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Clinical Skills and Knowledge (peer must be an RN)
Assessment
Nursing Diagnosis
Planning/Implementation/Evaluation
Technology
Patient/Family Education
Policy/Procedure/Protocols
Promoting Culture of Safety
Documentation
Therapeutic Relationships
Therapeutic Communication
Empowerment - Nurse, Patient, Family
Compassion
Advocacy and Ethics
Valuing of Diversity with Patients and Family
Professional Relationships
Collaboration with the Health Care Team
Valuing Teams/Teamwork
Valuing of Diversity in Team
Delegation
Professional Development
Self
Contribution to Others
Advancing Evidence Based Practice Through Innovation and Research
Evidence Based Practice and Research
Scale (NOTE: Level F is for Master's prepared RNs) A = Level A behaviors best describe the nurse C = Level C behaviors best describe the nurse D = Level D behaviors best describe the nurse E = Level E behaviors best describe the nurse F = Level F behaviors best describe the nurse
RN Name:
Uniqname:
Unit/Area:
Framework Level:
Evaluation Period:
Peer Feedback Form - FrameworkNOTE: DO NOT attempt to fill form in the website. Download (save) it to your computer, flash drive or H drive first. Close the website. Fill saved form only in Adobe Acrobat. Include nurse’s uniqname in file name - Example Peer: Type nurse information at right. Referring to Framework Nursing Behaviors, select ratings for the domain(s) you were requested to evaluate. You are encouraged to provide concrete examples in the text areas. Please complete form within 7 days.
Tip Sheet | Video Save your work - form does not auto-save. Using a Mac?
Please describe a time when you saw me at my very best. What qualities did I display in these domains?
Please provide your input regarding opportunities for my personal and/ or professional growth.
Peer submit instructions: Enter your name/uniqname/role at right. Digitally sign below. Save for your records.
Email the signed form to BOTH: 1) the nurse 2) nurse’s Clinical Nursing Director/Supervisor
Peer Signature: Tip Sheet | Video
Targ
et A
udie
nce:
Nur
sing
at M
ichi
gan
| Au
thor
/Con
tact
: K. D
unnu
ck |
Rev
iew
ed: 2
/4/2
1
Peer Name:
Uniqname:
Role:
For description of levels/behaviors,
refer to:
Framework Nursing Behaviors
STAFF MEMBER INFORMATION
RN Name:
Uniqname:
Unit/Area:
Framework Level:
Evaluation Period:
http://www.med.umich.edu/NURSING/performance_evaluation/docs/example-peerfeedback-filename.pdfhttp://www.med.umich.edu/nursing-PDE/framework/docs/behaviors.pdfhttp://www.med.umich.edu/NURSING/performance_evaluation/docs/tipSheet-Esign.pdfhttps://nursing.mivideo.it.umich.edu/media/t/1_8c06h04nhttp://www.med.umich.edu/nursing-PDE/framework/docs/behaviors.pdfhttp://www.med.umich.edu/NURSING/performance_evaluation/docs/tipSheet-hDrive.pdf#page=2https://nursing.mivideo.it.umich.edu/media/t/1_dy1p5c6hhttp://www.med.umich.edu/NURSING/performance_evaluation/docs/tipsheet-MacUsers.pdf
Assessment: [Select...]Diagnosis: [Select...]Planning: [Select...]Technology: [Select...]PatientFamily Eduation: [Select...]Policy: [Select...]Culture: [Select...]Documentation: [Select...]Diversity: [Select...]Therapeutic: [Select...]Empowerment: [Select...]Compassion: [Select...]Advocacy: [Select...]Collaboration: [Select...]Teamwork: [Select...]Diversity in Team: [Select...]Delegation: [Select...]Self: [Select...]Others: [Select...]EBP: [Select...]Describe a time: Peer, type your response here (replace this text, up to 1000 characters). Font size in text boxes will adjust smaller as you type.Input re growth: RN Name: Uniqname: Unit/Area: Framework Level: [Select...]Evaluation Period: Peer Name: Peer Uniqname: Peer Role: [Select...]