Cdhb Competent Rn Peer Review Form

CDHB COMPETENT RN PEER REVIEW FORM (Competencies for the RN scope of practice)

Please refer to Nursing Council of New Zealand (December 2007, reprinted May 2012) “competencies for the registered nurse scope of practice” for the specific indicators for each competency. Sufficient comments must be completed under each competency to substantiate the assessment.

Name of Nurse:

Practice Area:

Peer review completed by: (Name)

Position: Date: ______

Practice Area:

A. To be completed by the applicant:

To______

I requested that you carry out a Peer Review on me, ______to assist in my professional development, goal setting and ongoing education.

Name:______Signed: ______Date:______Staff member’s name and Designation OR

1 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc B. To be completed by the Nursing Line Manager:

To______

I request you carry out a Peer Review of ______to assist in his/her professional development, goal setting and ongoing education.

Name:______Signed: ______Date:______Staff member’s name and Designation

2 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Domain 1 Professional Responsibility

Competency Statements Comments/Rationale (comments must be given)

Manager Peer Review 1.1 Met / Not Met Met / Not Met Accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical and relevant legislated requirements

1.2 Met / Not Met Met / Not Met Demonstrates the ability to apply the principles of the Treaty of Waitangi/Te Tiriti o Waitangi to nursing practice

1.3 Met / Not Met Met / Not Met Demonstrates accountability for directing, monitoring and evaluating nursing care that is provided by nurse assistants, enrolled nurses and others

3 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Competency Statements Comments/Rationale

Manager Peer Review 1.4 Met / Not Met Met / Not Met Promotes an environment that enables client safety, independence, quality of life, and health.

1.5 Met / Not Met Met / Not Met Practices nursing in a manner that the client determines as being culturally safe.

Strengths:

Area in need of improvement (if any):

4 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Domain 2 Management of Nursing Care

Competency Statements Comments/Rationale

Manager Peer Review 2.1 Met / Not Met Met / Not Met Provides planned nursing care to achieve identified outcomes

2.2 Met / Not Met Met / Not Met Undertakes comprehensive and accurate nursing assessment of clients in a variety of settings

2.3 Met / Not Met Met / Not Met Ensure documentation is accurate and maintains confidentiality of information

5 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Competency Statements Comments/Rationale

Manager Peer Review 2.4 Met / Not Met Met / Not Met Ensures the client has adequate explanation of the effects, consequences and alternatives of proposed treatment options

2.5 Met / Not Met Met / Not Met Acts appropriately to protect oneself and others when faced with unexpected client responses, confrontation, personal threat or other crisis situations

2.6 Met / Not Met Met / Not Met Evaluates client’s progress toward expected outcomes in partnership with clients

2.7 Met / Not Met Met / Not Met Provides health education appropriate to the needs of the client within a nursing framework

2.8 Met / Not Met Met / Not Met Reflects upon and evaluates with peers and experienced nurses, the effectiveness of nursing care

6 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc 2.9 Met / Not Met Met / Not Met Maintains professional development

Strengths:

7 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Domain 3 Interpersonal Relationships

Manager Peer Review 3.1 Met / Not Met Met / Not Met Establishes, maintains and concludes therapeutic relationships with client

3.2 Met / Not Met Met / Not Met Practises nursing in a negotiated partnership with the client where and when possible

3.3 Met / Not Met Met / Not Met Communicates effectively with clients and members of the health care team

Strengths:

8 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Domain 4 Inter-professional Health care and Quality Improvement

Manager Peer Review 4.1 Collaborates and participates with colleagues and members of the health care team to facilitate and coordinate care

4.2 Recognises and values the roles and skills of all members of the health care team in the delivery of care

4.3 Participates in quality improvement activities to monitor and improve standards of nursing

9 D:\Docs\2018-04-13\074fcccbdc1b4e014f093e4972a1dc35.doc Strengths:

Peer review completed by: Signature: ______(Name)

Designation: Date:

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