Carroll Community College

Department of Nursing
NURS 203 –Transition to Registered Nursing
Summative Student Clinical Performance Evaluation

Student: Catherine Nye Date: 10/16/19 Clinical: Howard County General Hosp. Faculty: Minnema
S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not applicable (*) Critical behavior
Students who meet any of the following criteria will be given a remediation plan and may be placed on probation.
Failure to progress in these areas may result in failure of the course.
-One unsatisfactory grade in a critical behavior -Two needs improvements in a critical behavior
-Two unsatisfactory grades in a non-critical behavior -Four needs improvements
Student Instructor
Self- Eval of
Outcome 1 Eval Student
Apply the nursing process when implementing a plan of care (CO1) S/N/U S/N/U
1. *Prioritizes patient care based on assessment with assistance S S
2. Demonstrates accurate patient assessment skills S S
3. Incorporates data from the patient’s medical record in the provision of care S S
4. Uses patient assessment data to develop individualized plan of care with assistance S S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with assistance S
6. Establishes measurable patient outcomes based on nursing diagnosis with assistance S S
7. Establishes appropriate nursing interventions based on assessment with assistance S S
8. Evaluates patient response to care and revises plan as needed with assistance SS S
Student Instructor
Self- Eval of
Outcome 2 Eval Student
Participate in opportunities that promote professional growth (CO2) S/N/U S/N/U
9. Demonstrates professional behavior and appearance S S
10. Seeks input from patient, instructor, and healthcare team in the delivery of patient- S
centered care S
11. *Demonstrates accountability and accepts responsibility for own actions and attitudes S S
12. *Adheres to attendance policy S S
13. Participates actively in all clinical experiences S S
14. Engages in self-reflection and communicates learning needs to instructor S S
15. Completes assignments as required and submits on time SS S
Student Instructor
Self- Eval of
Outcome 3 Eval Student
Provide patient-centered care with assistance (CO3) S/N/U S/N/U
16. *Implements appropriate infection control precautions S S
17. Provides culturally sensitive care with assistance S S
18. Documents patient care accurately with assistance S S
19. Uses therapeutic communication skills S S
20. Follows through with all patient care with assistance S S
21. Demonstrates knowledge of medications for assigned patients S S
22. *Administers medication safely using six rights of medication administration NA N/A
23. Demonstrates caring behaviors S S
24. Uses SBAR to communicate patient status to instructor and healthcare team with S
assistance S
25. Acts as an advocate for patients and families with assistance S S

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/2018

 Carroll Community College
Department of Nursing
NURS 203 –Transition to Registered Nursing
Summative Student Clinical Performance Evaluation

26. *Demonstrates physical and mental competence S S

27. *Identifies safety concerns and notifies instructor and appropriate healthcare team S
members S
28. Demonstrates time management techniques S S
29. Implements patient and family education S S
30. *Updates instructor and healthcare team regarding changes in the patient’s condition S S
31. *Provides nursing care based on the policies and procedures of the facility S S
32. *Provides nursing care in accordance with the Maryland Nurse Practice Act S S
33. *Adheres to HIPAA guidelines S S
34. *Provides care according to ANA Scope and Standards of Nursing Practice S S
Student Instructor
Self- Eval of
Outcome 4 Eval Student
Plan nursing care based on scientific evidence (CO4) S/N/U S/N/U
35. Justifies patient’s plan of care based on current evidence S
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.
This rotation has helped me support people with issues ranging from anxiety and depression
to addiction to drugs and alcohol.

Which objective did you accomplish during this rotation? How did you do it?
I accomplished the uncomfortable task of asking questions like “do you have any thoughts of harming
yourself? Do you ever hear voices, what do the voices say? And just talk about things that are tough
and take the stigma out of mental illness. I did it by stepping out of my comfort zone, showing that I
care about my patients by taking the time to learn about them and just allow them to talk and using
therapeutic communication.

What are your goals for your next clinical rotation?

To learn all I can and be the best nurse and advocate for my patients as I possibly can.

Faculty Comments/ Student Learning Goals (Goals must be established even if performance is satisfactory.
If an item was identified as N or U, narrative comments are necessary to clarify student performance along
with goals to improve performance).
Cathy, you definitely put your heart and soul into your patient care, and want so much for your patients to move
towards a better life. Be careful that this passion doesn’t slip past personal boundaries by sharing any personal
information. Indeed, you have had a lot of personal experience that is truly valuable for others to hear. Consider
being a guest speaker, or share experiences with a support group. Exemplary work with the focused interaction
assignment this week. You did very well developing and implementing a patient education activity using the
nursing process. The best part of your work is your therapeutic communication skills. Clearly your insight and
empathy plays an important part in your ability to develop therapeutic relationships with your patients. Excellent
transfer of classroom theory to practice. Final Focused Interaction assignment grade – 47/47. Outstanding work!

Recommended for the near future (e.g., begin with clinicals). Please look at this reference: Reflective Practice in
Health Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673148/ Although the article is from a surgeon’s
journal, the author’s resources come from nursing (see references bottom of page.) Note the reflective steps in
the article. I know you want to be the very best RN you can be as you said, above. To do this the nurse must
really value reflective practice.
Catherine Nye has satisfactorily met the learning outcomes for psychiatric mental health nursing clinical at
Howard County General Hospital. Best of everything to you Cathy as you continue your nursing education, and

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/2018

 Carroll Community College
Department of Nursing
NURS 203 –Transition to Registered Nursing
Summative Student Clinical Performance Evaluation

beyond.

Student Signature: Catherine nye Date:10/16/19

J. Minnema,
Instructor Signature: RN, MS Date:

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/2018