Assignment 5: Evaluation of Clinical Performance and Clinical Failure

Marjorie Reilly
SUNY Delhi
NURS 603, CRN 11373, Measurement and Evaluation in Nursing Education
Kirsty Digger
December 3, 2016

Assignment 5: Evaluation of Clinical Performance and Clinical Failure

Student Scenario
*Content based upon QSEN Competencies and KSAs.
Developed 6/2016

Jane Doe is a first-year first-semester student in an ADN nursing program. Jane is an LPN with 7 years of
experience who attempted to challenge out of NU 101, but was unsuccessful. Jane continued to work full time
as an LPN while also attending nursing school and completing co-requisite coursework. Jane has passed her corequisite courses, but still has three courses that must be completed with NU 102 in order to progress to NU
201. Jane has passed the theory and lab components of the program, but has demonstrated consistently
unsatisfactory performance in the clinical component of the program, despite multiple conferences and
extensive written feedback providing formative discussion and evaluation of students strengths and areas for
learning, and the development and implementation of a learning contract.
Her semesters end clinical performance evaluation is as follows:

XYZ School Clinical Evaluation tool

Clinical Performance Evaluation Tool
Student
Name

Jane Doe

Faculty
Name

Marjorie Reilly

*Content based upon QSEN Competencies and KSAs.

Developed 6/2016

Semes
ter

Fall 2016

Student must obtain a 3 (75%) and a yes (Y) in all competencies at the final
evaluation for the course.
Core Competencies

Scor
e
Students will begin to develop critical thinking abilities utilizing the nursing process in the roles
of communicator and caregiver. Students will learn principles of professional nursing practice
and provide direct care to individuals in a variety of settings while recognizing the diverse
uniqueness of individuals with health alterations.
I. Patient-Centered Care
a. Begin to develop an individualized plan of care with a focus on assessment and
planning utilizing the nursing process. Begin to Interpret and utilize patient
assessment data to modify patient care.
b. Demonstrate caring behaviors. Communicate effectively with client.
c. Conduct a basic assessment while eliciting patient values, preferences, needs, with
respect for diversity.
d. Deliver care based on beginning knowledge of pathophysiology with respect for
individual values, preferences, needs, and diversity.
e. Assess the presence and extent of pain and suffering.
f. Demonstrate beginning competency in skills.
II. Teamwork and Collaboration
a. Develop effective communication skills with all appropriate members of the
healthcare team
b. Begin to develop collaboration skills in working with the inter-disciplinary team
members to address client care needs
c. Participate in pre and post conferences to identify patient needs and methods to
deliver care more effectively for the next interaction.
d. Demonstrate awareness of own strengths and limitations as a team member.
e. Initiate requests for help when appropriate to situation.
III. Evidence-Based Practice
a. Begin to understand the concept of evidence-based practice in determining best
clinical practice
b. Begins to utilize evidenced-based resources for clinical learning and practice
IV. Quality Improvement
Begin to deliver care in a timely and efficient manner.
Begin to identify areas and information in the health care setting about
processes/projects to improve care (QI).
Begin to understand the importance of variance reporting in how it impacts patient care
protocols and risk prevention. For example: Fall Risk
V. Safety
a. Integrate effective use of technology and standardized practices that support safety.
b. Implement strategies to reduce risk of harm to self or others.
c. Begin to recognize and report abnormal findings
d. Recognize and adhere to national patient safety guidelines that affect outcomes for
patients and families.
e. Perform clinical procedures demonstrating appropriate knowledge and skill.
f. Examine the healthcare environment to determine patient and family safety needs
g. Develop the awareness of the impact of unsafe practices by self and others and
communicate findings to appropriate healthcare providers.
*Content based upon QSEN Competencies and KSAs.
Developed 6/2016

3
3
3
3
3
2
2
2
2
2
3
3
3
3
3

3
3
2
3
2
3
1

h. Organize client care in a timely, effective, and safe manner

VI. Informatics
a. Navigate the patient written/electronic health record to plan patient care and
monitor changes in patient status.
b. Begin to document clear and concise responses to care in the patient
written/electronic health record as appropriate to the clinical setting.
c. Manage data, information, and knowledge of technology in an ethical manner.
Protect confidentiality of electronic health records.
VII.
Professionalism
a. Recognize and begin to demonstrate core professional values (caring, altruism,
autonomy, integrity, human dignity, and social justice).
b. Maintain professional behavior and appearance.

c. Provide evidence of preparation for clinical learning experiences.

d. Comply with the Code of Ethics, Standards of Practice, and policies and procedures
of XYZ University,
School of Nursing and clinical agencies.
e. Accept constructive criticism and participate in plan of action for improvement.
f. Maintain a professional attitude when interacting with inter-disciplinary team
members, faculty, and fellow students.
g. Arrive to clinical experiences at assigned times.
h. Demonstrate professional behaviors
i. Accept individual responsibility and accountability for nursing interventions,
outcomes, and other actions.
j. Engage in constructive self-evaluation.
k. Assume responsibility for learning.
TOTAL SCORE ( of 128 points possible)

1
2

2
2
3

2
2

1
1
1
1
1
1
1
83

*See clinical evaluation tool guidelines for full descriptions of grades 1-4
(Exemplar must include correlating core numbers I-VII and knowledge, skills, and attitude letter
(KSA))
4-exceeds
expectations

3-meets
expectations

2-below
expectations

1-does not meet

expectations

Faculty Comments:
Jane,
Although your grade for your clinical performance indicates failure, it is my hope that you will
accept my feedback in the spirit in which it is intended. I hope that this feedback will help you to
reflect upon your experiences this semester, and to ultimately make the decision as to whether
you wish to continue to pursue a career as a registered nurse.
The feedback I have given you here is to be used as a summary of your performance so that you
will understand the areas in which you did not meet clinical outcomes. As you know, our
meetings and my continual feedback throughout the semester, in addition to the learning
contract we developed together, were meant to be more diagnostic of issues with creation of
plan of action. That said, we will discuss your future options at our scheduled face-to-face
*Content based upon QSEN Competencies and KSAs.
Developed 6/2016

meeting later this afternoon.

