KRH Preceptor/Staff Nurse Evaluation

Please rate the individual KRH preceptor/staff nurse on how frequently she/he demonstrated the following clinical and professional characteristics. Thank you! We value your feedback.

Efficient use of time *
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Sound clinical judgment
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Clinical proficiency
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Effective teaching skills *
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Interest in new experiences
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Self-directedness
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Ability to establish rapport with others *
1 n   2 Seldom   3 Occasionally   4 Usually   5 Always  

Copes well with change
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Demonstrates positive professional image *
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Interest in working with students *
1 Never   2 Seldom   3 Occasionally   4 Usually   5 Always  

Please add any additional comments/suggestions:

Preceptor/Staff Nurse Name *

Student Name

Date of Experience *

School Name *

Enter the KRH department where you had this experience: *