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Name: Job Title: Department: Appraisal Date: Review Period: Appraised by: From: To: Employee ID: Hire Date: Overall Score:
Professional Equipment: A graduate of an accredited LPN program. Holds a current, valid state license. UNIT SPECIFIC: MED / SURG: Recent acute M/S experience preferred. ACUTE REHAB: Recent Acute Rehab experience preferred. FIM certification within 6 months. Physical Requirements: Demonstrates good oral and written communication skills. Demonstrates basic computer knowledge. Must be able to assist with the movement of an adult patient weighing up to 300 pounds. Must be able to stand and walk for extended periods of time. Must be able to distinguish colors. Able to care for patients with infectious diseases. Able to administer aerosol medications. Exposure Categories: None
Definition of Ratings
5.0 – Outstanding (exceptional; consistently exceeds expectations) 4.0 – Exceeds Expectations (consistently meets, and frequently exceeds expectations) 3.0 – Competent (conforms to standards, meets expectations) 2.0 – Needs Improvement (does not consistently meet expectations) 1.0 – Unacceptable (significantly below standard and unsatisfactory)
Hospital Behavioral Expectations
Performance Level Competency Performance Level Comments
Score: / 5.0 (25%)
5 – Outstanding; 4 – Exceeds Expectations; 3 – Competent; 2 – Needs Improvement; 1 – Unacceptable.
1.1 Courtesy: A. Acknowledge a customer's presence immediately by making eye contact. Respond in a warm professional manner. When possible, personalize conversations by using names.
give people your full attention. 1. C. privately. B. C. C.3 Communication: A. Acknowledge call lights within one minute. When answering the telephone. D. B.2 Respect/Privacy: A.B. Seek constructive feedback regarding his / her own practice. Address your concerns with co-workers professionally and privately 1. Anticipate patient needs. B. Close curtains for patient privacy as appropriate. Take ownership and responsibility for addressing problems. Acknowledge customer concerns immediately. 1. C. Cooperate with others. Listen carefully: do not interrupt. friendly tone. always identify yourself and speak in a professional.4 Responsiveness: A. Measure: Based on supervisory observation. Take initiative. B. 1.5 Teamwork: A. Keep patients and families informed about their progress through the system. (7%) (7%) (6%) (6%) (7%) (7%) (7%) (6%) (6%) (7%) (7%) (7%) (7%) (6%) 2 . Knock or announce your arrival before entering private patient areas. Discuss confidential or sensitive information only with appropriate parties.
(8%) (8%) (7%) (8%) (8%) (8%) (8%) (8%) (7%) 3 . The LPN collaborates with the patient's family. Nursing care is based on identified nursing diagnoses/care needs. The patient and/or significant other(s) are involved in the patient's care as appropriate.3 Evaluation: The LPN evaluates the patient's progress towards attainment of desired outcomes. physician and other clinical disciplines in making decisions regarding each patient's need for nursing care. Nursing care is based on standards of patient care. E. F. 3 – Competent. B. Performance Level Comments Score /5. 2. The LPN implements patient education and involves the patient. A. B. A.Nursing Process Performance Level Competency Score: / 5. and is consistent with the therapies of other disciplines.1 Diagnosis / Care Needs: The LPN analyzes the assessment data to identify care needs. family and/or significant other(s) as appropriate. Nursing care is prioritized based on assessment of patient's immediate condition or needs. 1 – Unacceptable. Evaluation of the patient's response to nursing care is evident in the ongoing assessment data. 2. D. The LPN formulates a plan to provide appropriate care based on identified patient needs.2 Implementation: The patient's nursing care is based on identified nursing diagnoses/care needs and patient care standards.0 2. 2 – Needs Improvement. A. C.0 (25%) 5 – Outstanding. 4 – Exceeds Expectations. Nursing diagnoses/care needs are derived from the assessment data.
