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Multi Rater Competency Assessment

2015 - 2016 - NURS 253 Practical Nursing Pre-graduate Experience MRA Final (201508)
NURS 253 Practical Nursing Pregraduate experience (PN, 18-Jan-2016 - 07-May-2016)
Student :
Clinical Teacher/Preceptor :
Advisor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Description :
Period :
Student hours :
Required Hours :
Validated hours :

Hayley Nolan
Gita Tarasiuk
Farah Jabri
Judy Martin
Milton District Hospital
Agency
ED
RAFT
18-Jan-2016 To 07-May-2016
448
448
448

I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes

Student Rating

Teacher Rating

1. Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and procedures of the
practice setting.

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies and

Satisfactory

Satisfactory

procedures.
H.N. : I abide by the standards created by Halton Healthcare Services, Humber College Institute of Technology (HCTAL) and Advanced Learning and
College of Nurses of Ontario (CNO). I ensure that I have access and I regularly review literature and resources provided by the facility, college and
CNO (i.e. Humber College Practical Nursing Handbook, CNO practice standards, etc.) If I have questions, I discuss this with my clinical advisor, the
student advisor at Milton District Hospital and/or clinical preceptor prior to acting. I ensure that I let relevant members of the healthcare team (i.e.
physicians, paramedics, etc.) my role as a student and clarify if I can and/or cannot perform an action. For example, I cannot witness a waste of a
medication such as a narcotic. I share this with other nurses when they ask and do not perform the action.

G.T. : Agreed

1. 2 Act in a professional, responsible, ethical and accountable manner.

Satisfactory

Satisfactory

H.N. : I act in a responsible, ethical and accountable manner outside and inside of the clinical setting. This includes being responsible for my actions
in regards to nursing care which includes documenting interventions and assessments. I ensure that I represent the values and expectations of the
facility, CNO and Humber College. I use my knowledge, skills and judgement to make clinical decisions that support the well-being of the patient. I
understand that I am responsible for my actions and/or care that I provide, therefore, I accept the potential consequences of my actions. I demonstrate
my competence with the guidance and supervision of my preceptor and/or other nurses.

G.T. : Agreed

1. 3 Use the three factor and decision making frameworks to determine strengths and limitations and
when to collaborate and consult with other professionals.

Satisfactory

Satisfactory

H.N. : As a student nurse, I consistently use the three-factor framework (nurse, client and environment) provided by the College of Nurses (CNO)
when accepting patient assignments. In addition, I also abide by the criteria for the rapid assessment fast tracking (RAFT) program in the emergency
department (ED). If I am concerned that a patient assignment does not meet the criteria for the RAFT program I inform my clinical preceptor. For
example, a patient with a head injury with loss of consciousness (>1 minute) after a motor vehicle accident with multiple hematomas and nausea was
sent to RAFT. After my initial assessment, I immediately informed my preceptor because I did not believe that the patient met the criteria of RAFT. I
also considered the three-factor framework when making this decision. We agreed that the patient did not meet RAFT criteria and we discussed the
issue with the physician. Further, I am continuously assessing my capabilities and competence.

G.T. : Agreed

1. 4 Integrate evidence-informed practice and a theory based approach into nursing care.

Satisfactory

Satisfactory

H.N. : I have learned from my current and prior clinical experience that evidence-informed practice goes hand-in-hand with decision making. I am
aware that all good clinical decisions are guided by research. . I use the knowledge I have obtained from prior clinical practice, simulation scenarios,
lectures, textbooks and life experience to guide my practice. I ensure that I have adequate access to resources on the unit (i.e. bringing textbooks,
having access to a computer). I also utilize the knowledge and skills from experienced nurses when I have questions.

G.T. : Agreed

1. 5 Assess practices and risk management principles and take action to ensure safety of clients,

Satisfactory

Satisfactory

self, and others.


H.N. : I ensure that I assess for safety during my initial "critical look" or general survey when providing patient care. I address any potential safety
concerns with my clinical preceptor. I use various safety measures such as ensuring beds are in the lowest position, ensuring the call bell is within
reach, practicing routine practices and contact/droplet/airbourne precautions when necessary, etc. I actively participated in a Crisis Prevention
Intervention training with my preceptor and other memebers of the unit. It gave me additionals the skills to assess and deal with situations which may
pose safety risks. I ensure my own safety. For example, on the unit, I cut myself with a sharp after a minor procedure performed on a patient. I
informed my preceptor and clinical advisor. I followed the necessary steps to ensure my safety. I addressed the issue and discussed ways to prevent
a future re-occurrence. I ensure that I communicate the importance of disposing of sharps with members of the interprofessional team when
necessary.

G.T. : Agreed

1. 6 Question and clarify unclear orders or directions and when uncertain.

Satisfactory

Satisfactory

H.N. : I ensure that I consult with my preceptor and/or physician if I am unsure about an order or directions. Since most of the orders are written, I
understand that it is very easy to misinterpret an order. For example, the doctor ordered the medication "metroclopramide" for a patient on the unit. I
retrieved the medication "metoprolol" from the automatic dispensing unit. I brought the medication to my preceptor and communicated that I was not
sure if it was the correct medication. My preceptor researched the medication and determined that it was in fact, not the correct medication. I review
other relevant material (i.e. textbooks) when I have any questions and/or concerns. I ensure that I reiterate the information to reduce the risk of
miscommunication. I ensure I have clarification prior to initiating a nursing intervention.

G.T. : Agreed

1. 7 Question, clarify or challenge questionable orders, decisions or actions by others.

