Preceptor Evaluation Feedback Forms - School of Nursing

UNIVERSITY OF BRITISH COLUMBIA SCHOOL OF NURSING
Nursing 427 Consolidated Practice Experience
Preceptor Evaluation of Student
Preceptor
Student:
Preceptor
Signature:
Date:
Student performance and learning are evaluated based on the UBC Program/Course Outcomes that are consistent with the CRNBC’s Standards of Practice.
1. Practices within the scope of professional nursing.
Exemplars of student attributes
1.1 Consistently applies and justifies application of the Professional Standards at current level of practice.
MP = Mid-point F =
Final
Consistent
Inconsistent Not Observed
MP F MP F MP F
1.2 Consistently applies a variety of knowledge, skills, attitudes and judgments in providing nursing care for
individuals, families, communities, and populations.
1.3 Consistently demonstrates accountability and responsibility in the performance of nursing roles and
responsibilities.
1.4 Performs safe and effective nursing care (i.e. psychomotor, communication and use of appropriate technology).
1.5 Completes all nursing care in a timely manner and in accordance with agency policies and protocols
1.6 Gives and receives constructive feedback and acts on feedback to promote competence.
1.7 Seeks opportunities for professional growth and development
1.8 Other:

2. Engages in relational practice with individuals, families, communities and populations.
Exemplars of student attributes
2.1 Fosters quality in relationships with all parties involved in health care encounters.
MP = Mid-point F =
Final
Consistent
Inconsistent Not Observed
MP F MP F MP F
2.2 Strengthens ability to engage relationally at individual, family, group and community levels.
2.3 Communicates in a clear and accurate written and verbal format.
2.4 Incorporates a critical inquiry and relational process to conduct organized and comprehensive assessments that
emphasize client input and determinants of health.
2.5 Supports clients in making informed decisions about their health care and respects those decisions.
2.6 Critically examines assumptions and variables in client care situations.
2.7 Recognizes and assumes responsibility for own values and beliefs and how they influence nursing care.
2.8 Other:
3. Uses critical inquiry in the provision of health care for individuals, families, populations, and communities.
MP = Mid-point F =
Final
3.1 Engages in critical problem solving.
Exemplars of student attributes
3.2 Draws upon research evidence, experiential knowledge, knowledge from other disciplines, and nursing’s distinct
disciplinary perspective to make practice decisions about the health and healthcare experience of the client
3.3 Critically analyses the social context of health and health care.
3.4 Applies critical thinking and systematic inquiry to support best practice in delivery of care.
Consistent
Inconsistent Not Observed
MP F MP F MP F

3.5 Other:
4. Exhibits leadership in the provision of health care for individuals, families, populations, and communities.
MP = Mid-point F =
Final
4.1 Practices according to the ethical standards of nursing.
Exemplars of student attributes
4.2 Applies basic leadership and management concepts within the healthcare context
4.3 Advocates for holistic, client-centered care across the health care continuum.
4.4 Demonstrates awareness of basic organizational concepts, such as the organizational vision and mission, the
organizational chart, and chain of command.
4.5 Uses effective time management skills, such as organization and prioritization when planning and implementing
care.
4.6 Identifies appropriate resources, material and human, to utilize in professional practice.
4.7 Recognizes the importance of professional and institutional policy and procedures in the delivery of health care.
4.8 Other:
Consistent
Inconsistent Not Observed
MP F MP F MP F
5. Engages in inter-professional practice in the provision of health care for individuals, families, populations, and communities.
MP = Mid-point F =
Final
Exemplars of student attributes
5.1 Functions in a collaborative capacity as a member of the healthcare team.
Consistent
Inconsistent Not Observed
MP F MP F MP F

5.2 Integrates inter-agency and community resources when planning and providing care for clients.
5.3 Maintains effective interprofessional communication as part of a health care team.
5.4 Utilizes professional ethical and legal standards in health care decision-making.
5.5 Other:

N427 Preceptor Mid-Point Evaluation of Student
Student Name:
Placement Site:
Type of Placement:
Comments:
Achievements & Strengths:
Areas to work on next:
Clinical Absences (Number of Days/Hours missed)
Days Absent Total Hours Missed Reason
Preceptor Signature: _____________________________________
Name of Preceptor: ______________________________________
Date: ____________________

N427 Preceptor Final Evaluation of Student Competencies
Student Name:
Placement Site:
Type of Placement:
Comments:
Achievements & Strengths:
Areas to work on for the future:
Clinical Absences (Number of Days/Hours missed)
Days Absent Total Hours Missed Reason
I confirm that this student:
Successfully completed all of the clinical requirements for N427
Has not completed the clinical requirements for N427
Preceptor Signature: _____________________________________
Name of Preceptor: ______________________________________
Date: _____________________________

Feedback: Preceptor Perspective
Please complete this evaluation of the Nursing 427 experience from your perspective as a preceptor. The completed
form should be placed in a sealed envelope and signed on the seal, and returned to the faculty member at the time of
the final evaluation interview. Alternatively, the form may be returned to the N427 Course Leader/Coordinator by
fax: 604-822-7466 or by mail: UBC School of Nursing T201-2211 Wesbrook Mall Vancouver BC V6T 2B5.
Please indicate the degree to which you agree with each of the statements below by placing a checkmark in the
appropriate column.
1. The information I received helped me to
understand the course.
2. The contact with the faculty organizing the
experience was useful.
3. The approach used to organize the shifts the
student would work was appropriate.
4. General objectives about the experience were
shared with me.
5. Information about the student’s psychomotor
skills competencies was useful.
6. The student’s own objectives clarified his/her
learning needs for me.
7. The student was prepared for the experience.
8. The faculty member was accessible to me as
needed during the experience.
9. The faculty member assisted with the
evaluation of the student.
10. If I had concerns about the student’s
performance, the faculty member was available
to help me.
11. I would rate the overall experience as positive.
Strongly
Agree
Agree
No
Opinion
12. To what extent did sharing the student’s learning plan facilitate the learning process
Disagree
Strongly
Disagree
13. What was the most helpful thing the student did to facilitate the learning process
14. What was the most helpful thing the faculty member did to facilitate the learning process
15. What was the most helpful thing in the context of the clinical environment that facilitated the learning process
Agency/Unit
Student
Preceptor
Date
Thank you for your feedback, it is important to us.