KENTUCKY STATE UNIVERSITY
SCHOOL OF NURSING
400 EAST MAIN STREET FRANKFORT, KENTUCKY 40601
BETTY WHITE HEALTH CENTER
Graduate Nursing Program
Graduate Nursing Program Advanced Adult/Gerontology Primary Care Nursing I, II, III Practicum Clinical Competency Evaluation
By completing the following form, preceptors evaluate the student's current achievement of the DNP Program Outcomes.
Semester/Year ___
Course ___
Student Name ___
Clinical Practicum Preceptor___
Faculty_____
Agency ___
Number of Clinical Hours with Preceptor
Evaluation Please Circle Midterm Final
PLEASE EVALUATE THE STUDENT'S PERFORMANCE BY SCORING EACH ITEM USING THE FOLLOWING CRITERIA:
Highly Competent Accurate performance without supervision. Utilizes appropriate consultation.
Competent Accurate performance with minimal supervision. Utilizes appropriate consultation.
Competent but Infrequently inaccurate. Requires direct
Needs Practice supervision. Utilizes appropriate consultation.
Unsatisfactory Inaccurate most of the time. Requires direct Most of the time supervision. Depends on consultation.
*Asterisks indicate the expected performance level at the end of the clinical experience.