FNP/AGNP 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 a clinical practice experience of 20 hours or longer. Students are required to obtain feedback from each preceptor with whom they work. Please record your evaluation and review it with the student.

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 Family Nurse Practitioner or Adult Geriatric Nurse Practitioner Options will be able to perform safely, as an entry level nurse practitioner.

The student is expected to demonstrate:

  • Developing independence in collecting subjective and objective data, generating diagnostic hypotheses, and implementing appropriate management plans.
  • Clinical judgments that integrate clinical and research based knowledge with individualized knowledge of patients and their family.
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N/A = Unable to evaluate
1 = Unsatisfactory
2 = Needs Improvement
3 = Average
4 = Above Average
5 = Excellent
SUBJECTIVE DATA
  • Obtains relevant, comprehensive, and problem focused health histories
  • Demonstrates skillful and sensitive interviewing techniques adapted to the patient and family

OBJECTIVE DATA
  • Performs the indicated examination, that correlates with the chief concern, in an accurate, organized, and efficient manner
  • Demonstrates the ability to conduct an effective physical exam, perform an organized exam pertinent to the chief concern, interact with the patient with confidence, and identify abnormal findings.

ASSESSEMENT
  • Evaluates signs and symptoms, including age appropriate changes, noting pertinent positives and negatives
  • Develops appropriate differential diagnoses with rationale.
  • Is able to provide a reasonable diagnosis/impression

PLAN

Intervention. Incorporates Evidence Based Practice and use of recognized guidelines

  • Implementation of diagnostic plans
  • Prescribes appropriate pharmacologic treatments
  • Prescribes appropriate non-pharmacologic treatments
  • Implementation of therapeutic plans
  • Implementation of educational plans based on individual and family needs
  • Modifies the plan of care on follow up after evaluating patients’ responses to prior interventions
  • Use of referral/consults and/or community resources
  • Provides anticipatory guidance and counseling for patients and families based on identified risks and health promotion needs and goals

PRESENTATION AND DOCUMENTATION
  • Oral presentation of history and physical in a structured, accurate, and comprehensive manner
  • Presents differential diagnoses and related management plan
  • Documents patient data in both a verbal and written standardized format

PROFESSIONALISM
  • Demonstrates the ability to maintain a balance between quantity/quality by adapting and performing effectively under pressure; efficiently organizes time spent with patient and family. Improvement over the semester is evident
  • Works collaboratively with a variety of health professionals to achieve patient care goals, promote stabilization, and restore health
  • Facilitates the patient’s transition within health care settings and across levels of care
  • Demonstrates professional appearance, behavior appropriate for the clinical setting, and preparation for clinical practice
  • Is receptive to feedback and constructive criticism; uses feedback to improve clinical expertise
  • Demonstrates good self-reflection about practice
  • Follows the standard primary care procedures and techniques. Seeks help in learning new skills and perfecting recently acquired skills
  • Provides safe and effective care seeking consultation and redirection when indicated
  • Demonstrates integration of NP role expectations relative to clinic expectations. Helps others to understand the NP role. Initiates action to improve health care delivery in clinics when appropriate (pt. flow, appts., etc.). Initiates action to improve working relationships with other health team members.