Clinical Evaluation Tool

NSG-300C

Semester/Year: ___________________________________________________

Evaluation Day and Date: ___________________________________________

Student First Name Last Name: ______________________________________

Clinical Faculty First Name Last Name: ________________________________

Course Objectives
1. Perform foundational nursing skills while caring for clients.
2. Develop techniques to perform a comprehensive health assessment that incorporates the diverse preferences and needs
of the clients.
3. Develop an individualized plan of care using the nursing process.
4. Provide client education that addresses the needs of clients and promotes wellness.
5. Demonstrate appropriate safety protocols and standards while working in the client-care setting.
6. Correctly document client health care information.
7. Demonstrate basic therapeutic communication skills while communicating with clients.
8. Demonstrate clear and professional communication with the health care team.
9. Exhibit ethical, legal, and professional nursing behaviors while providing client care.

© 2018. Grand Canyon University. All Rights Reserved.

 Midterm Final

Student

Student
NSG-300C Clinical Competencies

Faculty

Faculty
Assign a score of 1 to 3 for each
competency in the boxes below.
Client-Centered Care See the Clinical Scoring
Guidelines below for additional
detail.
Develop an individualized plan of care with a focus on assessment and planning, utilizing the
nursing process while respecting the diversity of clients.
Demonstrate caring behaviors, including assessing for the presence and extent of pain and
suffering.*
Conduct a comprehensive, holistic assessment while eliciting clients’ values, preferences, and
needs.
Demonstrate developing skills in selected psychomotor activities.
Demonstrate effective therapeutic communication skills with diverse clients and families.
Perform effective teaching with clients, families, and caregivers that addresses client needs and
the promotion of wellness.
Safety, Informatics, and Quality Improvement
Demonstrate standardized infection control practices (hand washing and PPE) that support
safety and quality, and implement strategies to reduce risk of harm to self or others.*
Document clear and concise responses to care, as appropriate for clinical setting (i.e., EHR,
paper documentation, care plan).

Protect confidentiality of all client data and promote the ethical use of electronic health
information.*
Identify methods to deliver care in a timely and cost-effective manner.

2
 Teamwork and Collaboration
Develop effective verbal and written communication skills with clients, team members, and
family.
Identify relevant data for communication in preconferences and postconferences.

Identify intraprofessional and interprofessional team member roles and scopes of practice, and
establish collaborative relationships with team members.
Identify the need for help when appropriate to situation.

Professional Role
Demonstrate core professional values (such as caring, altruism, autonomy, integrity, human
dignity, and social justice) while complying with the ANA Code of Ethics and Standards of
Practice, and policies and procedures of Grand Canyon University, College of Nursing and
Health Care Professions, and clinical agencies.*
Maintain a positive attitude and interact with interprofessional team members, faculty, and
fellow students in a positive, professional manner, including accepting constructive feedback
and developing a plan of action for improvement.*
Arrive punctually, demonstrate expected behaviors, complete tasks in a timely manner, and
maintain professional behavior and appearance.*
Accept individual responsibility and accountability for nursing interventions, outcomes, and
other actions; engage in self-evaluation; and assume responsibility for learning.*

Critical competencies are highlighted in yellow. Students who score a 1 (Does Not Meet) on any of these competencies at final evaluation will fail the clinical
course. Target performance is a Score of 3 (Independent) on the competencies marked with an asterisk* by final evaluation.
Content of this checklist is based on Quality and Safety Education for Nurses (QSEN) competencies and knowledge, skills, and attitudes (KSAs):
Quality and Safety Education for Nurses Institute. (2017). QSEN competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/

Midterm Evaluation Comments

3
Faculty Comments (Include strengths and areas for improvement):

Student Comments (Identify three areas for development):

4
Final Evaluation Comments

Faculty Comments (Include strengths and areas for improvement):

Student Comments (Identify three areas for development):

5
Student and Clinical Faculty Signatures

Signatures indicate student and clinical faculty have reviewed and discussed the Clinical Evaluation Tool.

