Nephrology Fellow 360º Evaluation Form

Dialysis Nurses

Fellow’s Name _________________________________________

Date ___________________________________

Please circle the number to the right of the statement that you think best characterizes the fellow’s behavior.

Sometimes
Usually
Always
Rarely
Never
 Communicates effectively with patients, families and healthcare personnel 1 2 3 4 5

 Maintains a compassionate and respectful relationship with patients and their families; responds to their needs 1 2 3 4 5

 Counsels and educates patients and their families 1 2 3 4 5

 Responds to pages within 5 minutes 1 2 3 4 5

 Works cooperatively, collaboratively and respectfully with other members of the healthcare team 1 2 3 4 5

 Maintains a professional appearance and demeanor 1 2 3 4 5

 Demonstrates commitment to ethical principles in providing or withholding care, confidentiality of patient information,
informed consent and business practices 1 2 3 4 5