PERFORMANCE APPRAISAL

Clinical Nurse I-IV

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Cristina Grasu Hire Date: Employee #:
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Appraisal
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PERFORMANCE LEVEL DEFINITIONS

Overall performance significantly exceeds requirements. Performance is characterized by notable skill,
Exceeds Performance
initiative, and superior job knowledge. This individual’s performance exceeds most others in the same or
Requirements (E) similar position.
Overall performance strongly meets and often exceeds standards. Performance represents a proactive
Strongly Meets (SM) contribution to the organization. This level of performance recognizes the extra effort, accomplishments and
outcomes related to advancing departmental, collaborative and organizational performance.
Overall performance consistently meets and may occasionally exceed standards. Performance represents a
Meets Performance significant contribution to the organization. Or, during the assessment period employee has been on the
Requirements (M) assigned job fewer than twelve months and is making satisfactory progress toward meeting overall
standards.
Overall performance does not consistently meet standards in several key areas. Improvement is required to
Improvement Needed (I) successfully meet expectations. Action plan and follow up are required to address performance deficiencies
and maintain current position. Corrective action may have preceded this rating.
Overall performance does not meet standards. Performance is inadequate (below minimum acceptable
Does Not Meet Performance standards and expectations). Performance is causing problems/disruptions/hardships to the department
Requirements (N) and/or co-workers and is having a negative impact on departmental effectiveness and/or productivity.
Corrective action has occurred.

PRIMARY RESPONSIBILITIES:
This section focuses on 3-5 essential elements of ongoing, day-to-day work. It reflects responsibilities and Performance Level
accountabilities associated with individual’s routine work. Special projects get addressed in Goals section.
Comments:
Cristina has a perceptual understanding of the overall clinical
situation based upon a deep background and knowledge of the
patients in AIC. Anticipates potential problems by following up with
CLINICAL PRACTICE patients’ laboratory lab values, treatment orders, and calling MD Exceeds
Assess, Plan, Implement/Coordinate,
Evaluate and pharmacist to optimize treatment. Cristina conducts literature
searches to new infusion treatments and brings it to the
pharmacists and colleagues. Colleagues can rely on Cris as a
resource, and if issues come up with patients, Cris either has the
answer or knows how to find the answer.
Comments:
COMMUNICATION Exceeds
Cristina reports patient care and environmental issues to unit
e.g. SBAR, Chain of Command, etc.
management for ongoing follow-up.
Comments:
Cristina recognizes inappropriate and outdated
DOCUMENTATION Exceeds
orders/interventions and seeks clarification and/or change. Follows
e.g. EMR and other records
up with staff who have not completed required regulatory
documentation to ensure compliance by end of the shift.
CEDARS-SINAI VALUES: Integrity ~ Excellence ~ Teamwork and Collaboration ~ Respect ~ Compassion ~ Innovation ~ Stewardship ~ Efficiency ~ Diversity
HROD 4/25/17 Nursing Values: Advocacy ~ Courage ~ Global Awareness ~ Inclusion Page 1 of 4

