PMHNP Student Evaluation

Thank you for serving as a clinical preceptor for Gonzaga University School of Nursing and Human Physiology. We recognize and appreciate your vital role in shaping exceptional future nurse practitioners.

Please use this form to evaluate the clinical practice of the student working with you.  The PMH-NP students are required to obtain feedback from each preceptor with whom they work.  Please record your evaluation and review it with the student. If they had a mentor during this rotation, please solicit feedback from mentor at the completion of this evaluation.

Gonzaga University Faculty review this form to learn about the level of student performance in clinical rotations, to monitor the standards of performance and to ensure that every student who graduates from GU’s PMH-NP track will be able to perform as an entry level Psychiatric Nurse Practitioner.

The student is expected to demonstrate:

  • Developing independence in collecting subjective and objective data, generating diagnostic hypotheses, and implementing appropriate treatment plans.
  • Clinical judgments that integrate clinical and research based knowledge with individualized knowledge of patients.

**The form is successfully submitted when completed in one sitting and a banner will pop up after the successful submission to let you know that it has been received.**

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N/A = Unable to evaluate
1 = Unsatisfactory
2 = Needs Improvement
3 = Average
4 = Above average
5 = Excellent
Assessment of Complex Acute and Chronic Illness
  • Recognizes clinical signs and symptoms of psychiatric illness
  • Differentiates between pathophysiological and psychopathological conditions
  • Thoroughly completes a comprehensive psychiatric evaluation
  • Orders laboratory and other diagnostic studies, integrating results into diagnosis and plan
  • Performs and interprets psychosocial assessments and family psychiatric histories
  • Performs and interprets functional assessments (activities of daily living, occupational, social, leisure, educational, coping skills
  • Generates and prioritizes a differential diagnoses list
  • Formulates diagnoses according to DSM V based on assessment data
  • Completes risk assessment (e.g. violence, abuse, neglect, suicide, trauma)

Therapeutic Communication and Rapport
  • Initiates a therapeutic relationship with patient and families/support system (e.g. developing therapeutic alliances, assessing literacy, health literacy, spiritual/cultural needs, and barriers to communication)
  • Maintains a therapeutic relationship with patient and family /support systems (e.g. encouraging adherence and clinical engagement, maintaining therapeutic boundaries)
  • Terminates a therapeutic relationship with patient and family/ support system (e.g. evaluating the effectiveness of a therapeutic relationship, appropriate closure and transitioning)

Clinical Management
  • Selects age appropriate therapeutic plan (risk/benefit, patient preferences, developmental considerations, financial, the process of informed consent)
  • Implements appropriate therapeutic treatment plan based on psychosocial theories, evidence-based standards, and practice guidelines
  • Selects appropriate medication plan (risk/benefit, patient preferences, developmental considerations, financial, the process of informed consent including patient teaching)
  • Evaluates patient responses and modifies plan as necessary
  • Thoroughly documents (e.g. adverse reaction, patient response, change in treatment plan) including clinical formulation
Professional Role Developement
  • Obtains and utilizes appropriate collateral information
  • Follows standards of care and integrates best practices
  • Utilizes consultations and referrals
  • Communicates with other members of the health care team effectively
  • Is aware of strengths and weaknesses. Uses self-evaluation and reflection for improving performance, initiates the health management and needed follow-up for clients under supervision.
  • Demonstrates integration of PMH-NP role expectations and demonstrates growth in development of autonomous practice