Satisfactory

Satisfactory

H.N. : I continuously question decisions by medical and nursing staff to aid in my learning. If I feel that an action is incorrect, I communicate this in a
way that conveys an opportunity for mutual learning, protection of patient safety and advocating for patient well-being. If I am unsure about any action
(i.e. order, nursing action, etc) within the clinical setting I ensure that I ask questions and/or clarify with my clinical instructor. If I do not believe my
questions/concerns have been addressed, I utilize other resources for information (i.e. textbooks).

G.T. : Agreed

1. 8 Respond in a professional manner to situations in which there is unsafe, unacceptable or

Satisfactory

Satisfactory

unprofessional behavior.
H.N. : I employ an ethical framework when making decisions which demands that I protect the client's privacy, confidentiality, well-being and choice. I
understand that nurses are well respected, highly educated professionals. It is imperative that all registered nurses and nursing students work
together to protect the integrity of the profession. I ensure that I continuously reflect my own professional behaviours and critically assess other
nurse's and/or nursing students professionalism. If I have any reason to believe a nurse's behaviour does not align with the inherent core values of
HHS, CNO or Humber College I communicate my concerns with my preceptor. I understand that if I do not advocate for the safety and well-being of
all persons within the health care facility, I am also liable for any consequences.

G.T. : Agreed

1. 9 Demonstrate understanding about the role of the nurse within health care.

Satisfactory

Satisfactory

H.N. : The nurse has many roles and responsibilities within the health care facility. The ultimate goal being positive outcomes and patient well-being.
However, a nurse must also be aware of the well-being of nursing staff, visitors, support staff and themselves. A nurse must be aware of the
expectations of the facility and the College of Nurses of Ontario. I also represent Humber College, therefore, I abide by regulations created by the
college. I am respectful of the facility and those who work in it. Although I am learning, I ensure that I maintain patient safety at all times. This includes
consulting with nurses, physicians, paramedics, correctional officers, unit clerks, etc.

G.T. : Agreed

Teacher comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies
and procedures of the practice setting. :
COMPETENT IN HER NURSING SKILLS

2. Communicate using strategies and technology to effect accurate and timely information sharing including data, research, and other
information.

2. 1 Contribute to team sharing and discussions.

Satisfactory

Satisfactory

H.N. : I actively participate in group discussion and sharing within the clinical setting. I more often than not take the initiative to initiate discussions
about relevant issues, questions or findings. I contribute to discussions by contributing findings from assessments and interactions with patients with
the multi-disciplinary team. I discuss methods in which I have learned and/or performed nursing actions with other nurses to aid in continuous
learning. For example, I learned how to take blood work from an unused saline lock when initially performing venipuncture on a patient with an
angiocath. I prefer this method because it reduces the need to remove devices from the catheter causing blood to leak out from the IV site. I discuss
with other nurses the different methods in which this can be done. I discuss and offer to show other nurses how I perform this skill.

G.T. : Agreed

2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.

Satisfactory

Satisfactory

H.N. : I ensure that I document all interventions performed and assessments conducted on the written charts within the unit. I ensure that I complete
all necessary charting before the shift is complete. I use the documentation assessment tools provided to keep track of my assessments in order to
chart them appropriately. I ensure that the information is relevant, factual and in a logical order. If I make a mistake, I ensure that I correct it
appropriately. I document with the use of black and/or blue pens. I ensure that I document specifics such as time and medications given (including
dose, route and location if necessary). For example, if I start an IV saline lock in a patient, I ensure that I document the time, needle gauge and site.

G.T. : Agreed

2. 3 Use effective communication techniques when reporting relevant information and providing

Satisfactory

Satisfactory

feedback to the appropriate members of the interprofessional heath care team.


H.N. : I ensure that I am clear, concise and relevant when communicating with members of the interprofessional team. I ensure that I use appropriate
language when necessary. For example, when communicating with other nurses, I would describe a patient that is "sweaty" as diaphoretic. I adjust
my language based on the professionals I am working with. I have continued to work on my SBAR communication techniques with members of the
healthcare team such as physicians. I ensure that I take a moment to organize my information prior to communicating with health care professionals
(i.e. nurse practitioners, physicians, registered nurses, paramedics, etc.) to ensure communication is accurate, concise and relevant. Further, to
prevent information repetition which costs valuable time. I will continue to ensure that my assessments are complete and well developed before
initiating contact (i.e. requesting pain medication for a patient).

G.T. : Agreed

2. 4 Evaluate and refine techniques used to communicate and share information with clients and the

Satisfactory

Satisfactory

interprofessional health care team.


H.N. : I ensure that I continuously reflect and assess how I communicate with others. I encourage feedback when appropriate to ensure that I am
providing my message in a clear and understandable manner. For example, I understand that sometimes I can speak very quickly which may be
difficult for patient's who are elderly or who speak another language. I ensure that I adjust my tone, volume and speed of speech during my
interaction. I ensure that I communicate with patient's that if I am speaking too quickly to let me know so that I can make further adjustments. I adjust
the language I use when communicating with patient's vs. healthcare professionals. For example, I use medical jargon when communicating with
medical professionals and I use laymans terms when communicating with patients to facilitate understanding.

G.T. : Agreed

2. 5 Ensure privacy and confidentiality.

