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Final Summary of Student Progress in Clinical Nursing Course
Student Name

Numerical Grade: ___________

Clinical Grade: _____________
Critical Behaviors:
1. Shows evidence of preparation for
the clinical experience. (II, III, IX)
2. Calculates medications correctly.
(II, V, IX)
3. Administers medications correctly.
(II, V, IX)
4. Maintains medical and surgical
asepsis. (II, III)
5. Performs psychomotor skills at
expected competency level. (II, III)
6. Adheres to agency guidelines.
(IV, V, VI, VII)
7. Gives accurate reports in the clinical
setting. (II, IV, VI, XI)
8. Recognizes hazards and takes
appropriate action in order to insure
patient safety. (II, V, IX)
9. Demonstrates respect for the rights,
dignity, culture and individuality of
all persons, within the context of
social justice including, but not
limited to: maintaining confidentiality
consistent with HIPAA regulations,
providing privacy, and avoiding
stereotyping. (V, VII, X)
10. Demonstrates caring behaviors
when working with individuals and
groups. (II, III, VIII)
11. Establishes therapeutic relationships with
intraprofessional and interprofessional
teams when providing patient centered
care.. (II, III, VI)
12. Makes evidence-based nursing
decisions that are within ethicallegal parameters and consistent with
HIPPA regulations. (III, VI)
13. Demonstrates responsibility and
accountability at a level consistent
with the expected knowledge base.
(I, II, V, VI)
14. Utilizes the nursing process at a
level consistent with the expected
knowledge base. (II, III, XI)



Course Number

CWID Number

Provide anecdotal behavioral comments as



Final Summary of Student Progress in Clinical Nursing Course

Critical Behaviors:
15. Modifies behavior in response to
guidance. (V, VI)
16. Promotes patient centered care with an
emphasis on patient safety utilizing
available technology. (IX)
17. Demonstrates behaviors consistent
with professional nursing roles
including, but not limited to:
motivation, integrity, leadership,
communication, organizational skills,
ability to work under stress,
appearance, punctuality, and
attendance. (V, VII, X)
a. Anticipates, recognizes and meets
persons needs (e.g., greets patients/
visitors when entering room,
introduces self to patients or visitors).
b. Demonstrates sensitivity to patient needs
(e.g., addresses comfort needs, listens to
patient concerns, etc.)
c. Considers patients best interests in all
aspects of patient care.
d. Demonstrates cooperation and
helpfulness to co-workers (e.g.,
when not busy offers to help
other staff if needed.)
e. Properly delegates tasks when
f. Seeks assistance when indicated.
g. Demonstrates positive, enthusiastic
approach in various interactions.
h. Uses time wisely and productively.
i. Displays eagerness to learn; seeks
appropriate learning experiences.
j. Adapts to changing unit and patient
care demands.
*Roman numerals refer to program objectives.
Summary of Student Strengths:



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Provide anecdotal behavioral comments as


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Final Summary of Student Progress in Clinical Nursing Course

Summary of Opportunities for Improvement:

Faculty-Student Negotiated Plan for Improvement:

Student Comments:

I have read this final evaluation and discussed it with the clinical instructor.
Student Signature


Faculty Signature


DATE APPROVED: Spring, 1985

EFFECTIVE DATE: Spring, 1985
DATE REVIEWED/REVISED: Spring, 2007, Spring 2010, Spring 2014
DATE OF NEXT MANDATORY REVIEW: Spring, 2015, Spring 2019
BY: Undergraduate Education Committee