Clinical Performance Evaluation

Patient-Centered Care-You met expectations in all of the competency areas of patientcentered care. You demonstrated the ability to begin to conduct assessments and to begin
developing individualized care plans that took into consideration basic pathophysiology, patient
cultural considerations, values and preferences. You also demonstrated beginning competency in
skills.
Teamwork and Collaboration-You did not communicate adequately with your instructor,
primary nurse, ancillary staff or peers. You were unable to identify when you were falling behind,
and were often unwilling to ask for assistance in areas with which you were unsure. In addition,
you were unable to participate fully in pre-conference due to inadequate preparation. Your post
conference participation reflected an inability to conduct a self-assessment to help you identify
areas for remediation and improvement in future rotations.
Evidence-Based Practice-You were able to implement beginning concepts of evidence-based
practice into your care of patients. However, this area could have been much stronger with
better clinical preparation and use of resources to enhance both your learning and
implementation of evidence-based concepts.
Quality Improvement-This was most definitely an area of strength for you. You were able to
identify a number of variance and quality improvement areas that would significantly impact
quality and safe delivery of patient care. In addition, these astute observations which you shared
with your peers were very educational, and helped your peers to begin cultivating an awareness
of these areas, and possible solutions for remediation. You were also able to deliver care to
individual patients in a timely and efficient manner. However, as I mentioned above, there were
many occasions when you failed to identify that you were falling behind in your other nursing
responsibilities.
Safety-Your lack of clinical preparation compromised your ability to provide safe care. Your
inability to identify abnormal lab values, vital signs, and physical findings adversely impacted
your ability to report and/or act upon these findings promptly, or at all. Here, your lack of
communication and lack of awareness of your need for assistance also contributed to
compromised safety for your clients. Although you were adept at providing AM care to your
patients, you failed to progress in your ability to gather, integrate, and analyze assessment data.
Although these issues were often identified by your primary nurse and instructor, your deficits in
this area could have ultimately resulted in delay in treatment or other repercussions for your
patients resulting from your failure to assess and failure to rescue.
Informatics-Although you were able to navigate the electronic medical record well and were
very careful in your handling of patient health data, your lack of preparation reflected suboptimal use of these available resources. In addition, your lack of preparation also contributed to
your inability to recognize abnormal findings, or to recognize trends (positive or negative) in your
patients. Your documentation showed minimal improvement throughout the semester, but
ultimately reflected your inability to conduct and document a comprehensive assessment.
Professionalism-You often arrived to clinical late and unprepared. Not only did this impair your
*Content based upon QSEN Competencies and KSAs.
Developed 6/2016

ability to safely care for your patients, you missed many valuable learning opportunities offered
by participation in our pre-conference work. In addition, your uniform was often wrinkled, you
appeared generally disheveled, you did not consistently have necessary equipment
(Stethoscope, watch, etc.). You were often flustered and unable to participate fully in preconference, nor were you able to engage in effective SBAR report with your patients primary
nurse. You were often short in your interchanges with instructor, peers, primary nurse and
ancillary staff, this also demonstrated a lack of professionalism, and was also a contributing
factor in your ability to provide safe and effective patient care. Due to your lack of preparation,
lack of professionalism, and impaired communication ability, you were often unable to plan and
conduct patient care independently, reflecting an inability to work autonomously. Finally, you
were unable to engage in adequate self-evaluation of your learning and performance deficits.
This exhibited itself in a number of ways including an external locus of control in which you
looked to external forces rather than to yourself in your identification and remediation of issues.
This, in addition to the other areas I have discussed, contributed to your inability to accept
responsibility for your learning.

Dec 19, 2016

Jane,
As I said earlier, I hope you will accept my feedback with an open mind. Although your clinical
performance this semester did not meet the clinical outcomes, I saw a great deal of unrealized
potential in you. I know that you had many factors contributing to your inability to meet
outcomes despite our shared efforts to address your issues. It is my hope that your experiences
this semester will be used by you as learning points which will help you in your decision as to
whether you wish to be readmitted to nursing.
We will discuss this clinical evaluation later this afternoon in our face-to-face meeting. I would
ask that you come prepared with questions regarding anything you might like clarified. Once you
have determined your future course of action, it would be my pleasure to help you proceed
accordingly. Should you decide to seek and successfully achieve readmission, it will be a pleasure
to once again work with you to help you reach your goal of becoming a registered nurse.

Marjorie Reilly

* Please note there is usually a signature page for faculty in addition to student comments and
signature

*Content based upon QSEN Competencies and KSAs.

Developed 6/2016

*Content based upon QSEN Competencies and KSAs.

Developed 6/2016