7/27/2019 Preceptor Evaluation Form

1/2

Hondros College School of Nursing

Nursing 299

Guide to Role Transition

Preceptor Form To Evaluate Student Performance

Student Name: ________________________________Preceptor Name:_______________________________

Clinical setting:____________________ Date:__________

KEY: The purpose of this tool is to demonstrate student progress and achievement intheir role transition. The goal is that the student performs skills safely and accurately,

maintains confidentiality, manages a client load efficiently, and acts in a professional

manner. Students must achieve a satisfactory rating in role transition to pass the course.

This feedback will be shared with the faculty member and the faculty member will

conduct a final course evaluation clinical tool utilizing preceptor feedback.

Rating Designation Description

4 Exemplary

Performs specified function safely and accurately,

achieving desired effect and with appropriate affect

each time. Performs efficiently and capably. Functionswith minimal supporting cues.

3 Satisfactory

Performs specified function safely and accurately,

achieving desired effect and with appropriate affectmost of the time. Occasionally functions inefficiently

within a delayed time period. Required occasionaldirective and/or frequent supporting cues.

2Needs

Improvement

Requires direct supervision to ensure specified function

is performed safely and accurately. Demonstratesconsiderable expenditure of excess energy in

performance behaviors. Requires frequent directive

and supportive cues.

1 Unsatisfactory

Lacks knowledge about application of nursing

principles. Unsafe or unable to demonstrate behaviors.

Lacks coordination and efficiency. Requires constantdirective cues.

7/27/2019 Preceptor Evaluation Form

2/2

Hondros College School of Nursing

Nursing 299

Guide to Role Transition

Preceptor Form To Evaluate Student Performance

Student Name: ________________________________

Preceptor Name:_______________________________

Clinical setting:____________________ Date:__________

4 3 2 1

1. Student asks pertinent questions relevant to patient care

2. Organizes assignments

3. Demonstrates understanding of responsibilities

4. Demonstrates understanding of patient needs for assignments

5. Has problem solving and decision making ability

6. Asks for assistance appropriately

7. Practices in a safe manner for patients, self, and other staff

8. Interacts well with staff, patients, and physicians

9. Completes assignments in a timely manner

10. Utilizes resources well11. Identifies own learning needs

12. Non-judgmental, on time, prepared, and displays professional appearance

13. Honest, dependable and follows agency policies

14. Seeks out additional learning experiences, motivated to learn

15. Keeps client information confidential in accordance with HIPAA

Comments and suggestions for improvement:

_____________________________

Preceptors Signature & Date: