St.

John Fisher College

Wegmans School of Nursing
Clinical Nurse Specialist Track
Preceptor Evaluation of CNS Student Performance

CNS Clinical Course

Student Name: _______________________ Preceptor Name: _______________________

Site: ________________________________ Phone: (___) _____________________

Preceptor email: _______________________

Spring ___ Fall ___ Year 20 ___

Clinical Course:
___ GNUR 684 Care of the Older Adults for CNS or GNUR 687 Care of Children for CNS
___ GNUR 685 Care of the Adult for CNS or GNUR 686 Care of Women for CNS
___ GNUR 688 Synthesis of CNS Practice

Evaluation Scale Key

N/A Not observed, no opportunity, not applicable to this site.
P *Poor Does not meet minimal expectations. Requires a clinical conference for student with site visitor.
D *Developing: Progressing toward competent but needs significant coaching & support.
C Competent: Meets expectations consistently. This rating or higher required on final evaluation to
advance to next clinical course.
O Outstanding Exceeds expectation.
* Any rating of Poor or Developing requires a comment from the preceptor.
CNS Core Competencies
1. Direct Care Competency: Direct interaction with patients, families, and groups of patients to promote
health or well-being and improve quality of life. Characterized by a holistic perspective in the advanced
nursing management of health, illness, and disease states.
2. Consultation Competency: Patient staff, or system-focused interaction between professionals in which
the consultant is recognized as having specialized expertise and assists the consultee with problem
solving.
3. System Leadership Competency: The ability to manage change and empower others to influence clinical
practice and political processes both within and across systems.
4. Collaboration Competency: Working jointly with others to optimize clinical outcomes. The CNS
collaborates at an advanced level by committing to authentic engagement and constructive patient,
family, system, and population-focused problem-solving
5. Coaching Competency: Skillful guidance and teaching to advance the care of patients, families, groups
of patients, and the profession of nursing.
6. Research Competency: The work of thorough and systematic inquiry. Includes the search for,
interpretation, and use of evidence in clinical practice and quality improvement, as well as active
participation in the conduct of research.
7. Ethical Decision Making, Moral Agency and Advocacy Competency: Identifying, articulating, and
taking action on ethical concerns at the patient, family, health care provider, system, community, and
public policy levels.

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
Professional Competencies Midterm Final
A. Seeks appropriate guidance from preceptor.
B. Collaborates with other professionals within practice setting where appropriate.
C. Recognizes own limitations & respects others’ roles.
D. Demonstrates an understanding of the planning & coordination of care with multi-
disciplinary providers.
E. Communicates & coordinates care with multidisciplinary providers. Recognizes need for
& initiates referrals with assistance of preceptor when appropriate.
F. Demonstrates recognition of the impact of varied reimbursements on the therapeutic plan.
G. Demonstrates beginning mastery of advanced practice nursing role.
H. Behaviors meet professional standards.
I. Demonstrates initiates for learning & maximizes learning opportunities.

