ORIENTATION OUTCOME EVALUATION FORM
Mentee:_____________________
Signature: ______________________ Signature: ______________________________
___________________________________________________________________________________________________________________________________________
Outcome Criteria
Therapeutic interventions
Utilization of nursing process
Ability to plan care and set goals.
Individualized nursing interventions.
Evaluation of goal achievement.
Overall impression of therapeutic
Interventions.
Communication
Verbal with patients, staff, peers, and
interdisciplinary team.
Documentation in charting, plans of
care, and assignments.
Mentor:____________________________ ▐ Orientation period: ________ to__________
SECTION 1: NEW HIRE SELF- EVALUATION
Date of Mid-Point Check-in Date of Final Check-in
________________________ ________________________ Comments:
Typical Behavior, Not all inclusive 5 4 3 2 1 5 4 3 2 1 (Strengths/Areas for
improvement)
Thorough holistic assessment of patient (history
taking, physical/behavioural assessments)
Plans nursing care.
Sets goals with patient/family.
Individualized interventions.
Incorporates appropriate interventions into care,
based on theoretical knowledge.
Performs technical skills accurately (i.e. IV, Blood
taking, safe medication administration)
Evaluates patient in meeting goals.
Modifies goals as necessary.
Putting it all together.
Conducts thorough interviews to gain information.
(i.e. initial history)
Communicates and offers psychosocial support.
Teaches necessary information.
Reports on patient progress.
Discusses theoretical aspects of care.
Participation in interdisciplinary rounds. (ie MDR
Rounds, Safety Huddles, Team Huddles)
Seeks and offers assistance when required.
Writes plans of care and updates Kardex.
Documentation thorough, clear and concise
(accurate, clear and comprehensive picture of the
client’s needs, nurse’s interventions and the
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Nonverbal with patients, staff, peers,
and interdisciplinary team.
Overall impression of communication
Critical Thinking
Ability to make decisions.
Problem-solving ability
Utilization of research in clinical
Practice.
General impression of critical
Thinking.
Outcome Criteria
Therapeutic interventions
Utilization of nursing process
Ability to plan care and set goals.
Individualized nursing interventions.
Evaluation of goal achievement.
Overall impression of therapeutic
Interventions.
client’s outcomes.)
Models behavior that promotes client comfort.
Acts with confidence.
Presents self as professional.
Putting it all together.
Appropriate decision-making.
Uses the nursing process to make proper decisions.
Ability to prioritize.
Analyzes strengths and weaknesses of patient
situations to achieve best outcome.
Solves problems to improve care to patient.
Identifies research appropriate for nursing practice.
Analyzes research findings and incorporates into
nursing care.
Putting it all together.
SECTION 2: MENTOR FEEDBACK FOR NEW HIRE
Date of Mid-Point Check-in Date of Final Check-in
________________________ ________________________ Comments:
Typical Behavior, Not all inclusive 5 4 3 2 1 5 4 3 2 1 (Strengths/Areas for
improvement)
Thorough holistic assessment of patient (history
taking, physical/behavioural assessments)
Plans nursing care.
Sets goals with patient/family.
Individualized interventions.
Incorporates appropriate interventions into care,
based on theoretical knowledge.
Performs technical skills accurately (i.e. IV, Blood
taking, safe medication administration)
Evaluates patient in meeting goals.
Modifies goals as necessary.
Putting it all together.
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Communication
Verbal with patients, staff, peers, and
interdisciplinary team.
Documentation in charting, plans of
care, and assignments.
Nonverbal with patients, staff, peers,
and interdisciplinary team.
Overall impression of communication
Critical Thinking
Ability to make decisions.
Problem-solving ability
Utilization of research in clinical
Practice.
General impression of critical
Thinking.
Conducts thorough interviews to gain information.
(i.e. initial history)
Communicates and offers psychosocial support.
Teaches necessary information.
Reports on patient progress.
Discusses theoretical aspects of care.
Participation in interdisciplinary rounds. (ie MDR
Rounds, Safety Huddles, Team Huddles)
Seeks and offers assistance when required.
Writes plans of care and updates Kardex.
Documentation thorough, clear and concise
(accurate, clear and comprehensive picture of the
client’s needs, nurse’s interventions and the
client’s outcomes.)
Models behavior that promotes client comfort.
Acts with confidence.
Presents self as professional.
Putting it all together.
Appropriate decision-making.
Uses the nursing process to make proper decisions.
Ability to prioritize.
Analyzes strengths and weaknesses of patient
situations to achieve best outcome.
Solves problems to improve care to patient.
Identifies research appropriate for nursing practice.
Analyzes research findings and incorporates into
nursing care.
Putting it all together.
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 Orientation Evaluation Tool Rating Criteria
The following criteria should be used in evaluating clinical performance of the outcome criteria of therapeutic interventions, communication, and
critical thinking. Please use the most appropriate rating.
5. Excellent
Meets criteria at a high level independently with minimum assistance; discussing process to achieve outcomes with preceptors, colleagues
4. Very Good
Meets criteria independently, seeking advice/confirmation on ways to perform at highly satisfactory level.
3. Satisfactory
Meets most objectives independently at a satisfactory level; needs some assistance to achieve objectives at a highly satisfactory level.
2. Needs Improvement
Performs actions safely; needs to work towards better achievement of outcome criteria; needs moderate amount of guidance in achievement
of criteria.
1. Poor
Fails to achieve these criteria at minimal level; needs extensive changes in behavior/ improvements to adequately meet these criteria.

FINAL COMMENTS
Self/Mentee Evaluation:
Strengths_________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

Areas for
improvement_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

Peer/Mentor Evaluation:
Strengths_________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Areas for
improvement_____________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

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 Feedback from CNS/NUA/Nurse Clinician

Midpoint Evaluation Check-in/Meeting, Date: _____________

Completed By:
Original returned to mentee/mentor □
Photocopy kept with CNS/NUA/NC □

Final Evaluation Check-in/Meeting, Date: _____________

Completed By:

Original returned to mentee/mentor □

Photocopy kept with CNS/NUA/NC □
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