Satisfactory

Satisfactory

H.N. : I have familiarized myself with CNO standards for maintaining confidentiality and privacy which was created considering PHIPA. I ensure that I
am familiarized with shredders on unit to dispose of papers which may contain patient information. I ensure that I do not take client information home
with me such as names and/or diagnoses. I ensure that despite of unit conditions (i.e. lack of private rooms) that I do my best to protect dignity by
speaking as quietly as possible and utilizing the curtains to create a private environment.

G.T. : Agreed

2. 6 Use technology to retrieve information including research and other date and to obtain and

Satisfactory

Satisfactory

forward information both within and outside the practice setting.


H.N. : I use many different systems when on the unit (Meditech, MedHost, etc) to retrieve valuable information about patients such as lab results,
information from triage and hospital visit history. The system is also used to manage patient stay times, input physician orders and book
appointments. I use online resources such as Google search and the College of Physicians and Surgeons of Ontario Doctor search regularly when
necessary.

G.T. : Agreed

Teacher comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
GOOD COMMUNICATION WITH PATIENT, FAMILIES AND HEALTH CARE TEAM

3. Engage in relational practice that is caring, compassionate and respectful.

3. 1 Establish therapeutic caring, compassionate, and culturally safe relationships with clients and

Satisfactory

Satisfactory

health care team members.


H.N. : I support that all Canadians deserve reasonable access to quality, competent, non-judgemental and compassionate nursing services. I
consider core principles of therapeutic nurse-client relationship such as empathy, respect, professional intimacy, power and trust (CNO, 2013) when
initiating care. I consider the patient's psychosocial, physical, spiritual, religious and emotional needs when creating a plan of care. I understand and
respect that every patient is different, therefore, each patient's plan should be created with this knowledge. I understand that individuals possess
unique needs that reflect their culture which deserve to be acknowledged and actualized. I do not limit these skills to patient interactions, but
interactions with all staff. I value the insight and knowledge from other cultures that are not my own.

G.T. : Agreed

3. 2 Establish a caring environment that supports clients in meeting their needs and outcomes,

Satisfactory

Satisfactory

managing their illness, or experiencing a peaceful death.


H.N. : I ensure that I demonstrate an open, positive and caring attitude when working with patients and their families. I understand the hospital can be
an unfamiliar and frightening place. I know that sometimes this can cause patients and/or their families to become hostile, upset and/or aggravated. I
do my best to empathize with them when providing care. I ensure that I convey non-judgment and openness so that they feel supported and
encouraged to ask questions. I use nursing techniques such as the therapeutic use of self and touch when providing care. For example, when a
patient is crying I may put my hand on their shoulder to convey support. I use other non-nursing specific techniques such as humor to comfort
patients.

G.T. : Agreed

3. 3 Demonstrate therapeutic use of self to foster client well-being.

Satisfactory

Satisfactory

H.N. : I understand that the use of self in nursing is a therapeutic agent. I offer unique knowledge, strengths and personality that can facilitate positive
changes in the patient's overall condition. I understand that the interaction I have with a patient can have positive or negative consequences in
regards to their day and/or long-term well-being. A nurse can encourage and empower patients to self-actualize.

G.T. : Agreed

3. 4 Utilize relational knowledge and skills, and ethical principles to support clients and to interact

Satisfactory

Satisfactory

with health care providers.


H.N. : I utilize my knowledge of relation skills such as empathy, listening, reflection when working with the multi-disciplinary team and providing care
to patients. I continuously try to demonstrate a non-judgmental, caring and understanding attitude with patients and co-workers.

G.T. : Agreed

3. 5 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

Satisfactory

Satisfactory

relational practice.
H.N. : A well-developed nursing care plan is the reflection of knowledge of client. A plan of care should always be client-centred. I understand that my
beliefs, values and personal experience are unique and differ from the experiences of others. I acknowledge that the beliefs, values and experiences
of others are equal in importance. It is imperative to nursing care to understand the person beyond their medical condition(s) which includes exploring
their beliefs, values and personal experiences.I understand that knowledge can be obtained from a variety of sources (i.e. friends, family members,
medical history, other health professionals) and directly from the patient. It is imperative to nursing care to understand the person beyond their past
and current medical history, diagnose(s) and disease(s).

G.T. : Agreed

3. 6 Collaborate with clients, members of the interprofessional and health care teams; and, consult

Satisfactory

Satisfactory

appropriately.
H.N. : I continuously interact with the patient, their family and other members of the inter-professional health team. I educate others about the role of
the student nurse in providing care. This includes the role I serve within the patient's plan of care, what year and program I am enrolled. I answer
inquiries about prior placements, experiences and competencies if necessary. In addition, I reassure patients that I am under the supervision of a
registered practical nurse appointed by Milton District Hospital. I convey that I am confident, knowledgeable and capable of providing care. If I am
unsure about my competence regarding a particular skill or intervention, I consult with my instructor and/or nursing staff. I ensure that I try to include
the patient and their family into providing care. I use their expert knowledge about the patient's wishes/desires for care when developing a plan of
care.

G.T. : Agreed

3. 7 Uphold practices and systems that support the diversity of clients and of the interprofessional

Satisfactory

Satisfactory

health care team.


H.N. : I ensure that I actively represent the attitudes, beliefs and values of Humber College and Halton Healthcare Services while interacting with the
multidisciplinary team and caring for patients. I am respectful of the unique background, culture and diversity of all persons I interact with within the
hospital setting.

G.T. : Agreed

3. 8 Provide effective client education.

