Wesleyan University-Philippines

Mabini Extension, Cabanatuan City

College of Nursing
RATING

Student’s Name: __________________________________________

Clinical Month: __________________________________________
Shift/Clinical Block/Group: ___________________________________
School Year: ___________________________________
Term: ___________________________________
Inclusive Date of Clinical: ___________________________________

STAFFING PERFORMANCE EVALUATION

Self Earned
Core Competency Weight evaluation Points
I. PATIENT CARE COMPETENCIES
A. Safe Quality Care
Ability to discuss nursing care of clients handled. 2
Utilizes the Nursing Process in all aspects of nursing care. 2
Knowledgeable in infection control measures. 2
Individualizes and Prioritizes care according to the client’s 2
needs.
Ability to discuss the rationale of nursing actions. 2
Ability to discuss pharmacologic management of clients and 3
nursing care involved.
Interprets physician’s orders accurately. 3
Understand the reason for diagnostic tests and procedures. 2
B. Communication
Establishes rapport with clients, significant others, and 1
members of the health team.
Observe proper behavior when dealing with unit Personnel. 2
Participates in the discussion during nursing rounds and 1
answers the questions correctly.
Utilizes proper channels of communication. 2
Observe complete and accurate endorsement procedures. 2
C. Collaboration and Teamwork
Collaborates in planning care with other members of the 2
health team.
Functions effectively as a team in the unit. 2
D. Health Education 2
Provides the patient and family members with the necessary 2
health teachings.
Provides diet information necessary for patient nutritional 2
needs.
Listens attentively to patients and their family member’s 2
concerns and can answer their questions within one
competence.
II. EMPOWERING COMPETENCE
A. Ethico-moral responsibilities
Respects the right of the patient 3
 Wesleyan University-Philippines
Mabini Extension, Cabanatuan City
College of Nursing
Accepts responsibility and accountability for own decisions 3
and actions as a beginner practitioner nurse
Advocates for clients 2
Maintains privacy and confidentiality of client’s information 3
Adheres to the code of ethics for nurse 3
B. Legal Responsibility
Adheres to legal and institutional protocols regarding informed 3
consent and other legal documents
Clarifies unclear or questionable orders, decisions or actions 3
made by other inter-professional health care team members
Documents all pertinent data correctly and completely 3
C. Personal and Professional Development
Update oneself with the latest trends and developments in 1
giving nursing care
Possess a positive attitude towards learning different nursing 4
procedures, skills, and knowledge used in the unit
Complies with the rules and regulations of the course 2
concerning uniforms and paraphernalia
Accepts criticisms and recommendation 1
Performs the function of a beginner practitioner nurse 2
following professional standards
Adheres to clinical requirements (e.g., case studies, quizzes, 6
examinations, attitudes, and attendance)
III. ENABLING COMPETENCIES
A. Management of Resources and Environment
Organizes workload to facilitate client care 1
Utilizes Financial resources to support client care 1
Adheres to policies, procedures, and protocols for the 2
prevention and control of infection
Observe proper disposal of waste 2
Defines steps to follow in case of fire, earthquake, and other 1
emergencies.
B. Records Management
Maintains accurate and updated documentation of clinical 3
care
Records outcome of client care 2
Observe legal imperatives record keeping 3

C. Research
Identify researchable problems related to the immediate care 1
of patients
Initiates a research study on an identified researchable 1
problem
Disseminates results of research findings 1
D. Quality Improvement
Share with the team relevant information regarding the client’s 1
condition
Encourages the client to verbalize relevant changes in his/her 1
condition
 Wesleyan University-Philippines
Mabini Extension, Cabanatuan City
College of Nursing
Documents and records all nursing care and actions 1
implemented
Reports to appropriate person/s significant variances 2
changed, responses immediately
Documents and reports observed variances regarding client 1
care
Provides appropriate suggestions on corrective measures 1
TOTAL 100

REMARKS
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CLINICAL INSTRUCTOR: ________________________________________________________

CONFORME: STUDENT’S SIGNATURE: __________________________________________