NNP Daily Evaluation

Name of orientee:

Name of person providing feedback:

Instructions: Please rate the orientee in each of the following categories.

Rounds

Prepared for rounds

1: Excellent

2: Good

3: Fair

4: Needs improvement

Priortizes patients' needs based on acuity

1: Excellent

2: Good

3: Fair

4: Needs improvement

Follows up on ordered tests (labs, xray, etc)

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with team (Neo, Fellow, bedside nurse)

1: Excellent

2: Good

3: Fair

4: Needs improvement

Diagnoses during rounding:

Please comment on your ratings in this category:

Daily NNP Duties

Sign-outs

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with all team members

1: Excellent

2: Good

3: Fair

4: Needs improvement

Dear doctor letters/Hospital courses

1: Excellent

2: Good

3: Fair

4: Needs improvement

Assignment/rounding sheet updates

1: Excellent

2: Good

3: Fair

4: Needs improvement

Please comment on your ratings in this category:

Delivery Room

Takes "head of bed" in deliveries

1: Excellent

2: Good

3: Fair

4: Needs improvement

Types of deliveries:

Please comment on your ratings in this category:

Admission

Determines correct orders, tests, imaging required

1: Excellent

2: Good

3: Fair

4: Needs improvement

Does all parts of admission checklist

1: Excellent

2: Good

3: Fair

4: Needs improvement

Follows up on ordered tests, imaging, etc.

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with team

1: Excellent

2: Good

3: Fair

4: Needs improvement

Diagnoses during admissions:

Please comment on your ratings in this category:

Discharge

Identifies infants close to discharge

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with care management

1: Excellent

2: Good

3: Fair

4: Needs improvement

Discharge checklist: orders, problem list, med rec, exam, dear doctor/hospital course, narrative summary

1: Excellent

2: Good

3: Fair

4: Needs improvement

Please comment on your ratings in this category:

Communication

Communication with changes in status

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with RN/ancillary staff

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with families

1: Excellent

2: Good

3: Fair

4: Needs improvement

Communication with consultants

1: Excellent

2: Good

3: Fair

4: Needs improvement

Please comment on your ratings in the category:

Procedures

What was your involvement in the procedures done today?

Performed independently

Performed with some assistance

Observed only

Please comment on your selection in this category:

Anything else you would like to tell us or think we should know?

Upcoming goals / focus for the next few days:

Rounds

Daily NNP Duties

Delivery Room

Admission

Discharge

Communication

Procedures

Request an appointment

Refer a patient

Patients and families

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