Satisfactory

Satisfactory

H.N. : I understand that teaching and nursing go hand-in-hand. I ensure that I assess any barriers to learning prior to initiating teaching in order to
make necessary accommodations. For example, if a patient is in pain I would ensure they received adequate pain relief prior to teaching. In addition, I
ensure that I assess prior learning and knowledge. I ensure that I am continuously providing education throughout the day by answering questions,
sharing knowledge about interventions and medications. I also understand that each patient learns in a different way. I ensure that I have access to
more than one type of educational support such as brochures, websites, videos and group learning activities. I confirm patient learning by asking the
patient to reiterate the education I have provided. For example, when providing education to a patient who has been given crutches, I assess their
prior knowledge and if they have used crutches in the past. I educate the patients using a variety of methods such as verbal instruction and
demonstration. I tell patients that drugs.com has printable instructions for use if they require further review. I ensure that I assess how the patient is
using their crutches and if they have any further questions prior to discharge.

G.T. : Agreed

Teacher comments for Engage in relational practice that is caring, compassionate and respectful. :

HALEY IS VERY RESPECTFUL, COMPASSIONATE. PARTICIPATE IN PATIENT CARE

4. Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the profession.

4. 1 Evaluate and refine leadership skills to develop solutions, resolve conflict, create a positive work

Satisfactory

Satisfactory

environment and organizational culture, and to strengthen advocacy role.


H.N. : I actively reflect on my contributions and participation in group discussions which pertain to patient care. I ensure that I initiate discussion with
the interprofessional team when I believe to have pertinent patient information based on my assessment using clinical judgment. I ensure that I
suggest interventions based on my knowledge of the patient's beliefs, values and goals for care.

G.T. : Agreed

4. 2 Provide feedback to peers and accept feedback from peers and members of the

Satisfactory

Satisfactory

interprofessional health care team.


H.N. : I regularly consult with my preceptor and other nurses on unit to discuss my progress. In addition, I communicate with other nursing students
from other institutions to discuss issues and concerns relevant to our learning. I ensure that I provide feedback that is honest. I ensure that learning is
based around the ultimate goal of providing quality patient care.

G.T. : Agreed

4. 3 Advocate for clients, self, others, and quality practice environment.

Satisfactory

Satisfactory

H.N. : I actively advocate for self within the clinical environment by searching for learning opportunities and demonstrating my skills. I share
opportunities for learning and skill enhancement with other nurses and students. For example, I advocated for the other nursing student on the unit by
letting educators know she was also interested in some of the learning opportunities I was also interested in such as venipuncture. I ensure that I
convey any concerns I have with my preceptor and/or staff members which may pose a risk to safety. For example, when I had a needle stick injury, I
completed the necessary incident reports and shared my experience with the educator. This will hopefully help prevent incidents from occurring to
other students and/or members of the interprofessional team.

G.T. : Agreed

4. 4 Support clients rights for self-determination and choice.

Satisfactory

Satisfactory

H.N. : I encourage and support the patient's right to autonomy and directing their care. I understand that patient culture, spirituality, religion and
personal values may influence care. I provide education and additional resources so that the client may make the best decision for their care. I
understand that a patient's plan of care may differ from my suggestions, but I continue to convey non-judgement and support. I consistently advocate
for the patient's best interest. I ensure that I provide information that is honest and factual. For example, it is common in the waiting room that patient's
become frustrated with extended wait times. When a patient insists on leaving without being seen by a physician, I ensure that I reiterate that it is their
choice to leave however their may be potential consequences to their health and well-being. I convey non-judgment, respect and support regardless
of their decision.

G.T. : Agreed

4. 5 Respond appropriately to unsafe, unacceptable, and unprofessional behaviors.

Satisfactory

Satisfactory

H.N. : I understand that client-centred care remains the forefront of nursing. I ensure that I actively aim to prevent unsafe, unacceptable and
unprofessional behaviour. I familiarize myself with the standards of Humber College, CNO, Halton Healthcare Services and the unit. I always critically
assess the urgency of a situation in which I am concerned about safety, professionalism and acceptable behaviour. I determine whether I can and/or
should intervene immediately or consult with my preceptor for guidance.

G.T. : Agreed

4. 6 Demonstrate public protection and acting in the interests of the public through collaboration and

Satisfactory

Satisfactory

consultation with other members of the interprofessional health care teams.


H.N. : I demonstrate acting in the interest of protecting the public by using clinical judgment to assess for actual and/or potential risks in the clinical
environment. This includes physical, psychological or environmental hazards. I ensure that I address any concerns with my preceptor, clinical advisor
and/or placement supervisor. I ensure that I do my due diligence to remove any actual and/or potential risks from the environment if able. I actively
seek opportunities to improve my knowledge and skills to protect the public. For example, I attended CPI training with other nurses from the unit.
These skills are useful for protecting staff and patients.

G.T. : Agreed

4. 7 Contribute to the creation of quality practice strategies and solutions.

Satisfactory

Satisfactory

H.N. : I ensure that I participate in discussions pertaining to quality practice such as safety and patient well-being. I contribute my own opinions,
assessments and recommendations to the discussion. For example, one of the RPNs on the unit was spiking bags of normal saline and priming the
line in advance to save time. However, I did not use these bags because I did not see them prepared and could not ensure that they were not tainted
in any way. I refrained from their use and supported my preceptors decision to share this finding with the unit manager.

G.T. : Agreed

4. 8 Assign, supervise, teach as appropriate, and provide feedback to unregulated care providers

Satisfactory

Satisfactory

(UCPs) in collaboration with the interprofessional health care team.


H.N. : I collaborate with members of the interprofessional team such as patient assistant liaisons, environmental services and volunteers to meet care
goals. I also incorporate the family and/or friends into providing care for family.

