Student Nurse Preceptorship Survey

Student Nurse Preceptorship Survey
Full Name of Primary Preceptor *

First Name Last Name
School Name
Hospital Location *
RR Unit *
SM Unit *
NPH Unit *

Student Nurse Preceptorship Survey
DIRECTIONS: Please rate your preceptor on the following items:
- EXCELLENT - Exceeded Expectations
- SATISFACTORY - Good/Met Expectations
- FAIR - Usually Met Expectations
- POOR - Did Not Meet Expectations
- N/A - Not Applicable

ASSESSMENT *

	Excellent	Satisfactory	Fair	Poor	N/A
Assessed and incorporated your learning style and preferences

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

COMPETENCY *

	Excellent	Satisfactory	Fair	Poor	N/A
Conveyed relevant policies and standards of practice on the unit/clinic

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

COMMUNICATION *

	Excellent	Satisfactory	Fair	Poor	N/A
Verbally expressed ideas in a way that you could understand
Communicated effectively with patients, families, staff, and physicians (BRN)
Demonstrated effective communication practices to minimize risks to self, patient (Q)
Served as a resource to document nursing care in the electronic medical record (Q)

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

CRITICAL THINKING *

	Excellent	Satisfactory	Fair	Poor	N/A
Guided you to set priorities and make appropriate decisions

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

Student Nurse Preceptorship Survey

INTERPERSONAL *

	Excellent	Satisfactory	Fair	Poor	N/A
Acknowledged your strengths and weakness in an honest and respectful way (Q)
Was personable and approachable
Reflected a positive attitude/desire to work with you (BRN)
Provided patient centered care with sensitivity and respect for diversity of others (Q)

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

LEADERSHIP ACCOUNTABILITY *

	Excellent	Satisfactory	Fair	Poor	N/A
Demonstrated nursing expertise in the delivery of care through planning, delegating, and supervising others (BRN)
Served as a role model for ethical and legal behaviors
Used resources appropriately and efficiently (material and human)
Modeled professional development behaviors (i.e., life-long learner, specialty certified, member of a professional nursing organization)

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

FACILITATION OF LEARNING *

	Excellent	Satisfactory	Fair	Poor	N/A
Advocated to meet your needs in the learning environment
Evaluated your knowledge/skills and provided constructive feedback
Helped you meet your educational objectives of the preceptorship/practicum

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

KNOWLEDGE INTEGRATION SKILLS *

	Excellent	Satisfactory	Fair	Poor	N/A
Reviewed outcomes of nursing care (ie: nursing sensitive indicators, HCAHPS) (Q)
Used clinical evidence to make decisions and guide practice (Q)

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *

Student Nurse Preceptorship Survey

OVERALL EXPERIENCE *

	Excellent	Satisfactory	Fair	Poor	N/A
Placement helped me meet my educational/career goals
Clinical placement compared to other clinical placement sites
Computer access for this rotation
Unit orientation by your preceptor or other member of the staff on the unit

Please provide an explanation for any areas marked "poor" and/or provide any other comments regarding your experience: *
Would you recommend this unit to other students? *
If no, please provide comments below: *
What type of program are you currently enrolled in? *
Are you interested in employment at UCLA Health? *
Please provide any other comments about your experience below:
Should be Empty: