Cebu Normal University

College of Nursing
Cebu City

PERFORMANCE APPRAISAL FOR HEAD NURSING EXPERIENCE

Name:_________________________________ Rating: _________________________

Inclusive date of assignment: _______________ Clinical Division: ________________

Rating Scale:
5- excellent 4-very good 3-good 2-satisfactory 1-NI

5 4 3 2 1
1 Receives endorsements from previous shifts
2 Does accurate patient categorization.
3 Makes appropriate assignment for various categories of nursing personnel
4 Take the lead in formulating NCP.
5 Plans daily team activities.
6 Coordinates with various health team members in the implementation of
NCP.
7 Makes rounds with doctors, staff and student nurses.
8 Sees to it that doctor’s orders are carried cautiously and legally.
9 Supervises team members especially on complicated procedures.
10 Initiates planned team activities.
11 Check’s team member’s documentation.
12 Evaluates effectiveness of nursing care delivered and improves it when
necessary.
II. PERSONNEL MANAGEMENT
1 Allocates equitable assignment.
2 Employs individual conferences and counseling.
3 Coordinates needed activities for the team’s professional development.
III. UNIT MANAGEMENT
1 Ensures adequate facilities/ supplies and materials.
2 Assures strict implementation of hospital rules and policies.
3 Provides a safe, therapeutic environment.
4 Accomplishes daily ward report.
5 Endorses the unit properly to the succeeding shift.
IV. CRITICAL FACTORS
1 Accepts limitations in performing his/her roles.
2 Possesses appropriate decision-making ability in any given situation.
3 Acts as a role model in all occasions
4 Appreciates the value of professionalism at all times.
5 Performs her/ his roles in accordance with the philosophy and objectives of
the agency.
Total Score: __________________ Equivalent Grade: ____________________

Comments/Remarks: ______________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Signature of Student:_________________________________
Signature of Clinical Instructor: ________________________