G.T. : Agreed

Teacher comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
HALEY AVOCATE FOR ANALGESIC FOR HER PATIENT THAT ARE IN NEED FOR PAIN

5. Integrate the nursing process into all aspects of nursing care and across diverse practice settings.

5. 1 Formulates clinical judgments that meet clients unique and changing health needs and priorities,

Satisfactory

Satisfactory

outcomes, and overall condition and incorporates these into evolving plans of care.
H.N. : I ensure that I continuously assess patients from the moment I first assess them to the moment they are discharged. I try to anticipate patient
needs and probable outcomes of treatment. For example, if a patient comes in with redness

G.T. : Agreed

5. 2 Devise evidence-informed plans of care that are holistic and client-centred.

Satisfactory

Satisfactory

H.N. : I use the knowledge I have obtained from prior clinical placements, lectures and independent research to create plans of care. I use the
information I obtain from assessment, prior medical history and from the patient/patient family to create a plan of care. I ensure that my actions reflect
the wishes and needs of the patient. I utilize different types of interventions to provide care for the patient's physiologic, psychological, emotional and
spiritual needs.

G.T. : Agreed

5. 3 Use clinical judgment to assess clients, prioritize needs, outcomes, and nursing interventions.

Satisfactory

Satisfactory

H.N. : I provide care for patients based on my knowledge, skills and judgment obtained from prior clinical experience. However, I wish to continue
developing my ability to anticipate patient needs. I do my best to anticipate their needs for care with the guidance of my preceptor and other nurses.
For example, if a patient comes in with symptoms of a urinary tract infection, I provide them with a urine sample specimen container in order to ensure
that I have a sample if the doctor requests a sample. I am continuously trying to prioritize how to provide care for multiple patients as efficiently as
possible. For example, when a patient comes in for IV antibiotics I ensure that I set the patient up with the antibiotics as soon as possible. While the IV
runs, I am able to use my time on the unit to help other patients.

G.T. : Agreed

5. 4 Collaborate in the evaluation, refinement and modification of plans of care.

Satisfactory

Satisfactory

H.N. : On the unit, I am constantly evaluating care provided to patients. For example, if a patient comes into the ED with a primary complaint of fever,
I ensure that I check their temperature 1 hour after an antipyretic (i.e. Tylenol) has been given. If the patient is no longer febrile, I make note of this on
the patient's chart through documentation. If the fever has not subsided with the help of antipyretic medication, I would make a note of this on the
patient's chart and inform the most responsible physician. I understand that a patient's condition may change from when they first enter the
emergency department. I ensure that my actions are appropriate in ensuring patient safety and well-being. For example, an ambulatory patient was in
the emergency room on one of the chairs. The patient asked for help stating he felt like he was "going to black out" and "going to have an allergic
reaction". The patient appeared unwell, anxious and diaphoretic. The patient did not have a call bell at the bedside, so I ran for assistance from
another nurse. I immediately took the patient's vitals and relayed this to the CRN. The patient was transferred to the main ED for his care. I
understand the scope and role of the practical nurse in the ED and when it's appropriate to consult with a registered nurse. I actively participate in
discussions pertaining to patient care with the intra-professional and inter-professional healthcare team. Further, I ensure that I contribute relevant
assessment findings to the refinement, modification, and evaluation of care. I contribute the effectiveness of implemented nursing interventions.

G.T. : Agreed

5. 5 Safely and competently perform treatments and use techniques, and technology autonomously

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Satisfactory

and in collaboration with clients and members of the interprofessional health care team.
H.N. : I ensure that if I implement a nursing intervention that it is evaluated within a specific time frame. I understand that some interventions can be
evaluated quickly (i.e. administering an antipyretic for a febrile patient) and some must be evaluated over time (i.e. rehydration therapy for a patient
who has been vomiting). I ensure that I am knowledgeable about therapeutic and expected outcomes. Further, I am knowledgeable about potential
adverse effects/reactions. For example, when I begin to administer a new antibiotic to a patient, I ensure that I educate them about any potential signs
and symptoms which could indicate an adverse reaction (i.e. itching, rash and/or hives, etc.). I tailor my plan of care to monitor the effectiveness of
nursing interventions. For example, for a patient receiving a new antibiotic via IV I initially start the intravenous at 50 ml/hr for the first 5 minutes. I
assess the patient for any reactions prior to adjusting the rate to infuse more quickly. I ensure that I communicate all interventions with my preceptor.

G.T. : Agreed

5. 6 Collaborate with the clients across the lifespan and with members of the interprofessional health

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care team to create a client centered plan of care that is articulated with competence both in writing
and orally.
H.N. : Fortunately, I have had the opportunity to work with a very diverse population of patients within the clinical environment (i.e. children, elderly,
young adults, etc.). I understand that patient's have different needs based on variables such as their age, gender, culture, primary complaint for
seeking care and inherent uniqueness. I ensure that I adjust my interventions and communication to meet these needs. For example, when
performing a bladder scan on a 4-year-old, I ensure that I use very simple terms when describing the procedure. I ensured the child that it would not
be painful. Since children at this age may be fearful of painful procedures, I ensure that I am honest about pain expected when initiating interventions.
I ensure that I chart all of my interventions clearly in the nursing notes.

G.T. : Agreed

5. 7 Use awareness of own knowledge and skills, the three factors of nurse, client and environment

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and the practice decision-making framework to guide practice.


