Enrolled Nurse Clinical Feedback

Organisation: MIT Student Placement

Thank you for being a mentor/preceptor for our
nursing student and supporting their clinical
practice development. RN feedback is vital as it
helps students and Clinical Tutors understand the
student’s strengths and areas for further
development. Please discuss any feedback of note
with student as well as Clinical Tutor.
Performance Scale (Please evaluate student performance in relation to their
current level in the programme):
0 Not observed or no opportunity to observe
1 Not yet performing at the level expected & concerned about progress
2 Not yet performing at the level expected but expect to progress
3 Performing at the level expected
4 Exceeding expectations of performance
5 Exceptional performance

Domain Domain Competencies Observation

Accepts responsibility for ensuring that his or her nursing practice and conduct meets
1 0 1 2 3 4 5
the standard of the professional ethical and relevant legislative requirements
Demonstrates the ability to apply the principles of Te Tiriti o Waitangi / Treaty of
0 1 2 3 4 5
Waitangi to nursing practice
Demonstrates understanding of the enrolled nurse scope of practice and the registered
0 1 2 3 4 5
nurse responsibility and accountability for direction and delegation of nursing care.
Promotes an environment that enables health consumer safety, independence, quality
0 1 2 3 4 5
of life, and health
Participates in ongoing professional and educational development. 0 1 2 3 4 5
Practises nursing in a manner that the health consumer determines as being culturally
Responsibility
Professional

0 1 2 3 4 5
safe
Please give examples of when professional responsibility was demonstrated:

Domain Domain Competencies Observation

2 Provides planned nursing care to achieve identified outcomes 0 1 2 3 4 5
Contributes to nursing assessments by collecting and reporting information to the
0 1 2 3 4 5
registered nurse.
Recognises and reports changes in health and functional status to the registered nurse
0 1 2 3 4 5
or directing health professional.
Contributes to the evaluation of health consumer care. 0 1 2 3 4 5
Ensures documentation is accurate and maintains confidentiality of information 0 1 2 3 4 5
Provision of Nursing

Contributes to the health education of health consumers to maintain and promote

0 1 2 3 4 5
health.
Care

Please give examples of when management of nursing care demonstrated:

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Enrolled Nurse Clinical Feedback

Domain Domain Competencies Observation

Establishes, maintains and concludes therapeutic interpersonal relationships with
3 0 1 2 3 4 5
health consumer
Communicates effectively as part of the health care team. 0 1 2 3 4 5
RelationsInterpers

Uses a partnership approach to enhance health outcomes for health consumers. 0 1 2 3 4 5

onal

Please give examples of when interpersonal relationships demonstrated:

hips
(Nurse Client)

Domain Domain Competencies Observation

Collaborates and participates with colleagues and members of the health care team to
4 0 1 2 3 4 5
deliver care.
Quality ImprovementsHealth Care andInter- professional

Recognises the differences in accountability and responsibility of registered nurses,

0 1 2 3 4 5
enrolled nurses and healthcare assistants.
Demonstrates accountability and responsibility within the health care team when
assisting or working under the direction of a registered health practitioner who is not a 0 1 2 3 4 5
nurse.
Please give examples of when interprofessional evidence-based practice demonstrated:

Name and Signature

Preceptor name (and role) Preceptor Signature
Signature of Charge Nurse /
Date
Coordinator / Team Leader
Feedback discussed . Yes / No .
Clinical Tutor name
with student?
Comments

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Enrolled Nurse Clinical Feedback

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