RATINGS:

3 = Exceeds Expectations

2 = Meets Expectations

1 = Needs Improvement

ANNUAL EVALUATION

DATE:

____/____/____

NOTES

Perform all assigned tasks in accordance with our established policies and procedures and as instructed by your supervisors.

Follow work assignments, and/or work schedules in completing and performing your assigned tasks.

Cooperate with inter-departmental staff as well as other facility staff to ensure that nursing services can be adequately maintained to meet the needs of the residents.

Create and maintain an atmosphere of warmth, personal interest and positive emphasis, as well as a calm environment throughout the unit and shift.

Report all complaints and grievances made by a resident immediately.

Notify the facility when you will be late or absent from work – at least two hours prior to your shift start time.

Report work-related injuries or illnesses and/or occupational exposures to blood, body fluids, infectious materials, and hazardous chemicals to your supervisor.

Report known or suspected incidents of fraud to the supervisor.

Participate in and receive the nursing report upon reporting for duty.

Follow established policies concerning exposure to blood/body fluids.

Assist residents with daily dental and mouth care (i.e., brushing teeth/dentures, oral hygiene, special mouth care, etc.).

Assist residents with bath functions (i.e., bed bath, tub or shower bath, etc.) as directed.

Assist residents with dressing/undressing as necessary.

Assist residents with hair care functions (i.e., combing, brushing, shampooing, etc.).

Assist residents with nail care (i.e., clipping, trimming, and cleaning the finger/toenails. (NOTE: Does not include diabetic residents.)

Keep residents dry (i.e., change gown, clothing, linen, etc., when it becomes wet or soiled.).

Change bed linens. Keep linens tight to avoid wrinkles from forming under the resident.

Make beds (occupied and unoccupied).

Put extra covers on beds as requested.

Position bedfast residents in correct and comfortable position. Reposition every two hours.

Assist resident with bowel and bladder functions (i.e., take to bathroom, offer bedpan/urinal, portable commode, etc.).

Maintain intake and output records as instructed.

Check and report bowel movements and character of stools as instructed.

Assist residents in preparing for medical tests (i.e., lab work, x-ray, therapy, dental, etc.).

Assist residents in preparing for activity and social programs (i.e., church services, parties, visitors, etc.).

Assist in transporting residents to/from appointments, activities, and social programs, etc., as necessary.

Assist with lifting, turning, moving, positioning, and transporting residents into and out of beds, chairs, bathtubs, wheelchairs, lifts, etc.

Assist residents to walk with or without self-help devices as instructed.

Assist with the application of nonsterile (moist and dry) warm/cold compresses.

Shave male residents.

Keep hair on female residents clean (facial, underarms and legs) as desired by the resident.

Assist in preparing the resident for a physical examination.

Weigh and measure residents as instructed.

Measure and record temperatures, blood pressures, pulse, and respirations as instructed.

Answer resident calls as promptly as feasible.

Keep water cups clean and filled with ice water, straws and within easy reach.

Offer residents liquids to drink/hydration frequently throughout each shift, unless resident is on fluid restriction.

Ensure that residents who are unable to call for help are checked frequently – at least once every two hours.

Check each resident routinely to ensure his/her personal care needs are being met in accordance with his/her wishes.

Observe and report the presence of pressure areas and skin breakdowns.

Report injuries of known or unknown source, including skin tears.

Ensure that the resident’s room is ready for receiving the resident (i.e., bed made, name tag up, etc.).

Make resident comfortable (i.e., assist in getting into bed, obtain ice water, etc.).

Inventory and mark the resident’s personal possessions as instructed.

Store resident’s clothing.

Assist residents with packing their personal possessions when they are being transferred to a new room or when they are being discharged.

Transport residents to new rooms or to the Lobby area.

Assist with loading/unloading residents from vehicles as necessary.

Assist with the care of a dying resident.

Provide post-mortem care as instructed.

Administrative Duties

Ratings:

3 = Exceeds Expectations

2 = Meets Expectations

1 = Needs Improvement

Annual

Evaluation

Date:

____/____/____

Notes

Review care plans daily to determine if changes in the resident’s daily care routine have been made on the care plan.

Inform the Nurse Supervisor/Charge Nurse of any changes in the resident’s condition so that appropriate information can be entered on the resident’s care plan.

Ensure that your notes reflect that the care plan is being followed.

Record all resident information using electronic documentation.

Report all changes in the resident’s condition to the Nurse Supervisor/Charge Nurse as soon as practical.

Report all accidents and incidents you observe immediately.

Agree not to disclose assigned user ID code and password for accessing resident/facility information and promptly report suspected or known violations of such disclosure to the supervisor.

Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the supervisor.

Report any known or suspected unauthorized attempts to access the facility’s information system to the supervisor.

Ensure that departmental computer workstations left unattended are properly logged off or the password protected automatic screensaver activates within established facility policy guidelines.

Safety & Infection Control

Ratings:

3 = Exceeds Expectations

2 = Meets Expectations

1 = Needs Improvement

Annual

Evaluation

Date:

____/____/____

Notes:

Keep call buttons within easy reach of each

resident.

Immediately notify the Nurse Supervisor/Charge Nurse of any resident leaving/missing from the facility.

Follow established safety precautions in the performance of all duties.

Keep residents’ personal possessions off the floor and properly stored.

Keep floors dry. Report spills immediately.

Keep excess supplies and equipment off the floor. Store in designated areas.

Clean, disinfect, and return all resident care equipment to its designated storage area after each use.

Report all hazardous conditions and equipment to the Nurse Supervisor/Charge Nurse immediately.

Report all safety violations.

Report any communicable or infectious disease to the Director of Nursing and/or to the Infection Control Coordinator.

Follow established isolation precautions and procedures.

Wear and/or use safety equipment and supplies.

Safely use only the equipment you have been trained to use.

Report defective equipment to the Nurse Supervisor/Charge Nurse.

Practice appropriate handwashing and use of hand sanitizer at all times.