Domain L: Professional Responsibilities

Employee Name______

Performance Review*

(*This document has been edited from the School District of Beloit School Nurse Performance Review)

School Nurse

Domain 1: Professional Responsibilities

Component I: Maintaining Accurate Records

Elements: Government/state/county compliancy reporting • School District student health reporting

Levels of Performance
Element / Unsatisfactory / Basic / Proficient / Distinguished
A) Government/state/county compliancy reporting / Nurse fails to maintain and submit required compliancy reports.
/ Nurse maintains and submits required compliancy reports.
/ Nurse properly maintains and submits required compliancy reports. Reports are usually submitted in a timely fashion.
/ Nurse properly maintains and submits required compliancy reports. Reports are consistently submitted in a timely fashion.
B) School District student health reporting / Nurse fails to document and maintain confidential student health records.
/ Nurse maintains confidential student health records and documents student health concerns.
/ Nurse accurately maintains confidential student health records and documents student health concerns. Reporting and documenting is usually done in a timely fashion.
Nurse is knowledgeable of School District health services policies.
/ Nurse accurately maintains confidential student health records and documents student health concerns. Reporting and documenting is consistently done in a timely fashion.
Nurse is knowledgeable of School District health services policies and is actively involved in the development and review of these policies/procedures.

Evaluator’s Comments

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Domain 1: Professional Responsibilities

Component II: Contributing to School, District, and Community

Elements: Relationships with colleaguesRelationships with students and their familiesParticipation in school and district projects Demonstrates employee responsibilities Supports a safe and healthy school environment  Provides/contributes to Health Education Programming (HEP) in the school and community

Levels of Performance
Element / Unsatisfactory / Basic / Proficient / Distinguished
A) Relationships with colleagues / Nurse’s relationships with colleagues are negative.
/ Nurse maintains cordial relationships with colleagues to fulfill the duties that the school requires.
/ Nurse maintains supportive and cooperative relationships with colleagues.
/ Nurse maintains supportive and cooperative relationships with colleagues. The nurse assumes a leadership role.
B) Relationships with students and their families / Nurse makes no attempt to communicate with students and families about health related issues and concerns
/ Nurse communicates with students and families about health-related issues and concerns, but responses to their concerns are minimal.
/ Nurse communicates with students and families on a regular basis about health related issues and concerns and is available to respond as needed to their concerns.
/ Nurse communicates with students and families on a regular basis about health related issues and concerns and is available as needed to respond to their concerns. The nurse handles concerns with great sensitivity and delivers care in a non-judgmental and non-discriminatory manner.
C) Participation in school and district projects / Nurse avoids becoming involved in school and district projects.
/ Nurse participates in school and district projects only when asked.
/ Nurse volunteers to participate in school and district projects and makes a substantial contribution.
/ Nurse volunteers to participate in school and district projects and assumes a leadership role.
Levels of Performance
Element / Unsatisfactory / Basic / Proficient / Distinguished
D) Demonstrates employee responsibilities. / Nurse fails to present self in a professional manner. Reliability, accountability and punctuality are in question.
/ Nurse usually presents self in a professional manner. Reliability, accountability and punctuality are apparent.
/ Nurse consistently presents self in a professional manner. Reliability, accountability and punctuality are excellent.
/ Nurse consistently presents self in a professional manner. Reliability, accountability and punctuality are exemplary.
E) Supports a safe and
healthy school environment / Nurse makes no attempt to recognize the health and safety needs of staff and students.
/ Nurse is aware of the health and safety needs of staff and students.
/ Nurse recognizes the health and safety needs of staff and students, and offers suggestions as to how these needs may be met.
/ Nurse recognizes the health and safety needs of staff and students and assumes a leadership role in planning programs and providing interventions to address those needs.
F Provides/contributes to Health Education Programming (HEP) in the school and community / Fails to provide/contribute HEP within the school and community.
/ Provides minimal HEP within the school and community.
/ Provides effective HEP in the school and community.
/ Provides effective HEP within the school and community. Takes a leadership role in the delivery of HEP and is knowledgeable of health education curriculum.

Evaluator’s Comments:

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Domain 1: Professional Responsibilities

Component III: Growing and Developing Professionally

Elements: Enhancement of professional knowledge and skills  Service to the profession.

Levels of Performance
Element / Unsatisfactory / Basic / Proficient / Distinguished
A) Enhancement of professional knowledge and skills / Nurse does not engage in professional development activities to enhance knowledge or skill.
/ Nurse engages in professional development activities to a limited extent when they are convenient.
/ Nurse seeks out opportunities for professional development activities to enhance content knowledge and nursing skills.
/ Nurse seeks out opportunities for professional development activities to enhance content knowledge and nursing skills. The nurse is able to apply this new knowledge/skill to his/her work with students and families.
B) Service to the profession / Nurse makes no effort to share knowledge/skills with others or to collect school health data.
/ Nurse contributes to the profession by sharing knowledge/skills with others.
Nurse assists in collecting school health data.
/ Nurse contributes to the profession by sharing knowledge/skills with others.
Nurse collects school health data and participates in the interpretation of this data.
/ Nurse contributes to the profession by initiating activities that share his/her knowledge/skills with others. The nurse participates in local, state, or national organizations.
Nurse uses school health data to improve health programming for the school community.