H.N. : As aforementioned, I am continuously applying the skills I have learned in class and in prior clinical placements to provide care to patients.
Additionally, I use the three-factor framework to determine if a patient assignment is appropriate. This is important because due to the nature of the
ED, the condition of the patient can change quickly for better or worse. If I have any concerns about a patient prior and/or after an assessment I
discuss these concerns with my preceptor.

G.T. : Agreed

5. 8 Manage workload, time, and physical resources to provide effective, efficient and ethical care.

Satisfactory

Satisfactory

H.N. : Due to the nature of the ED, it's important to be adaptable to the environment in order to provide safe, effective and ethical care to patients. I
understand that increase in patients can change the nurse's ability to provide effective, efficient and ethical care. Therefore, a sound ability to prioritize
and manage time is imperative. I have had the opportunity to work independently and as a part of a team to provide care to the patient flow. For
example, one day my preceptor was sick and was not on the unit. I worked with the unit RNs to show them how to work within the RAFT environment.
I handled the majority of the patient care and flow while delegating tasks such as dressings, medications and blood work. I ensured that I tried my best
to prioritize care to promote fast delivery of care. For example, if a patient is ordered blood work and x-rays at the same time. I ensure that blood work
is taken first so that it can be sent to the lab for analysis while the patient is in x-ray.

G.T. : Agreed

Teacher comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
PROVIDE ETHICAL AND SAFE NURSING TO HER PATIENTS IN A TIMELY MANNER

6. Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and holistic health care in a
complex and changing environment.

6. 1 Collaborate with clients to determine needs, mutually agreed health outcomes, approaches to
care, and to evaluate care.

Satisfactory

Satisfactory

H.N. : Foremost, I convey openness and willingness to listen when working with patients. I provide patients with information that is honest and factual
so that they may make their own informed decisions about care. If a patient does not agree with the care plan, I try to suggest compromises. I ensure
that I inform the patient about the plan of care prior to initiating interventions. I understand that not all patients have the same goal for care. I
collaborate with multiple professionals in order to create a plan of care that reflects the clients needs and interests. I educate myself about the
resources and services available to provide quality care to patients. I utilize other members of the inter-professional team such as physio-therapist,
respiratory therapists, and speech-language pathologists effectively. I encourage and take into consideration the assessments from other
professionals. I regularly communicate with other members of the interprofessional team to understand more about their role when providing care to
the patient and how our roles work together to achieve care goals.

G.T. : Agreed

6. 2 Contribute as a member of the interprofessional and health care teams to respond to changing

Satisfactory

Satisfactory

client needs and outcomes.


H.N. : I understand my role as a student nurse in the clinical setting. I am able to spend more one-on-one time with the patient and gain valuable
information regarding the patient's condition and care. I ensure that I take the time to review the patient's chart, notes/assessments made by other
clinicians (i.e. pharmacy, social work, medicine) and develop thorough assessments. I ensure that I communicate any discrepancies, significant
findings and conflicts with the appropriate practitioners. I also communicate if I have reason to believe that an issue may be anticipated. I ensure that
problems are addressed within a reasonable amount of time related to the urgency of the situation. I document assessment, intervention and
evaluation accordingly.

G.T. : Agreed

6. 3 Consult with and seek out assistance from members of the interprofessional health care team.

Satisfactory

Satisfactory

H.N. : I work closely with many different healthcare professionals on a daily basis. I understand that each professional has a unique set of skills
related to their training and experience which may be beneficial to patient care. I use critical thinking to decide who to communicate with if I require
help. For example, when entering an order from the doctor on Meditech, if I am unsure about how to order enter it I speak with the unit clerk. Another
example, if a physician asks for a specific swab and/or specimen container that I am not familiar with, I consult with laboratory. I convey openness and
willingness to learn with all members of the health care team.

G.T. : Agreed

6. 4 Use teamwork, consensus building, and conflict resolution and leadership skills to meet

Satisfactory

Satisfactory

expected client outcomes.


H.N. : I ensure that I establish an open and mutually beneficial relationship with other students on the unit to foster teamwork. I regularly
communicate with unregulated care providers (i.e. PALS, volunteers) and regulated health professionals (i.e. respiratory therapists, occupational
therapists, OT/PTAs). I build rapport with other professionals. I ensure that each professional's perspective and contributions are acknowledged. I
understand that each member of the team has invaluable knowledge and expertise to contribute to the well-being of the patient. For example, I spoke
with environmental services in order to understand how to dispose of sharps containers and replace them when they are full.

G.T. : Agreed

6. 5 Integrate effective, collaborative, and consultative strategies to meet clients needs within a
changing environment.

Satisfactory

Satisfactory

H.N. : I ensure that I continuously evaluate the patient's condition in order to identify if the assistance of another professional and/or a change of
location is required. I familiarize myself with the different resources and services available to the patient that are provided by other members of the
inter-professional team. I collaborate and consult with these professionals to provide a more specific and quality plan of care. I also consult with the
patient to determine their wants and needs to facilitate client-centred care.

G.T. : Agreed

6. 6 Respect the unique role and competencies of all members of the interprofessional health care

Satisfactory

Satisfactory

team.
H.N. : I respect the knowledge, skills, experiences and contributions each member of the health care team provides to patient care. I understand that
each member of the team is working towards a common goal. I do not believe that one person's knowledge and expertise is more valuable or less
valuable. I collaborate and utilize the family when available.

G.T. : Agreed

6. 7 Collaborate as a member of the interprofessional health care team to respond to changes in

Satisfactory

Satisfactory

nursing knowledge and practice and in the health care environment.


