FNS Peer Input Tool for Annual Evaluation: Collaboration, Communication, and Professional Relationships

Peer feedback for (RN name): Directions:

 Evaluatee to send domain portions to peers who evaluatee would like feedback from

 Clinical Thinking and Judgment domain is to be completed by another RN

 Peers should indicate within the last column the level they feel is appropriate for the Evaluatee on each row

 Peers are encouraged to support their views with concrete examples

 Peers should complete the peer review within 7 Days and return electronically to the Manager/Designee and Evaluatee

Peer Should Designate Role Entry / Competent Expert Mastery Appropriate Level Below

DOMAIN: Collaboration Communication and Professional Relationships: Through shared values and a clear professional identity, demonstrates and role models an interdisciplinary collaborative approach to patient care. Working with others in a way that promotes and encourages each person’s contributions. It involves inter- and intra-disciplinary work with colleagues and ability to negotiate and resolve conflict.

Identifies the need for Facilitates appropriate Establishes and maintains appropriate communication to communication within the liaisons to the different units maintain patient care departments in the institution for within the hospital to maintain patient care continuity of care

Develops an awareness of the Consistently provides patient Establishes and develops new importance of external care utilizing the externally relationships and procedures relationships and the impact on developed relationships with external agencies to patient care issues facilitate and initiate patient care

Identifies the need for follow- Consistently provides follow-up Able to provide consistent up communication to our patient information to referring follow up with customers, seeks referring facilities hospitals and pre-hospital care opportunities to improve providers communication and provides immediate service recovery when problems develop

Understands the need for Provides communication on a Consistently promotes and communication between proficient level and supplies provides exemplary professional professionals and understands feedback throughout their communication and feedback the importance of feed back to professional practice throughout their professional the process practice, constantly looking for opportunities to improve this process

Understands the need and Participates in the flight Is able to constructively provide advantages flight debriefing debriefing process and receive flight debriefing process feed-back in a professional manner, in both the formal and

1 Peer Should Designate Role Entry / Competent Expert Mastery Appropriate Level Below

informal situation

Aware of the need to represent Demonstrates ongoing Consistently represents the UMHS values outside of the commitment to represent the values of UMHS in non- health systems setting values of UMHS in non-traditional traditional settings settings

Understands the importance of Recognizes customer service as a Able to consistently create customer service relationship built on maximizing positive customer experiences fulfillment of needs for all and initiate customer (service) involved to create a positive recovery in situations that are experience sub optimal

Understands the role of the Participates in communication Exhibits responsibility for the flight nurse as a member of a and decision making that successful outcome of each multi professional unit maximizes the success of the team mission team transport experience

Please describe a time when you saw me at my very best. What qualities did I display in this domain?

Please provide your input regarding opportunities for my personal and/or professional growth

I have completed the Peer Feedback Class as required by the UMPNC contract, paragraph 28E, for participation in the peer review process. Name: Date:

2 Revised 7/2015 Professional Development Framework RSAM Steering Committee/JIT Approved.

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