Burlington-Edison School District

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Nurse Name: Click here to enter text. Report Period Start: Click here to enter a date. Report Period End: Click here to enter a date.

Observer Name: Click here to enter text.

DOMAIN 1: ORGANIZATION SKILLS (Notes: Hi-lighted area shows level of performance)

Component 1 a: Demonstrates Productivity Through Effective Time Management Component Unsatisfactory Basic Proficient Distinguished Time School Nurse does School Nurse exhibits School Nurse exhibits School Nurse exhibits Management not demonstrate some time management time management skills, strong time management any time skills. Some work is attends meetings and skills. Work is reliably management skills. completed. Reminders gets reports and work completed. Is reliable to Work is not are needed. completed. attend meetings and completed. other activities.

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Component 1 b: Demonstrates Appropriate professional Preparation and Planning Component Unsatisfactory Basic Proficient Distinguished Preparation School Nurse shows School Nurse shows School Nurse often School Nurse shows and Planning no professional some professional shows professional professional preparation preparation or preparation and planning preparation and planning and planning at all times planning. in some areas as as described by best as described by best described by best practices of the NASN. practices of the NASN. practices of the NASN.

Component 1 c: Plans and Completes Tasks in a Timely Fashion Component Unsatisfactory Basic Proficient Distinguished Completes Tasks are not done Tasks are done with Tasks are completed in a Tasks are consistently Tasks or are done late. reminders or timely manner. done on time or early. inconsistently.

Component 1 d: Maintains Appropriate Records Component Unsatisfactory Basic Proficient Distinguished Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. Maintains Health records are not Health records are Health records Health records are Records updated on the folder or in generally done but are maintained maintained and updated the computer with current updated information is on the folder and regularly with clear health information, student absent. Updated on computer expectations both on the contacts, and immunization information is needed in files. computer and on folder. records. the computer files.

Component 1 e: Develops and Implements Health Policies, Programs, and Procedures in Collaboration with Administration and School Boards Component Unsatisfactory Basic Proficient Distinguished Implements School Nurse does School Nurse School Nurse implements School Nurse displays Policies, not develop or implements and shows health policies, thorough knowledge of Programs and implement health some understanding of programs, and Idaho Falls School Dist 91 Procedures policies, programs, existing health policies, procedures and Health Services protocol, and procedures and programs, and contributes to the policies and procedures, shows no procedures of Idaho development of new and utilizes them knowledge of Idaho Falls School Dist 91. health policies, consistently. School Nurse Falls School Dist 91 programs, and evaluates the Health Services procedures. Has good effectiveness of these protocol, policies, understanding of the guidelines on an on-going and procedures policies, programs and basis and proposes procedures. changes as indicated.

Component 1 f: Demonstrates Knowledge Identifying Student Health/Medical Needs and Developing Appropriate Programs Component Unsatisfactory Basic Proficient Distinguished Identifies School Nurse School Nurse School Nurse School Nurse Student demonstrates little demonstrates basic demonstrates good demonstrates knowledge Health/Medica knowledge knowledge identifying knowledge identifying identifying student l Needs identifying student student health/medical student health/medical health/medical needs health/medical needs and may develop needs and develops based on current research needs and does not programs occasionally appropriate programs on best practice and is develop programs. for routine needs. when needed active in developing programs to meet the health/medical needs of students.

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. Click here to enter text.DOMAIN 2: COORDINATING FUNCTIONS (Notes: Hi-lighted area shows level of performance)

Component 2 a: Works Well with Administrators, Teachers, Other Nurses, and Staff Members (Homebound Teacher, Secretaries, and Health Aides) Component Unsatisfactory Basic Proficient Distinguished Works Well School Nurse School Nurse maintains School Nurse School Nurse relationships With Staff relationships with cordial relationships relationships with with colleagues are colleagues are with colleagues to fulfill colleagues demonstrate characterized by support absent, negative or the duties that the support and cooperation. and cooperation. The self-serving. school district requires School Nurse takes initiative in assuming a leadership role regarding health issues.

Component 2 b: Provides In-service Training for Students, Staff and Parents Component Unsatisfactory Basic Proficient Distinguished Provides In- Health education in- Health education in- Health education in- School Nurse actively service service programs service programs are service programs are well creates in-service Training are not done. done when required but planned. Program goals programs. They are poorly planned and may are generally achieved. extremely well planned, fall short of program purposeful, and meet or goals. exceed the program objectives/goals.

