Total Hours (Clinical + Simulation) = ______

1 of 8

Clinical Hours / Simulation hours
Date / Time / Hours / Instructor Initials / Date / Time / Hours / Instructor Initials
Total / Total

Total Hours (Clinical + Simulation) = ______

Instructor Name (Printed) Signature Initials Instructor Name (Printed) Signature Initials

Do not write below this line. For Clinical Facilitator only.

Items Reviewed:_____ Clinical/Simulation Hours_____ Clinical Evaluation Tool

_____ Reflective Logs _____ Wonderlic

______

Clinical Facilitator SignatureDate

NRS 470C – Leadership and Management

Clinical Evaluation Form – To Be Completed by Clinical Instructor

Complete One Column Per Week

Indicate in the space provided the level of performance

S= Satisfactory, acceptable performance (does not require comments)P= Progressing towards satisfactory (instructor comments optional)

U= Unsatisfactory, failing performance (must contact course coordinator immediately, requires comments from instructor)

NYO= Not yet observed

***Student must obtain “Pass” for each objective by the end of the clinical rotation to progress in the nursing program***

Date / Final ***
Instructor Initials (Please sign last page)
OBJECTIVES: / Pass/Fail
Demonstrate acceptable professional behavior according to standards of professional nursing practice. (CO 1-16)
Use professional literature to support assessment and nursing interventions. (CO 13)
Include nursing interventions that support patient advocacy and compassion. (CO 6, 10, 11, 12, 14, 15)
Incorporate principles of relationship-based care across the lifespan. (CO 1-16)
Assess the bio-psycho-social-cultural and spiritual needs of the client and family as they relate to personal goals of wellness. (CO 3, 6, 15)
Identify professional, legal, and ethical behaviors at all times by collaborating with other members of the health care team in providing care to assigned patients. (CO 2, 6, 8, 11, 12, 14)
Incorporate concepts of teaching-learning in nursing care to deliver health teaching and promote health. (CO 11, 12, 13, 14)
Utilize effective communication skills with pediatric clients, families, peers, and members of the health care team in order to promote, maintain, or restore an optimal level of health. (CO 4, 5, 7, 9)
Correlate principles of growth and development to nursing care of individuals and groups. (CO 11, 12, 16)
Utilize the steps of the nursing process to plan, prioritize, and implement realistic nursing interventions for clients with complex needs and/or within a complex care environment to promote, maintain, or restore an optimal level of functioning. (CO 1-16)
Acknowledge the need for personal and professional life-long learning. (CO 14)
Instructor Comments:
(Students to initial all comments)

Final Evaluation Pass Fail

Additional comments from student/clinical instructor:

Student Signature ______Date ______Clinical Instructor Signature ______Date ______

NRS 470C – Leadership and Management

Reflective Log 1

To be completed by student on the first day of clinical rotation

Date______

1. Discuss you expectations for this leadership clinical experience.

1. What leadership roles and responsibilities were observed?

1. Describe the management and communication style of the leader you observed today.

Instructor Initials ______

NRS 470C – Leadership and Management

Reflective Log 2

To be completed by student after completing ~ 30 hours of clinical rotation

Date______

1. What conflicts or problems has the leader encountered?

1. What strategies were utilized by the leader to resolve the conflicts or problems?

1. Identify strategies utilized by the leader to improve team dynamics.

Instructor Initials ______

NRS 470C – Leadership and Management

Reflective Log 3

To be completed by student on the final day of clinical rotation

Date______

1. What impact does the leader have on the organization? How does this impact patient safety?

1. What leadership qualities do you feel you possess?

1. How do you plan to incorporate and/or demonstrate leadership skills in your own professional nursing practice?

Instructor Initials ______

Confidentiality Consent for Leadership Clinicals

Student shall not at any time during their clinical rotation or thereafter disclose to any person or entity any confidential information learned or obtained while working with a clinical instructor during their leadership clinical experience at Denver School of Nursing.

______

Student SignatureDate

Student Name ______Clinical Quarter ______Year______

Revised 03.28.14