Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

Student Kristy Saz Date 1/6/21 Week #5 Faculty

Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical
(Meets) (Requires assistance) (Unable) applicable 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
Instructor 
Student Eval of
Course Goal 1 Self-Eval Student 
Analyze the effectiveness of the plan of care (PG1) S/N/U S/N/U 
Using faculty as a resource:  
1. Prioritizes and completes daily nursing tasks S S 
2. Completes assessments accurately S S 
3. Uses EMR/MAR, patient charts, handoff report to provide care S  S
4. *Establishes appropriate nursing priority list S S 
5. Creates measurable patient outcomes S S 
6. Establishes appropriate nursing interventions S S 
7. Evaluates patient response to care and revises plan as needed S S 
Instructor
Student Eval of
Course Goal 2 Self-Eval Student 
Seek opportunities that promote professional growth (PG2) S/N/U S/N/U 
Using faculty as a resource:  
8. Adheres to dress code S S 
9. Seeks input from patient, instructor, and healthcare team when providing care S S 
10. *Demonstrates accountability and accepts responsibility for own actions and attitudes S S 
11. Actively participates in all clinical experiences S S 
12. Communicates learning needs to instructor S S 
13. Completes assignments/evaluations as required Submitted late by technological error. S N 
Instructor
Student Eval of
Course Goal 3 Self-Eval Student 
Provide patient-centered care with faculty as resource (PG3) S/N/U S/N/U 
Using faculty as a resource:  
14. *Implements appropriate infection control precautions S S 
15. Identifies client’s cultural needs S S 
16. Accurately documents patient care S S 
17. Communicates appropriately with patient, family, healthcare team, and instructor S S 
18. Explains the actions, side effects, and nursing implications of medications Explains the actions, S 
side effects, and nursing implications of medications     Knowledge of  medications  was accurate
and communicated to the patient.  Remember to keep the explanation simple to aid in
understanding.  We had the opportunity to evaluate IV compatibilities using the resources on line
at CHC. Kristy accurately identified the need to hold heparin for the patient due for a surgical
procedure today.     S
19. *Administers medication using the six rights      Medication assignment was for 2 patients.  S S 
Routes included oral, topical, SC injection, and IV medications.  One IV medication
was  immuno  globin and it was the first time the patient received it.  This medication had 4
different rates changing every half hour.  The medication was viscous and required a great deal of
attention and tubing intervention to get it to run properly.   Kristy stayed at the bedside and
monitored the patient while the infusion began for 20 minutes.  Medications were due at multiple

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

times.  Kristy needs to work on her speed of delivery without sacrificing accuracy but no gross
amount of time was spent on the medication pass.  For the patient in room 307 the first time we
gave oral medications Kristy did fail to assess swallowing before giving chewable aspirin.  Other
medication delivery times she did assess swallowing prior to giving oral meds.       
20. Demonstrates concern, compassion and empathy with patients S S 
21. *Demonstrates physical and mental competence S S 
22. *Notifies instructor and appropriate healthcare team members with safety concerns and changes S 
in the patient’s condition S
23. Identifies patient and family health education needs S  S
24. Provides nursing care in accordance with the Maryland Nurse Practice Act and the ANA Scope & S 
Standards of Nursing Practice S
25. *Adheres to HIPAA guidelines S S 
Criteria: S = Satisfactory U = Unsatisfactory NA = Not (*) Critical
(Meets) (*) Critical behavior  (Unable) applicable behavior
Instructor
Student Eval of
Course Goal 4 Self-Eval Student 
Implement nursing care based on scientific evidence (PG4) S/N/U S/N/U 
Using faculty as a resource:  
26. Incorporates evidence-based rationales that support the patient plan of care S 
S
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.
This clinical rotation has helped enhance my role as a nurse by providing opportunities to practice clinical skills and hands on
nursing care. This semester I’ve been given the opportunity to hang primary and secondary IV’s, apply topical medications, and
provide subcutaneous injects. Performing these hands on nursing skills repetitively has been helpful in improving my performance
and enhancing my growth as a nurse.

Which objective did you accomplish during this rotation? How did you do it?
This clinical rotation I accomplished objective 18 “Administers medication using the six rights”. This objective was important to
meet, and a task that requires concentration and focus. I accomplished this objective by focusing on making sure I had the right
patient by asking for name, DOB and allergies, checking EMAR to verify that the medication being administered was scheduled at
the correct time, performing 3 checks to ensure that what was being given was the correct medication and the right dose,
simultaneously checking the expiration date, documenting that the medication was administered and providing the site if needed. I
also ensured that medications were given through the correct route, and repeated this process for all medications given.

What are your goals for your next clinical rotation?

My main goal for my next clinical rotation is improving time management when practicing medication administration. I plan to
achieve this by practicing my skills more routinely through use of open lab as well as clinical rotation.

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).
This clinical day was one on one between Kristy and myself.  I am sure it was nerve wracking but Kristy acted professional and
demonstrated patience with the computer which often signed her out right in the middle of a task.  Being at a new facility was a
challenge but she learned where things were stored and the timing of vital signs.  Documentation and computer use was different

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

from the previous site at Howard.  Kristy was able to demonstrate accurate patient nursing priorities and interventions.  Her stated
outcomes were appropriate.  She was able to prioritize correctly with medications for 2 patients.   
During the debrief we reviewed both patient charts, dx. tests, meds and she was able to explain lab values and how they related to
each patient. We also reviewed the day and critiqued her cations identifying strengths as well as areas for growth.
Kristy communicated with the primary nurses but acted independently when appropriate.   
As she progresses forward I hope she works on confidence and speed without sacrificing safety.   I do recommend additional
clinical time for her benefit.
Great job today Kristy. 

Student Signature: Kristy Saz Date: 1/6/21

Instructor Signature: Jane Schroeder, MSN, RN Date: 1/6/2021

Definitions:
Coaching – Faculty guides student to define objectives, set goals, and develop action plans through collaboration in the decision-making process
Assistance – Student unable to perform task independently; needs some aid or minimal direction from faculty to complete tasks. Not autonomous but does not
require coaching.
Resource - Faculty serves as a facilitator but student is capable of completing self-directed tasks.

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020