Evaluator’s Comments

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Domain 2: Delivery of Service

Component I: Advocating for and Maintaining Student Health

Elements: Provide care for the sick and injured  Health assessments

Levels of Performance
Element / Unsatisfactory / Basic / Proficient / Distinguished
A) Provide care for the sick and injured / Nurse’s ability to provide care for the sick and injured demonstrates an inadequate knowledge of basic first aid, infectious disease control, and parameters of basic standards of nursing care.
/ Nurse’s ability to provide care for the sick and injured demonstrates minimal knowledge of basic first aid, infectious disease control and parameters of basic standards of nursing care.
/ Nurse’s ability to provide care for the sick and injured demonstrates effective and appropriate knowledge of basic first aid, infectious disease control and parameters of basic standards of nursing care.
/ Nurse’s ability to provide care for the sick and injured demonstrates effective and appropriate knowledge of basic first aid, infectious disease control and parameters of basic standards of nursing care. Nurse demonstrates a keen sensitivity in providing care for the sick and injured.
B) Health assessments / Nurse fails to perform state and district mandated health assessments and screenings. Nursing assessment skills are inadequate with poor nursing interventions.
/ Nurse adequately performs, evaluates, and coordinates state and district mandated health assessments and screenings.
Nurse demonstrates acceptable nursing assessment skills with adequate nursing interventions.
/ Nurse appropriately performs, evaluates, and coordinates state and district mandated health assessments and screenings.
Nurse demonstrates excellent nursing assessment skills with appropriate nursing interventions.
/ Nurse appropriately performs, evaluates, and coordinates state and district mandated health assessments and screenings.
Nurse demonstrates exceptional nursing assessment skills with appropriate nursing interventions, implemented in a safe and timely manner.

Evaluator’s Comments

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Domain 2: Delivery of Service

Component II: Training and Supervision of Non-Nursing Personnel

Elements: Medication administration  Health-related procedures

Levels of Performance
Element / Unsatisfactory / Basic / Proficient / Distinguished
A) Medication administration / Nurse fails to follow district medication administration policies and procedures.
/ Nurse follows district medication administration policies and procedures, and is knowledgeable of related statutory requirements. Nurse instructs and monitors staff according to district policy.
/ Nurse demonstrates accurate medication administration and provides effective staff instruction and monitoring. Nurse consistently follows district medication administration policies and procedures and is knowledgeable of related statutory requirements.
/ Nurse demonstrates accurate medication administration and provides effective staff instruction and monitoring. Nurse consistently follows district medication administration policies and procedures and is knowledgeable of related statutory requirements. Nurse is actively involved in the review and revision of district medication administration policies and procedures.
B) Health-related procedures / Nurse fails to demonstrate appropriate skills in performing, delegating, instructing and monitoring of health-related procedures.
/ Nurse usually demonstrates accurate nursing skills in performing health-related procedures. Delegation, instruction and monitoring of health-related procedures is usually done in an appropriate manner.
/ Nurse consistently demonstrates accurate nursing skills in performing health-related procedures. Nurse appropriately delegates nursing acts and provides effective staff instruction and monitoring.
/ Nurse consistently demonstrates accurate nursing skill in performing health-related procedures. Nurse appropriately delegates nursing acts and provides effective staff instruction and monitoring. Nurse is actively involved in the review and development of district policies related to these procedures.

Evaluator’s Comments

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INSTRUCTIONS
This performance review is divided into 2 domains.
Domain 1:Reflects the professional responsibilities of the school nurse.
Domain 2:Reflects direct nursing services for students.

• Each domain is then subdivided into components.
• Each component is comprised of elements.

Please evaluate the school nurse by selecting his/her level of performance for each element.
Check the appropriate box.
The levels of performance are: unsatisfactory, basic, proficient, distinguished
Completed By ______Date ______

*This documenthas been edited from the School District of Beloit School Nurse Performance Review

Reference: Scope and Standards of Practice, School NursingEnhancing Professional Practice: A Framework for Teaching, 2nd ed.

National Association of School Nurses, Inc. 2011Charlotte Danielson, 2007

Suggested Performance Review Procedures

1. A school nurse performance review should be completed individually by the following.
2. Student Services Administrator
3. Appropriate Site Administrator
4. School Nurse
5. Evaluating parties should meet to discuss the individual performance reviews.
6. The final performance review will be a composite of the 3 individually prepared reviews.