Student Signature at Midterm: Date:

Student Signature at Final: Date:

Clinical Faculty Signature at Midterm: Date:

Clinical Faculty Signature at Final: Date:

6
Remediation for Unsatisfactory Areas
If a student earns a score of 1 on any competency at either the midterm or final evaluation, the clinical faculty and student must
complete the following documentation for remediation of unsatisfactory areas. Didactic faculty are required to sign off on this plan as
well.

Unsatisfactory Student-Centered Strategy for Success

Include Situation (dates and behaviors), Background, Assessment,
Indicate applicable competencies
and Recommendation (including timeframe)

I have reviewed the content with the clinical faculty and agree with the remediation plan for the student.

Didactic Faculty Signature at Final: Date:

7
Clinical Scoring Guidelines
The Clinical Evaluation Tool (CET) is used in all clinical nursing courses across the BSN Pre-Licensure program. Each clinical
nursing course aligns with its co-requisite didactic course and builds on prior knowledge, skills, and attitudes from other courses and
levels within the program, as appropriate. Faculty members will perform either a final clinical evaluation, or both a midterm and final
clinical evaluation depending on the length of the clinical rotation, using the CET for each student. Faculty will discuss the evaluation
with students, and both students and faculty must sign and date the form acknowledging the evaluation was completed and discussed.
A copy of the signed CET should be uploaded into the LoudCloud classroom. Faculty will also complete the corresponding rubric in
LoudCloud for each student.
General Criteria:
When observing students in the clinical setting and assigning a score, faculty will consider the following general criteria:
 Supervision: The degree of supervision required for the expected level of clinical practice.
 Clinical Judgment: The competence of nursing care based on the application of the nursing process, nursing diagnoses, and
clinical reasoning to make informed decisions that provide safe, quality client care.
 Professionalism: The nature of the interactions and communication with clients and the interdisciplinary team, professional
demeanor, and appearance.
 Application of Skills and Knowledge: The ability to apply nursing knowledge, theory, and skills in the clinical setting.
 Self-Direction: The ability to address one's own learning goals and needs.

Scoring Guidelines:
Faculty will assign a score of 1 to 3 for each clinical competency listed on the CET. When observing students in the clinical setting,
faculty will apply the following sets of criteria holistically when assigning a score for each clinical competency. If a student scores a 1
in any category, the clinical faculty should complete an Early Alert and meet with the student to discuss the student's performance and
plans to improve. The clinical faculty also needs to complete the remediation portion on the CET. The remediation portion will then
need to be shared with the didactic faculty for review and signature.
Score = 3 (Independent)
To achieve a score of 3, the student:
 Functions independently, appropriately, and safely in the clinical setting.
8
  Demonstrates frequent, informed clinical judgment and ensures safe, quality client care.
 Demonstrates consistent professionalism and effective communication with clients, families, and the interdisciplinary team
while maintaining professional demeanor and appearance at all times.
 Demonstrates consistent, accurate integration of nursing knowledge, skills, and attitudes in the clinical setting.
 Engages consistently in a self-directed approach to learning, independently seeks appropriate guidance and resources.

Score = 2 (With Assistance or Supervised)

To achieve a score of 2, the student:
 Functions appropriately and safely with occasional guidance and/or supervision in the clinical setting.
 Demonstrates average clinical judgment and ensures safe, quality client care.
 Demonstrates sufficient professionalism and effective communication with clients, families, and the interdisciplinary team
while maintaining professional demeanor and appearance most of the time.
 Demonstrates reasonable integration of nursing knowledge, skills, and attitudes in the clinical setting.
 Attempts a self-directed approach to learning, but needs help recognizing resources and learning opportunities.

Score = 1 (Does Not Meet)

To achieve a score of 1, the student:
 Does not function safely in the clinical setting, even with persistent guidance.
 Rarely demonstrates appropriate clinical judgment and struggles to rationalize measures for safe, quality client care.
 Demonstrates a consistent lack of professionalism and effective communication skills with clients, families, and the
interdisciplinary team while failing to maintain a professional demeanor and appearance.
 Demonstrates a significant lack of integration of nursing knowledge, skills, and attitudes in the clinical setting.
 Does not attempt a self-directed approach to learning and requires persistent, detailed instructions regarding learning
opportunities and resources and is unable to utilize them without support.