates effective utilization of time, equipment, and she did not complete
supplies, resources and others. her self evaluation. She
strives to accurately
complete and sign off her
timecards.

Peers: Responsible for her

actions. I know I can rely on
Melissa to do what she says
she will do.
Respect  Successful Self: N/A
Consideration for others. Performer 
Supervisor: Melissa
Key Performance Behaviors demonstrates an interest in
+ Displays courtesy and sincerity. the thoughts, opinions,
+ Demonstrates appropriate verbal and non-verbal values and needs of co-
behavior with an approachable nature that does not hurt workers and customers. She
or offend others. usually leaves the
+ Commits to being fully present in all interactions. impression that the
+ Responds appropriately and professionally, even to perspectives of others are
people who are difficult (e.g., upset, angry, etc.) valued and respected.
+ Acknowledges others contributions and efforts.
Peers: Very considerate
toward staff and Pts

Excellence  Successful Self: N/A

Demonstrates commitment to performing above and Performer 
Supervisor: Melissa applies
beyond through continual improvement of self, knowledge and skills that
teams, processes and ultimately St. Luke’s. she has gained through self-
Key Performance Behaviors development and education
+ Seeks out opportunities to develop skills and to her day-to-day work. She
knowledge. is learning to work
+ Prepares for problems or opportunities in advance and concurrently on multiple
adopts additional responsibilities. priorities, a skill that will
+ Demonstrates outstanding initiative, innovation and continue to improve with
creativity. experience. She sometimes
+ Exemplifies a positive attitude and pride in work and has difficulty handling
company while being adaptable. change.
+ Demonstrates a commitment to delivering on his/her
duty and presenting oneself as a loyal and trustworthy
representative of St. Luke’s.

JOB PERFORMANCE

These descriptions are general and flexible. Competencies should be rated in a way that is appropriate for
the expectations of the job and the work environment.
REQUIRED: Add supporting performance comments about contributions, professional strengths and/or
development opportunities.

  Comments:

Job / Technical Knowledge  Successful Self: N/A

Performer 
Demonstrates knowledge in their skill set, Supervisor: Melissa has sufficient
position, and industry. Demonstrates proficient skills and knowledge to perform the
use of skills, equipment, resources, procedures job.
and technical knowledge required to perform
essential tasks as outlined in their job. Works to
continue to develop additional knowledge.
Commitment to Safety  
Performer
Demonstrates workplace safety by
understanding, encouraging and behaving in a
manner that supports a safe work environment.
Takes personal responsibility for safety.
Successful Self: N/A
 
Supervisor: Melissa understands
many safety practices expected by
the organization. She tends to know
the specifics and the reasons for
each safety requirement and treats
each expectation as non-negotiable.
She is accountable to completing
MIDASs on herself and takes
constructive feedback to improve
her practice.

Quality  Successful Self: N/A

Performer 
Demonstrates the ability to regularly produce Supervisor: Melissa meets
customer focused, accurate, thorough and expectations in terms of quality of
professional work. work. She produces accurate results
and pays attention to detail.

Efficiency  Successful Self: N/A

Performer 
Displays the ability to accomplish job tasks with Supervisor: Melissa carries her
the least amount of necessary time, resources share of the workload and strives to
and effort to achieve desired or better than complete a seamless handoff to the
desired outcomes. oncoming shift. She continues to
grow in her ability to work
concurrently on multiple priorities
without losing sight of the big
picture. She Is successfully
supporting 2E, 4S, and MMS6.
Recognition 2E 1.18.17 - Created 2017/01/19 by JACKIE HURZELER
Melissa, Rina, Krista, and Evan,

You have all been called out by name and recognized by 2E patients as someone they felt provided them with
exceptional care. Thank you for your commitment to creating exceptional patient experiences and outcomes.
Your hard work does not go unnoticed.

Recognition 2E 12.26.16 - Created 2016/12/29 by JACKIE HURZELER

Hi Janet,

Here is the email as promised. I told you about Rachel's compliment today. She did have another compliment
on 12/15 as well!

Melissa Waite Samson also had a kudos.

There were many compliments towards "all of the staff" and I have no doubt there were other CSU staff
members included in that as well.

We truly value and appreciate your staff and all that they do for 2E and our patients. Thank you for having an
amazing team.

Stephanie Parker, BSN RN, CMSRN

Nursing Supervisor, 2E

 
 CAREER GOALS / PLANS

Self: N/A

OVERALL SCORE

The overall score is calculated from 50% ICARE Values and 50% Job Performance based on the
Supervisor’s rating assessment only. Although the peer feedback and self-feedback are not directly
calculated into the overall score, this feedback is essential for supervisors.

Supervisor Final Comments

Melissa has accomplished a lot in her first year, orienting to and supporting 3 medical units. As
Comments
demonstrated by nurse leader rounding feedback, her patients value having Melissa as their nurse. I
would like to support Melissa in her second year either by taking a position with a home unit or remaining
to pre-schedule with CSU. I believe further experience and time will only strengthen Melissa's knowledge
and skill set.

Employee Acknowledgement & Comments

My signature indicates that I received a performance appraisal and does not necessarily imply my
agreement or disagreement with the evaluation content.

    I completed a discussion with my supervisor about my performance

 
Comments
Employee: MELISSA WAITE SAMSON M.W. (electronic signature for the evaluation of
MELISSA WAITE SAMSON performed on the computer of JACKIE L
HURZELER)

Date (yyyy/MM/dd): 2017/07/12 12:56 PM EDT

Manager: JACKIE L HURZELER J.H. (electronic signature for the evaluation of
MELISSA WAITE SAMSON)

Date (yyyy/MM/dd): 2017/07/12 12:57 PM EDT