H.N. : As aforementioned, I ensure that I educate others about my roles and capabilities as a student nurse. I contribute my assessments to the interprofessional and intra-professional team. I ensure that I communicate relevant findings within a reasonable amount of time-related to the acuity of the
concern. I ensure that I document my findings appropriately.

G.T. : Agreed

Teacher comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
HALEY EVALUATE HER PATIENTS FOR PAIN MEASURES AND COMMUNICATE HER FINDING TO ME OR TO THE ER DOCTOR ON A TIMELY
MANNER

7. Engage in Quality Assurance consistent with the regulatory framework.

7. 1 Act in the best interests of clients and protect clients from harm through collaboration and

Satisfactory

Satisfactory

consultation with other members of the interprofessional and health care teams and by through
competent and safe practice.
H.N. : I continuously collaborate with nursing staff, patients, families, and preceptor to ensure that the patient is receiving the best possible care. I
ensure that I advocate for care that meets the patient's social, emotional and physical needs. I provide patients with the information they need to make
decisions about their care. I continuously provide care that reflects patient-centred care.

G.T. : Agreed

7. 2 Commit to Quality Assurance practice to identify strengths and areas for professional growth and
in accordance with the regulatory framework (CNO).

Satisfactory

Satisfactory

H.N. : I continuously reflect on my performance within the clinical setting. I work with other nurses and healthcare professionals to help further my
knowledge and competence. I have attended group learning sessions (i.e. CPI training, before the code workshop, etc.) to further my knowledge in
order to provide the best quality of care to patients. I use relevant materials such as textbooks and online resources when unsure about a skill,
procedure and/or medical intervention.

G.T. : Agreed

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance program

Satisfactory

Satisfactory

(CNO).
H.N. : I am familiar with the QA program requirements and purpose. I recognize that nurses are responsible for demonstrating an on-going
commitment learning during my career. I understand that self-assessment and reflection are important factors for creating a QA program initiative.
Further, I understand that using the feedback from other professionals allows a nurse to identify areas which may need improvement but have failed
to notice. I use SMART when creating goals within clinical practice.

G.T. : Agreed

7. 4 Assume responsibility to seek out feedback for colleagues and peers and learning opportunities

Satisfactory

Satisfactory

that foster professional development.


H.N. : I continuously seek out opportunities for learning on the unit at MDH. I communicate with other nurses that I am eager to help and participate in
any interventions on the unit. I understand that gaining experience through hands-on-learning is the purpose of clinical placement. I will continue to
use the resources provided by my preceptor, institution, facility and regulatory body to improve my knowledge. I will ensure that I am competent by
asking a respected and competent practitioner to evaluate my abilities. For example, when catheterizing a patient, I work with a registered nurse to
ensure that I perform the procedure correctly. I listen to their tips and advice so that I can apply it to my future practice.

G.T. : Agreed

7. 5 Consistently review nursing research and information about health care to improve competence

Satisfactory

Satisfactory

and to support clients.


H.N. : I continuously familiarize myself with available resources and opportunities to advance my learning (i.e. websites, study aids, etc.). I share
these resources with others. I ensure that I am familiar with these resources incase I need to use these resources quickly while working. I keep up-todate with the latest nursing techniques and skills. I will continue to explore other resources available to benefit my current and future practice.

G.T. : Agreed

7. 6 Develop professional responses to health care system changes resulting from advances in

Satisfactory

Satisfactory

research, technology, and changes in societal and political forces.


H.N. : I ensure that I participate in learning about how to utilize various systems on the unit. I ensure that I have adequate access to reference
materials in case I need review.

G.T. : Agreed

Teacher comments for Engage in Quality Assurance consistent with the regulatory framework. :
HALEY PER

8. Use critical thinking, problem solving and decision making skills to meet the health care needs and expected outcomes of clients.

8. 1 Use critical thinking to inform decision making in all aspects of nursing care.

Satisfactory

Satisfactory

H.N. : I apply knowledge I have obtained from lecture, textbooks, prior clinical experience and life experience when making decisions in the clinical
setting. I ensure that I base my interventions on evidence I have obtained from assessments and research. I wish to continue developing my critical
thinking when making decisions such as to informing the physician. I will continue to work closely with my preceptor to discuss questions, issues and
concerns to improve my clinical decision making.

G.T. : Agreed

8. 2 Use clinical judgment to assess and refine assessments in collaboration with the

Satisfactory

Satisfactory

interprofessional health care team, formulate nursing diagnoses, plan nursing interventions, and
outline evaluative criteria.
H.N. : I provide care for patients based on my knowledge, skills and judgment obtained from prior clinical experience. However, I wish to continue
developing my ability to anticipate patient needs. I understand that this will come with experience. Until then, I will continue to work with my preceptor
and the nurses on unit to review my assessments and my critical thinking when providing nursing care. I ensure that I follow through the nursing
process. For example, I assess the patient when they initially arrive to the RAFT area. I use my nursing knowledge to formulate a nursing diagnosis. I
create a plan that will address the diagnosis(es). I implement these interventions. I evaluate the effectiveness of my interventions.

G.T. : Agreed

8. 3 Evaluate and refine critical thinking, problem solving, and decision-making skills.

Satisfactory

Satisfactory

H.N. : I continuously interact with my preceptor and other members of the interdisciplinary health team in regards to implementing interventions. If I
am unsure about which intervention to use, I ensure that I discuss this with my preceptor and/or an experienced nurse before acting. I regularly
discuss my rationales for implementing or withholding an intervention. I ask for feedback and advice from more experienced nurses to further enhance
my learning. I have really developed my confidence when providing information and care to patients.

