Performance Review Template for Nurses

PERFORMANCE EVALUATION: NURSING PERSONNEL

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I. GENERAL INFORMATION

Employee Name: [________________________________]
Employee ID: [________________________________]
Job Title: [________________________________]
Department/Unit: [________________________________]
Evaluation Period: From [____/____/____] to [____/____/____]
Reviewer Name/Title: [________________________________]
Date of Review: [____/____/____]

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II. PERFORMANCE RATING SCALE

• 5 – Exceptional: Performance consistently exceeds expectations; demonstrates mastery and leadership.
• 4 – Exceeds Expectations: Performance frequently exceeds requirements; consistently high quality.
• 3 – Meets Expectations: Performance consistently meets requirements; reliable and competent.
• 2 – Needs Improvement: Performance occasionally falls below requirements; requires corrective action.
• 1 – Unsatisfactory: Performance consistently fails to meet core competencies; immediate intervention required.

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III. CORE COMPETENCIES EVALUATION

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IV. NARRATIVE ASSESSMENT

Summary of Achievements:
[__________________________________________________________________________]
[__________________________________________________________________________]

Areas for Development/Growth:
[__________________________________________________________________________]
[__________________________________________________________________________]

Progress Toward Previous Goals:
[__________________________________________________________________________]
[__________________________________________________________________________]

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V. GOAL SETTING (UPCOMING REVIEW PERIOD)

• Goal 1: [______________________________________________________________]
• Goal 2: [______________________________________________________________]
• Goal 3: [______________________________________________________________]

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VI. EMPLOYEE COMMENTS

The employee may provide comments regarding the evaluation process or their performance.
[__________________________________________________________________________]
[__________________________________________________________________________]

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VII. SIGNATURE AND ACKNOWLEDGMENT

By signing below, the parties acknowledge that this performance evaluation has been discussed. The employee’s signature does not necessarily indicate agreement with the contents, but acknowledges that the evaluation has been reviewed.

Evaluator Signature:

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Date: [____/____/____]

Employee Signature:

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Date: [____/____/____]

Department Head/HR Representative:

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Date: [____/____/____]

Template Document: Performance Review Template for Nurses

• Purpose: This procedure establishes a standardized framework for assessing the clinical proficiency and professional conduct of nursing staff to ensure high quality patient care.

• Scope: This policy covers all registered nurses and licensed practical nurses working within the [Department Name] unit during their annual performance review cycle.

• Document owner: Nursing Administration Department

• Effective date: [Date]

• Version: [Version number]

• Applies to: All nursing personnel and clinical supervisors

Roles and responsibilities

Procedure

1. Notify the nurse of the upcoming performance review at least [Number] weeks before the scheduled meeting date. (Responsible: Nurse Manager)
2. Distribute the self assessment template to the nurse via the [Software Name] portal for completion. (Responsible: Human Resources)
3. Submit the completed self assessment form to the supervisor no later than [Date]. (Responsible: Staff Nurse)
4. Gather feedback from at least [Number] colleagues regarding the nurse's clinical performance and patient interaction quality. (Responsible: Nurse Manager)
5. Schedule a private meeting in [Room Name] to discuss the evaluation results and professional development goals. (Responsible: Nurse Manager)
6. Review the core competencies and narrative assessment sections during the face to face evaluation meeting. (Responsible: Nurse Manager)
7. Document specific goals for the upcoming [Number] month period to support the nurse's career advancement. (Responsible: Nurse Manager)
8. Allow the nurse to provide written comments regarding the evaluation findings within [Number] days of the meeting. (Responsible: Staff Nurse)
9. Obtain signatures from both the evaluator and the nurse to finalize the performance review document. (Responsible: Nurse Manager)
10. Upload the signed evaluation document to the employee's permanent personnel file for future reference. (Responsible: Human Resources)

Records and revision

• Prepared by: [Full name]
• Reviewed by: [Full name]
• Date completed: [Date]
• Signature: ______________________
• Date signed: [Date]