Patient/Client Sphere of Influence Midterm Final

Student must be evaluated as competent in bolded competencies at final evaluation of GNUR
684/687 to pass the clinical component of this course.
Direct Care Competency
a. Conducts comprehensive, holistic, wellness and illness assessments using known or
innovative evidenced-based techniques, tools, and methods.
b. Obtains data about context and etiologies necessary to formulate differential
diagnoses and plans of care, and to identify and evaluate outcomes.
c. Employs evidenced-based clinical practice guidelines to guide screening and
diagnosis.
d. Assesses the effects of interactions among the individual, family, community, and
social system on health and illness.
e. Identifies potential risks to patient safety, autonomy and quality of care based on
assessments across the patient/client sphere of influence.
f. Synthesizes assessment data, advanced knowledge, and experience, using critical
thinking and clinical judgment to formulate differential diagnoses for clinical
problems amenable to CNS intervention.
g. Prioritizes differential diagnoses to reflect those conditions most relevant to signs,
symptoms, and patterns amenable to CNS interventions.
h. Selects interventions that may include but are not limited to application of
advanced nursing therapies, initiation of intraprofessional team meetings;
consultations and other communications to benefit the patient; management of
patient medications, clinical procedures and other interventions; psychosocial
support including patient counseling and spiritual interventions.
i. Designs strategies to meet the multifaceted needs of complex patients and groups
of patients.
j. Develops evidenced-based clinical interventions and systems to achieve defined
patient outcomes.
k. Uses advanced communication skills within therapeutic relationships to improve
patient outcomes.
l. Provides direct care to selected patients based on the needs of the patient and the CNS’s
specialty knowledge and skills.
m. Determines when evidenced based guidelines, policies, procedures, and plans of
care need to be tailored to the individual.
Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
 n. Leads development of evidenced-based plans for meeting individual, family,
community, and population needs.
o. Provides leadership for collaborative, evidenced-based revisions of diagnoses and
plans of care to improve patient outcomes.
Consultation Competency:
a. Initiates consultation to obtain resources as necessary to facilitate progress toward
achieving identified outcomes.
b. Communicates consultation findings to appropriate parties consistent with professional
and institutional standards.
System Leadership Competency:
a. Provides leadership in promoting intraprofessional collaboration to implement
outcome-focused patient care programs meeting the clinical needs of patients,
families, populations, and communities.
b. Coordinates the care of patients with the use of system and community resources
to assure successful transitions, enhance delivery of care, and achieve optimal
patient outcomes.
Collaboration Competency: See nursing/nursing practice sphere.
Coaching Competency:
a. Coaches patients and families to help them navigate the healthcare system.
b. Designs health information and patient education appropriate to the patient’s
developmental level, health literacy level, learning needs, readiness to learn, and
cultural values and beliefs.
c. Provides education to individuals, families, groups, and communities to promote
knowledge, understanding, and optional functioning across the wellness-illness
continuum.
d. Provides leadership in conflict management and negotiation to address problems in the
healthcare system.
Research Competency:
Interpretation, translation & use of evidence:
a. Analyzes research findings and other evidence for their potential application to
practice.
b. Integrates evidence into health, illness, and wellness management of patients,
families, communities and groups.
c. Applies principles of evidenced-based practice and quality improvements to
patient care.
d. Cultivates a climate of clinical inquiry across the patient/client sphere of
influence:
a. Evaluates the need for improvement or redesign of care delivery processes
to improve safety, efficiency, reliability, and quality.
b. Disseminates expert knowledge.
Evaluation of clinical practice: See nursing/nursing practice & organization/system sphere.
Conduct of research:
a. Participates in conduct of or implementation of research, which may include
identification of questions for clinical inquiry; conduct of literature reviews; study
design and implementation; data collection; data analysis; dissemination of findings.
7. Ethical Decision Making, Moral Agency and Advocacy Competency:
a. Facilitates resolution of ethical conflicts:
a. Identifies ethical implications of complex care situations.

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
 b. Considers the impact of scientific advances, cost, clinical effectiveness,
patient and family values and preferences, and other external influences.
c. Applies ethical principles to resolving concerns across the three spheres of
influence.
b. Facilitates patient and family understanding of the risks, benefits, and outcomes of
proposed health care regimen to promote informed decision-making.
c. Advocates for equitable patient care by:
a. Participating in organizational, local, state, national or international level of
policy-making activities for issues related to their expertise.
b. Evaluating the impact of legislative and regulatory policies as they apply to
nursing practice and patient or population outcomes.