Component 2 c: Functions as an Advocate for the Student and Family Demonstrating Willingness and Ability to Respond to Student and Parent Needs Component Unsatisfactory Basic Proficient Distinguished Functions as School Nurse is not School Nurse is aware School Nurse responds School Nurse is proactive Advocate for aware of of some student/family to student/family needs in responding to Students/Parents student/family needs and responds to and advocates on their student/family needs, needs. some of those needs. behalf. seeking out resources when necessary to advocate for them.

Component 2 d: Is Available for Consultation with Students, Parents, Staff and Others and Creates a Welcome

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. Environment Component Unsatisfactory Basic Proficient Distinguished Is Available School Nurse is School Nurse responds School Nurse is School Nurse is for unaware or does not to student/family/staff knowledgeable and approachable and Consultation respond to questions, interests, or cooperative when available in providing questions, interests, concerns. consulted by accurate information in or concerns of student/family/staff. consultation with student/family/staff student/family/staff. .

Component 2 e: Demonstrates Ability to Identify and Utilize Community or Agency Support Services Component Unsatisfactory Basic Proficient Distinguished Identifies/Utilize School Nurse is not School nurse is aware School Nurse is aware of School Nurse is aware of s Community aware of resources of some resources multiple resources school, district, and Support Services available through available through the available and is able to community resources the school, district, school, district, or use them to meet the and actively utilizes local, or community community needs of students, state, federal resources family, and staff to enhance health services

Component 2 f: Contributes to the Education of the Client with Special Health Needs by Assessing, Planning, and Providing Appropriate Nursing Care, Including the Evaluation of Outcomes Component Unsatisfactory Basic Proficient Distinguished Provides School Nurse does School Nurse uses basic School Nurse displays School Nurse displays Education for not use the nursing knowledge of the solid use of the nursing extensive knowledge of Student process to make nursing process to process and develops the nursing process with Health Needs plans to contribute identify health needs. plans for most students continuing pursuit of to the education of Plans are inadequate or with special health needs knowledge. Health plans the student with are completed on very are completed for all special health needs few students students needing them and are individualized and continually monitored

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. Click here to enter text.DOMAIN 3: COMMUNICATION SKILLS (Notes: Hi-lighted area shows level of performance)

Component 3 a: Demonstrates Ability to Work Effectively with School Staff to Manage Health Programs for Component Unsatisfactory Basic Proficient Distinguished Works School Nurse does School Nurse is aware of School Nurse alerts School Nurse alerts Effectively not make staff specific student health teachers to specific teachers of specific health with Staff aware of specific concerns but does not health concerns of some concerns of a majority of health concerns of communicate these of their students their students. Health their students concerns to teachers alerts are created and routinely updated as needed

Component 3 b: Contributes Effectively to IEP Meetings Component Unsatisfactory Basic Proficient Distinguished Participates in School Nurse makes School Nurse attends School Nurse attends School Nurse attends IEP IEP Meetings no effort to attend IEP meetings but IEP meetings and does meetings and does or share knowledge contributes in limited some assigned tasks and required tasks. Nurse with other team ways. participates in sharing initiates the sharing of members in IEP knowledge to contribute knowledge that meetings. to the meeting. contributes to the IEP meetings on an ongoing basis.

C omponent 3 c: Communicates Effectively with Student, Parents, Staff and Administrators Component Unsatisfactory Basic Proficient Distinguished Communicate School Nurse does School Nurse responds School Nurse provides School Nurse frequently s Effectively not communicate to questions from information to student, provides information to with student, student, parent, staff parents, staff and student. Parents, staff and parents, staff and and administrators. administrators as administrators as administrators. appropriate. appropriate. Communication reflects current needs of student and school environment.

Component 3 d: Maintains Confidentiality in a Professional Manner Component Unsatisfactory Basic Proficient Distinguished Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. Maintains School Nurse is not School Nurse efforts to School Nurse maintains School Nurse is highly Confidentialit alert to issues of maintain confidentiality by proactive in maintaining y confidentiality. confidentiality are releasing confidential confidentiality and inconsistent information only to educates others to appropriate personnel remember the importance with parents consent. of confidentiality.

Component 3 e: Develops and Demonstrates Good Rapport with Students Component Unsatisfactory Basic Proficient Distinguished Develop School Nurse ignores School Nurse School Nurse School Nurse interactions Rapport with students or has interactions with interactions with are friendly and Students interactions that are students are generally students are generally demonstrate warmth, negative, demeaning, appropriate but may friendly and caring and mutual respect sarcastic, or reflect occasional demonstrate warmth, in accordance with inappropriate to the inconsistency or caring and respect for developmental and cultural individual or student. students’ exhibit the nurse. norms Students exhibit minimal respect for the disrespect for the nurse. nurse.