PRIMARY RESPONSIBILITIES:
This section focuses on 3-5 essential elements of ongoing, day-to-day work. It reflects responsibilities and
accountabilities associated with individual’s routine work. Special projects get addressed in Goals section.
PATIENT SAFETY/QUALITY
Nursing Sensitive Indicators – NSI
Quality Assurance Performance
Improvement – QAPI, etc.
Department/Position-Specific
LEADERSHIP
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VITAL BEHAVIORS:
This section focuses on 4 vital behaviors identified to improve the patient experience (IPE).
Treat patients,
family members and
co-workers with
courtesy and respect
Explain things in a
way that patients,
family members and
co-workers will
understand
Listen carefully in
order to understand
patients, family
members and
co-workers
Anticipate and
respond to patient,
family member and
co-worker requests
and concerns in a
timely manner
CEDARS-SINAI VALUES: Integrity ~ Excellence ~ Teamwork and Collaboration ~ Respect ~ Compassion ~ Innovation ~ Stewardship ~ Efficiency ~ Diversity
HROD 4/25/17
PERFORMANCE APPRAISAL
Clinical Nurse I-IV
Performance Level
Comments:
Cristina ensures the needs of all patients in AIC as well as the
capabilities of nurses assigned to care for them during infusion
treatments: recognizes when greater expertise is required and Exceeds
intervenes appropriately. She ensures that policies are followed by
other staff in relation to compliance with regulatory bodies (ex.
Joint commission and Department of Public Health). She takes lead
role to spearhead change, including follow through to completion.
Comments:
Cristina is inclusive of the team regarding daily actives, updates, and
Exceeds
provides support/coverage when needed. She promotes harmony
and teamwork, and shows appreciation for contributions and
achievements by the team.
Comments:
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Performance Level
Comments:
Cristina demonstrates courteous, polite, and respectful behaviors to all
clients. Cris is an excellent patient advocate, and does not hesitate to
Exceeds
communicate with others nurses of providers to help improve the
patient experience. She assumes responsibility and accountability for
her patients.
Comments:
Cris uses creative strategies to ensure our pediatric patients and their
families understand the plan of care in the ambulatory infusion center. Exceeds
Cris is very through and accountable when preparing for the following
day’s patients; she thoroughly checks orders/charts and follow up on
issues.
Comments:
Cristina
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Comments:
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Nursing Values: Advocacy ~ Courage ~ Global Awareness ~ Inclusion Page 2 of 4
 PERFORMANCE APPRAISAL
Clinical Nurse I-IV

GOALS for THIS Performance Appraisal Period:

This section captures up to 4 key goals within the individual’s influence. It describes work priorities for a Goal Status
specific period and reflects special projects, strategic/operational initiatives, process improvement work,
stretch assignments, professional development. Comments reflect accomplishments, outcomes, results.
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GOALS for NEXT Performance Appraisal Period: E.g., special projects, unit/team process improvements, etc.
This section captures up to 4 key goals within the individual’s influence, that are to be achieved within the next appraisal period.
Suggestion: Include at least 1 process improvement/operational effectiveness related goal and 1 professional development goal.

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COMPLIANCE and REQUIREMENTS VERIFICATION CONFIRMATION STATUS

This section highlights the individual’s compliance-related accountabilities for the appraisal period.
Education/Licenses/Certifications Click to select

Mandatory Organizational Requirements (e.g., Fire Card, Corporate Compliance, etc.) Click to select

Clinical Competencies Confirmation Click to select

Nursing Portfolio Click to select

RN Self-Assessment Click to select

Attendance and Tardiness Standards Click to select

Comments/Corrective Action(s), if applicable - Required if above status is NOT Met &/or Performance Level is below Meets
Note: If corrective actions have been taken, during the performance cycle, please indicate below.
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Summary of RN Peer Feedback Comments and Wider Feedback

This section encapsulates examples of peer feedback and may also reflect wider feedback (e.g., commendations, etc.)
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CEDARS-SINAI VALUES: Integrity ~ Excellence ~ Teamwork and Collaboration ~ Respect ~ Compassion ~ Innovation ~ Stewardship ~ Efficiency ~ Diversity
HROD 4/25/17 Nursing Values: Advocacy ~ Courage ~ Global Awareness ~ Inclusion Page 3 of 4
 PERFORMANCE APPRAISAL
Clinical Nurse I-IV

OVERALL PERFORMANCE APPRAISAL SUMMARY Overall Performance Level

This section represents the individual’s overall performance level within the appraisal period. It
often conveys 2-3 core messages and may highlight examples of values/behaviors in action.
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Employee Comments (Optional)

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I have received this document, discussed its contents with my manager, and had the opportunity to make written comments. My
signature indicates that I have been advised of my performance level and does not necessarily imply that I agree with this evaluation.

Employee Signature: ______________________ _______________ Date:

Appraiser Signature:  _________________________________ Date:

2nd Level Signature:  _________________________________ Date:

CEDARS-SINAI VALUES: Integrity ~ Excellence ~ Teamwork and Collaboration ~ Respect ~ Compassion ~ Innovation ~ Stewardship ~ Efficiency ~ Diversity
HROD 4/25/17 Nursing Values: Advocacy ~ Courage ~ Global Awareness ~ Inclusion Page 4 of 4