G.T. : Agreed

8. 4 Integrate knowledge from variety of nursing, health, and other theory into nursing practice to

Satisfactory

Satisfactory

provide safe and competent care.


H.N. : I utilize a variety of resources such as online resources, textbooks, materials on unit and the expert advice of experienced nurses while
practicing on the unit. I ensure that I discuss my assessments, questions and concerns with my preceptor. If I am unsure about a procedure and/or
intervention, I ensure that I have reliable resources on hand to review.

G.T. : Agreed

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

H.N. : I have worked with the guidance of my preceptor to develop my prioritization abilities while on the unit. I understand that certain procedures,
medical interventions and diagnostic tests take time to complete. I try to consider this when completing multiple actions on the unit. For example, if a
patient requires blood work, an ECG and an x-ray. Since blood work takes an hour to process in lab, I ensure that the blood work is taken and sent to
lab first. I would then send the patient to x-ray. When the patient returns, I can complete an ECG. By the time this is all complete, the lab work is in
process.

G.T. : Agreed

8. 6 Demonstrate professionalism, responsibility, and accountability.

Satisfactory

Satisfactory

H.N. : I act in a responsible, ethical and accountable manner outside and inside of the clinical setting. This includes being responsible for my actions
in regards to nursing care which includes documenting interventions and assessments. I ensure that I represent the values and expectations of the
facility, CNO and Humber College. I use my knowledge, skills and judgement to make clinical decisions that support the well-being of the patient. I
understand that I am responsible for my actions and/or care that I provide, therefore, I accept the potential consequences of my actions. I demonstrate
my competence with the guidance and supervision of my preceptor and/or other nurses.

G.T. : Agreed

8. 7 Use critical thinking, the practice decision-making framework and the nurse-client-environment

Satisfactory

Satisfactory

framework to inform clinical judgments and practice.


H.N. : As aforementioned, as a student nurse, I consistently use the three-factor framework (nurse, client and environment) provided by the College
of Nurses (CNO) when accepting patient assignments. In addition, I also abide by the criteria for the rapid assessment fast tracking (RAFT) program
in the emergency department (ED). If I am concerned that a patient assignment does not meet the criteria for the RAFT program I inform my clinical
preceptor. I ensure that I process any decisions with the guidance of my preceptor to determine a course of action that protects the safety and wellbeing of the patient.

G.T. : Agreed

Teacher comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Haley use critical thinking skills to support her clinical decision-making.

9. Final Exam Results

9. 1 Final Exam Results

Satisfactory

G.T. : Agreed

Teacher comments for Final Exam Results :


Haley has good relationship and interaction skills with patient, families and with the healthcare team. Demonstrate good clinical competency
assessment and nursing skills. She is an active participant

Student Final Summary with Strategies for Continued Growth

I have had an amazing experience at Milton District Hospital's emergency department. I have had the opportunity to work with diverse populations of
patients with different needs in a challenging and unpredictable setting. I have been able to develop strong assessment, prioritization, and critical
thinking skills. I have been able to apply many skills I have learned in lecture and in simulation such as IV maintenance, urinary catheterization, wound
dressing, intramuscular injections, subcutaneous injections, etc. I have developed the confidence to work independently with patients, patient's
families and the interprofessional health care team. I understand the role of the RPN within the clinical setting. I have had the opportunity to work with
different members of the intra-professional and inter-professional teams such as registered nurses, nurse practitioners, medical doctors, and clinical
educators. I have had further opportunity to develop my computer skills by using the Meditech system to input orders and look up results from
diagnostic tests. I have also taken advantage of certifications and workshops provided to staff on the unit to further my learning.
I wish to continue developing my clinical assessments, prioritization, multitasking and confidence as I begin my own independent practice as a nurse. I
ensure that all of my actions are safe and reflect the welfare of all patients. I will continue to prioritize safety and well-being. I have proven competence
in the classroom and I wish to ensure this knowledge translates into my clinical practice. I have developed many strong relationships with members of
the intraprofessional and interprofessional team on the unit. I wish to have the opportunity to marry the skills I have learned in the emergency room
such as assessments, medication administration, health teaching, developing therapeutic relationships and time management setting within a more
traditional bedside nursing environment. I would like to work in an environment that allows me to develop therapeutic relationships with patients and
families. Further, I would like to be able to work with patients from when they are initially hospitalized to their discharge. This will allow me to see small
daily changes in the patient's condition which I have not had the opportunity to experience in the emergency setting.

Teacher Final Summary with Strategies for Continued Growth


Needs to improve in her multitasking skills. Haley should continue with her nursing studies to RN

Advisor Final Summary with Strategies for Continued Growth


As identified by Haley and Nurse Gita, Hayley has improved on her documentation, assessment and communication skills. Hayley, continue to ask
questions when in doubt or when things need to be clarified. Hayley is practicing safely and competently, she's a team player and respectful to pts
and staff. Great work!

Student's References
College of Nurses of Ontario Practice Standards and Guidelines, RNAO, Humber College, Canadian Fundamentals of Nursing

Refer to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Grade

Unsatisfactory

Satisfactory

Program Coordinator Feedback


The Program Coordinator has reviewed the evaluation

Yes

No

Student Sign Off


I met with my Clinical Teacher/Preceptor and discussed my evaluation

Yes

No

In general this evaluation accurately reflects my performance

Yes

No

Submitted Date: 12-Apr-2016 10:36