Evaluatee to Send Domain Portions to Peers Who Evaluatee Would Like Feedback From s1

Clinical Care Coordinator RN Peer Input Tool for Annual Evaluation: Response to Diversity

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

Response (responsiveness; sensitivity) to Diversity: The sensitivity to recognize appreciate, and incorporate differences in the provision of care. Differences may include, but are not limited to, individuality, culture, spiritual beliefs, gender, gender expression, sexual orientation race, ethnicity, family configuration, lifestyle, socioeconomic status, age, values, etc.

Seeks opportunities for Demonstrates team values that Embraces diversity in the work individual growth in diversity orient people to care about the environment as a means to training and responsiveness success of others, embracing achieve enhanced patient care diversity outcomes

Identifies learning barriers Utilizes creative and variable Leads the healthcare team in based on differences and instructional methodologies that incorporating diversity into creatively removes or address diverse individual needs practice minimizes barriers and learning styles

Promotes an environment that Seeks internal and external Interprets and communicates embraces diversity in the resources to address the diverse complex patient/family cultural workplace needs of patients and families needs and role models caring practices

Maintains awareness of the cultural norms for patient populations, seeking validation in individual situations

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:

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