RN Case ManagerRN Peer Input Tool for Annual Evaluation: Advocacy

Peer feedback for(RN name):

Directions:

  • Evaluatee to send domainportions to peers who evaluatee would like feedback from
  • Clinical Thinking and Judgment domain is to be completed by another RN
  • Peers should indicate within the last column the level they feel is appropriate for the Evaluatee on each row
  • Peers are encouraged to support their views with concrete examples
  • Peers should complete the peer review within 7 Days and return electronically to the Manager/Designee and Evaluatee

Role Entry / Competent / Expert / Mastery / Peer Should Designate Appropriate Level Below
DOMAIN: Advocacy: Working on another’s behalf, representing the concerns of the patient/family/community, and serving as an agent in identifying and helping to resolve ethical and clinical concerns within the clinical setting
Patient/Family Involvement in Decision-Making
Recognizes, respects, and supports, and supports patient/family rights and maintains confidentiality.
Aware of UMHS patient rights and responsibilities. / Promotes patient’s self-determination in all decisions, honoring that right even when decisions differ from recommendations of the healthcare team, and assists the health team’s understanding of and respect for the patient’s decisions. / Advocates and facilitates on behalf of patients and families for service access or creation, and for the protection of the patient’s health, safety, and rights.***
Recognizes limitations to patient’s autonomy preventing imminent danger to the patient or others.
Goal Setting
Knows, understands, and honors patient’s goals for discharge plan.
Develops a plan for the day and plan for the stay that is based on patient goals. / Identifies critical elements of patient story in order to collaboratively and optimally facilitate patient/family goal setting for transitions of care. / Evaluates patient/family’s level of understanding and comfort with progress towards goals and potential need for goal revision.
Identifies multidimensional (physiological, social, and spiritual) factors and integrates into ongoing goal setting and individualized plan of care.
Advocacy with Payers
Assures that patient receives information on benefits and costs related to current stay and post-discharge care and services.*** / Negotiates with payers regarding available options for transitions of care and informs patient of risk/cost/benefit of all options.*** / Identifies trends and issues in payer coverage that impact patient service delivery and works to resolve them at individual and system levels.***
Please describe a time when you saw me at my very best. What qualities did I display in this domain?
Please provide your input regarding opportunities for my personal and/or professional growth
I have completed the Peer Feedback Class as required by the UMPNCcontract, paragraph 28E, for participation in the peer review process.
Name: / Date:

Revised 7/2015 Professional Development Framework RSAM Steering Committee/JIT Approved.

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