1

AZUSA PACIFIC UNVERSITY

SCHOOL OF NURSING
STUDENT EVALUATION FORM
(To be completed by School Nurse Preceptor)
Student:
Preceptor:

Nicole Chan
Martha Bajet Clinical Faculty: Christy Ragland, RN, MSN, PHN

Clinical Agency: San Diego Unified School District Area of Practice: School Nursing
Course Name and #: Community Health Nursing/ GNRS 587
Semester/Year: Spring 2015
Date: ____7/21/15_________
Please rate the following student competencies according to the scale below:
5 = Strongly Agree 4 = Agree 3 = Agree with 2 = Disagree 1 = Strongly Disagree
Reservation
N/A = Not applicable
Comments
1. The student demonstrated safe knowledge
and skill in the clinical area.

1 _____________5_______

2. The student shared with the preceptor the

5
course objectives, individual learning goals,
and weekly objectives.

1 ______________5______

3. The student demonstrated critical thinking

and effective clinical decision making in
meeting the biological, psychological,
sociocultural, and spiritual needs of clients.

1 _______________5_____

4. The student utilized principles and skills

of effective communication in relationship
with clients, families, and aggregates.

1 ________________5____

5. The student utilized principles of teaching

5
and learning in educating clients, families, and
aggregates.

1 _____________5_______

6. The student was able to apply theoretical

5
knowledge and research findings to support
clinical practice.

1 ____________5________

7. The student applied principles of leadership 5 4

and management as a member of the health care
team including collaboration, delegation, and
accountability.

1 _________5___________

8. The student exhibited professional role

5
behavior based on legal/ethical principles and
standards of practice.

1 _____________5_______

9. The student demonstrated individual

5
responsibility for planning and implementing
learning activities in the clinical setting.

1 _____________5_______

10. The student was receptive to preceptor

feedback and evaluation.

1 ____________5________

11. The student developed an effective

relationship with the preceptor.

1 _____________5_______

Additional comments:
It was a true pleasure to have Nicole at Rosa Parks. She demonstrated great initiative in
learning all about school nursing. I believe Nicole will be an outstanding clinician in whichever
setting she chooses to practice. It was a pleasure mentoring Nicole.
From a school perspective, I do recommend you consider adding days to the school nursing
rotation. 3 days does not allow for students to learn all there is to learn about school nursing.
I would recommend at minimum 4-6 days, 2 weekly if possible. This would allow mentors to
work closer with students and expose them to many aspects of school nursing and all students
within the school setting.

Signature: __________________________________________ Date:___________________