Nursing/Nursing Practice Sphere of Influence Midterm Final

Student must be evaluated as competent in bolded competencies at final evaluation of GNUR
685/686 to pass the clinical component of this course.
Direct Care Competency
a. Identifies potential risks to patient safety, autonomy and quality of care based on
assessments across the nursing/nursing practice sphere of influence.
b. Assists staff in the development of innovative, cost effective programs or protocols of
care.
c. Evaluates nursing practice that considers safety, timeliness, effectiveness,
efficiency, efficacy and patient centered care.
Consultation Competency:
a. Provides consultation to intraprofessional colleagues.
b. Analyzes data from consultations to implement practice improvements.
System Leadership Competency:
a. Facilitates the provision of clinically competent care by staff through education,
role modeling, teambuilding, and quality monitoring.
b. Performs system level assessments to identify variables that influence nursing
practice and outcomes included by not limited to recurring practices that enhance
or compromise patient or system outcomes.
c. Determines nursing practice interventions that will promote patient, family and
community safety.
d. Uses effective strategies for changing behavior to encourage adoption of
evidenced-based practices and innovations in care delivery.
e. Evaluates impact of CNS and other nursing practice on systems of care using
nurse-sensitive outcomes.
Collaboration Competency:
a. Provides leadership for establishing, improving, and sustaining collaborative
relationships.
b. Practices collegially with medical staff and other members of the healthcare team
so that all providers’ unique contributions to health outcomes will be enhanced.
Coaching Competency:
a. Participates continuing education of nurses and other providers:
a. Completes a needs assessment as appropriate.
b. Promotes & implements professional development of staff nurses and
continuing education activities.
c. Mentors nurses to translate research into practice.

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
 b. Contributes to the advancement of the professional by disseminating outcomes of CNS
practice through presentations and publications.
c. Mentors others to acquire new knowledge and skills and develop their careers.
d. Mentors others in applying the principles of evidence-based care.
e. Uses coaching and advanced communication skills to facilitate the development of
effective clinical teams.
f. Provides leadership in conflict management and negotiation to address problems in the
healthcare system.
Research Competency:
Interpretation, translation & use of evidence:
a. Designs programs for effective implementation of research findings and other evidence
in practice.
b. Cultivates a climate of clinical inquiry across the nursing/nursing practice sphere
of influence:
a. Evaluates the need for improvement or redesign of care delivery processes
to improve safety, efficiency, reliability, and quality.
b. Disseminates expert knowledge.
Evaluation of clinical practice:
a. Fosters an intraprofessional approach to quality improvement, evidenced-based
practice, research, and translation of research into practice.
b. Uses quality monitoring data to assess the quality and effectiveness of programs in
meeting outcomes.
Conduct of research:
a. Participates in conduct of or implementation of research, which may include
identification of questions for clinical inquiry; conduct of literature reviews; study
design and implementation; data collection; data analysis; dissemination of findings.
Ethical Decision Making, Moral Agency and Advocacy Competency:
a. Fosters professional accountability in self or others.
b. Promotes a practice climate conducive to providing ethical care.
c. Facilitates intraprofessional teams to address ethical concerns, risks, benefits and
outcomes of patient care.
d. Promotes the role and scope of practice of the CNS to legislators, regulators, other
health care providers, and the public:
a. Communicates information that promotes nursing, the role of the CNS and
outcomes of nursing and CNS practice through the use of the media, advanced
technologies, and community networks.
b. Advocates for the CNS/APRN role and for positive legislative response to
issues affecting nursing practice.

Organization/System Sphere of Influence Midterm Final

Student must be evaluated as competent in bolded competencies at final evaluation of GNUR
688 to pass the clinical component of this course.
Direct Care Competency
a. Identifies potential risks to patient safety, autonomy and quality of care based on
assessments across the organization/system sphere of influence.
b. Assesses the impact of environmental/system factors on care.
c. Develops evidenced-based clinical interventions and systems to achieve defined
system outcomes.

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
 d. Differentiates between outcomes that require care processes modification at the
individual patient level and those that require modification at the system level.
Consultation Competency: See nursing/nursing practice sphere
System Leadership Competency:
a. Performs system level assessments to identify variables that influence nursing
practice and outcomes included by not limited to:
a. Population variables
b. Environment
c. System of healthcare delivery
d. Regulatory requirements
e. Internal and external political influences/stability
f. Health care financing
g. Recurring practices that enhance or compromise patient or system
outcomes.
b. Determines nursing practice and system interventions that will promote patient,
family and community safety.
c. Uses leadership in maintaining a supportive and healthy work environment.
d. Develops age-specific clinical standards, policies and procedures.
e. Uses leadership, team building, negotiation, and conflict resolution skills to build
partnerships within and across systems, including communities.
f. Considers fiscal and budgetary implications in decision making regarding practice
modifications:
a. Evaluates the use of products and services for appropriateness and cost/benefit
in meeting care needs.
b. Conducts cost/benefit analysis of new clinical technologies.
c. Evaluates impact of introduction or withdrawal of products, services, and
technologies.
g. Leads system change to improve health outcomes through evidence based
practice:
a. Specifies expected outcomes.
b. Designs programs to improve processes and outcomes.
c. Facilitates the adoption of practice change.
h. Disseminates outcomes of system-level change internally and externally as applicable.
Collaboration Competency:
a. Assesses the quality and effectiveness of intraprofessional, intra-agency, and inter-
agency communication and collaboration.
b. Establishes collaborative relationships within and across departments that
promote patient safety, culturally competent care, and clinical excellence.
c. Facilitates intra-agency and inter-agency communication.
Coaching Competency:
a. Mentors health professionals in applying the principles of evidence-based care.
Research Competency:
Interpretation, translation & use of evidence:
a. Analyzes research findings and other evidence for their potential application to
practice.
b. Assesses system barriers and facilitators to adoption of evidenced-based practices.
c. Cultivates a climate of clinical inquiry across spheres of influence:
a. Evaluates the need for improvement or redesign of care delivery processes

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
 to improve safety, efficiency, reliability, and quality.
b. Disseminates expert knowledge.
Evaluation of clinical practice:
a. Participates in establishing a quality improvement agenda for unit, department,
program, system or population.
b. Provides leadership in planning data collection and quality monitoring.
c. Uses quality monitoring data to assess the quality and effectiveness of programs in
meeting outcomes.
d. Develops quality improvement initiatives based on assessments.
e. Provides leadership in the design, implementation and evaluation of process
improvement initiatives.
f. Provides leadership in the system-wide implementation of quality improvements and
innovations.
Conduct of research:
a. Participates in conduct of or implementation of research, which may include
identification of questions for clinical inquiry; conduct of literature reviews; study
design and implementation; data collection; data analysis; dissemination of findings.
Ethical Decision Making, Moral Agency and Advocacy Competency:
a. Fosters professional accountability in self or others.
b. Facilitates intraprofessional teams to address ethical concerns, risks, benefits and
outcomes of patient care.
c. Advocates for equitable patient care by:
a. Participating in organizational, local, state, national or international level of
policy-making activities for issues related to their expertise.
b. Evaluating the impact of legislative and regulatory policies as they apply to
nursing practice and patient outcomes.
d. Promotes the role and scope of practice of the CNS to legislators, regulators, other
health care providers, and the public:
a. Communicates information that promotes nursing, the role of the CNS and
outcomes of nursing and CNS practice through the use of the media, advanced
technologies, and community networks.
b. Advocates for the CNS/APRN role and for positive legislative response to
issues affecting nursing practice.

Preceptor Comments: (midterm evaluation)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Student Comments: (midterm evaluation)

Strengths & future learning needs:

__________________________________________________________________________________________

__________________________________________________________________________________________

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14
Preceptor Comments: (final evaluation)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Student Comments: (final evaluation)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

P D C O
Please rate this students overall clinical performance in this course:

Total number of precepted clinical hours: ______________

Preceptor Signature: _______________________________ Date: _____________

Student Signature: _______________________________ Date: _____________

Faculty Signature: ________________________________ Date: ____________

Adopted from National CNS Competency Task Force (2010). Clinical Nurse Specialist Core Competencies.
Available: http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf
TBC revised 9/06, TLS revised 11/13, 01/14