Component 3 f: Demonstrates Knowledge and Ability to Communicate with Physicians and Pharmacists Component Unsatisfactory Basic Proficient Distinguished Communicate School Nurse does School Nurse School Nurse School Nurse initiates s with not communicate communicates with communicates with communications that are Physicians / with physicians or physicians and physicians and consistently high quality, Pharmacists pharmacists pharmacists when pharmacists in a clearly expressive, and necessary professional manner for appropriate for intended clarification of health recipient matters

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. DOMAIN 4: PROFESSIONAL RESPONSIBILITIES (Notes: Hi-lighted area shows level of performance)

Component 4 a: Pursues Continued Professional Growth through Education Component Unsatisfactory Basic Proficient Distinguished Pursues School Nurse School Nurse School Nurse seeks out School Nurse seeks out Professional engages in no participates in opportunities for opportunities for Growth professional professional activities professional professional development development to a limited extent development and and encourages other activities to enhance when they are participates in school nurses to seek knowledge skills convenient professional growth further knowledge to opportunities to enhance the nursing enhance nursing process process. knowledge.

Component 4 b: Demonstrates Knowledge and Understanding of Legal and Ethical Aspects of Nursing Practice Component Unsatisfactory Basic Proficient Distinguished Understands School Nurse exhibits School Nurse is aware School Nurse is aware of School Nurse adheres to Legal and a lack of knowledge of the Idaho Nurse the Idaho Nurse Practice Idaho Nurse Practice Act Ethical regarding the Idaho Practice Act and Act and adheres to the and Idaho Board of Nursing Practices Nurse Practice Act adheres to the Idaho Idaho Board of Nursing Rules and Regulations. and the Idaho Board Board of Nursing Rules Rules and Regulations. Additionally, school nurse of Nursing rules and and Regulations. Duties are delegated as follows the Practice regulations. appropriate Guidelines of the National Association of School Nursing. Delegation of duties is appropriate.

Component 4 c: Carries Out Duties and Responsibilities in a Professional Manner Following District Policies and Procedures Component Unsatisfactory Basic Proficient Distinguished Performs School Nurse School Nurse is aware School Nurse abides by School Nurse abides by Duties in practices without of School Dist School Dist 91 Health School Dist 91 Health Professional reference to School 91.Health Services Services Services Manner Dist 91 Health Policies/Procedures Policies/Procedures Policies/Procedures. Nurse Services routinely. is also actively involved in Polices/Procedures. policy development and revision.

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. Click here to enter text.Component 4 d: Demonstrates Sensitivity to the Political and Organizational Structure of the System and Community Component Unsatisfactory Basic Proficient Distinguished Participates in School Nurse avoids School Nurse School Nurse volunteers School Nurse volunteers to School / becoming involved in participates in school to participate in school participate in school and District school and district and district projects and district projects district projects, making a Projects projects. when specifically making a substantial substantial contribution asked. contribution. and assumes a leadership role in a major school or district project.

Component 4 e: Plans and Presents Programs on Growth and Development, Communicable Diseases, Hygiene, Safety, First Aid, CPR and Health Wellness Education In All Areas of the School Component Unsatisfactory Basic Proficient Distinguished Presents School Nurse does School Nurse provides School Nurse provides School Nurse provides Growth and not provide health health instruction formal health formal health instruction Development education to groups when requested. instruction within within groups or in Programs of individuals or in groups or in classrooms, classrooms, based on classroom settings based on sound learning sound learning theory as theory as appropriate appropriate for for developmental level. developmental level. Involvement in health curriculum development is apparent.

Component 4 f: Provides Health Counseling Component Unsatisfactory Basic Proficient Distinguished Provides School Nurse does School Nurse does School Nurse provides School Nurse provides Health not provide health provide health consistently high consistently high quality, Counseling counseling or it is of counseling but it is quality, individualized individualized counseling uniformly poor inconsistent in quality. counseling to person or to person or group. quality group. Feedback provision is made for students, parents or staff.

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001. SUMMARY: Click here to enter text.

DEVELOPMENT PLANS: Click here to enter text.

NURSE COMMENTS: Click here to enter text.

Acknowledgment I have reviewed this document and discussed the contents with the observer. My signature means that I have been advised of the contents of this observation and does not necessarily imply that I agree with the results.

______Nurse Signature/Date

______Observer Signature/Date

Adapted with permission from “Enhancing Professional Practice: A Framework for Teaching” by Charlotte Danielson, ASCD Publications, 1996, and Components of Professional Practice, ETS, 2001.