4 – Exceeds Expectations. Nursing diagnoses/care needs are revised based on reassessment data. Performance Level Comments Score /5.0 3. and nursing intervention on appropriate chart forms.2 The LPN applies Standard Precautions during patient contact and when handling contaminated materials. C. Documents medications. 2.0 (25%) 5 – Outstanding. (8%) (7%) (7%) (8%) Quality Patient Care Performance Level Competency Score: / 5. 2 – Needs Improvement. 3. concise manner. Completes Discharge Instruction Sheet as appropriate. A. B.4 Documentation: Documents patient care management in clear. 3.B. 1 – Unacceptable. (25%) (25%) (25%) 4 . treatments. and nursing intervention on the patient care record.3 The LPN incorporates performance improvement recommendations for change in practice and uses the recommendations to improve the quality of nursing care. Measure: Based on chart review of 6 charts. Records patient's response to hospitalization. 3 – Competent. treatments.1 The LPN provides patient care according to established nursing standards and policies and procedures.
(25%) (25%) (25%) 5 . needles.3. utilizing Five Rights of Medication Administration. BLS. 2 – Needs Improvement. Consider the following items to determine the rating: • Does the LPN follow the restraint policy and procedure? • Does the LPN always adhere to standard precautions by washing hands and gloving appropriately? • Does the LPN utilize available safety devices? i. IV caths and securement devices. ACLS and ATCN as required by units.1 The LPN acquires and maintains current knowledge in nursing practice. Safety Carnival and other educational offerings as appropriate. 4. Measure: Based on supervisory observation.0 (15%) 5 – Outstanding. avoiding overrides. etc. 4. The LPN uses the Pyxis appropriately. 3 – Competent.4 The LPN administers medications and IV's appropriately.? (25%) Education Performance Level Competency Score: / 5.e. wasting medications appropriately. Maintains NRP. using Pyxis tape as intended. 4 – Exceeds Expectations.3 Attends 80% of Unit Staff Meetings. The LPN consistently utilizes "two unique identifiers" with patients. Performance Level Comments Score /5. • Do patients have armbands/allergy bands? • Does the LPN use the Pyxis appropriately. 1 – Unacceptable.0 4. PALS.2 Attends 80% of Mandatory Licensed Staff In-Services to include Nursing Skills Festival. following hospital policy and procedures.
the LPN must score a "1" for the entire standard. (25%) (25%) (25%) (25%) Goal Results Objectives Title: Accomplishments 6 . • If 4. applying age specific principles of learning.0 (10%) 5 – Outstanding.4 Completes 100% of yearly mandatory hospital education programs: 1 Fire Safety 2 Patient/ Personal Safety 3 Infection Control / OSHA (25%) 4 5 External / Internal Disaster BLS Measure: Employee Education Record.4 Provides patient/family education as appropriate.2 Administers medications appropriately and safely for age specific variations.3 Provides safety measures appropriate to age of patient. 3 – Competent. 4 – Exceeds Expectations. 5.4 is not met. 5. 2 – Needs Improvement. Consider the following to determine the rating: • The LPN must attend 80% of both the Mandatory Licensed Staff meetings as well as 80% of Unit Staff meetings to score a "2" under this standard. Measure: Based on chart review of 6 charts and observation.4. 1 – Unacceptable. Age Appropriate Care Performance Level Competency Score: / 5. 5. Performance Level Comments Score /5. If the LPN attends greater than 80% this gives him/her a chance to exceed in this standard.0 5.1 The LPN completes his/her annual competency as related to Age Appropriate Care.
SMART goals should be: S – Specific M – Measurable A – Attainable R – Realistic T – Time-bound Objectives Title: Weight Development Plan Development Objectives Title: Manager’s Comments 7 .Objectives Title: Accomplishments Objectives Title: Accomplishments Next Year’s Goals Goals for the upcoming year should be established by the manager and employee. SMART goals will help to focus efforts and clearly define objectives.
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