Xavier University – Ateneo de Cagayan
College of Nursing
Campion Hall, XU Main Campus
Corrales Avenue, Cagayan de Oro City
RLE EVALUATOIN TOOL (Leader)
COPAR
Name of Stunt:_________________________ Clinical Area:__________________
Inclusive Dates of Experience:_____________________________
Clinical Instructor:______________________________ Score:____________
DIRECTIONS: Student Leaders/PCI is to be rated on their performance in the area
they are assigned to. Careful evaluation is done with regards to the tasks assigned
to each leader.
Upon completion of the evaluation tool, determine the overall rating, giving weight to
various performance categories as appropriate to the particular assignment. Please
indicate remarks in the space provided if needed.
SCORING CONTENT
4- Excellent High performance. Consistently performs tasks reflecting the
highest level of performance. Exceeds most job requirements and
significantly contributes to the team goal.
3- Very Good Performance is fully satisfactory. Does tasks showing mastery of
performance with minimal supervision which meets all basic
requirements
2- Satisfactory Student performs fairly. Does tasks showing development and
movement toward mastery of performance with help or direct
supervision in some aspects. Meets most and falls short of some
requirements. Needs corrective coaching in problem areas.
1- Needs Fails to meet most minimum job requirements. Does tasks
Improvement reflecting beginning level of performance. Tasks not done properly
but demonstrates understanding of concepts involved with tasks.
Heeds corrective coaching and does monitoring.
BEHAVIOR/ SKILLS 4 3 2 1 REMARKS
Use of Management Process
A. Planning
1. Meets w/ C.I. & Nurse In charge
prior to exposure to area assigned.
2. Assigns family to each student
under his/her supervision a day prior
to exposure.
3. Conducts conference w/ students
before, during, &/or after duty hours.
4. Prioritizes the daily planning of
students to meet the Group’s Goals on
time.
5. Identifies key priorities at the
beginning of exposure.
6. Reviews goals & objectives w/ co-
students.
7. Assesses and assists the students
under him/her supervision in the
management of their assigned family
as necessary to maximize time used.
8. Strives to end the workday on time.
9. Handles paper works promptly and
efficiently.
10. Collects and submits requirements
of students to CI on time.
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1. Explains the group structure and
sub-leaders under his/her supervision.
2. Models responsibility and
accountability to the group.
3. Organizes activities in the area
effectively and efficiently.
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1. Assigns families to each student
fairly.
2. Considers the students competence
in family assignment.
D. DIRECTING
1. A good role model to the students
under his/her supervision.
2. Show supportiveness and
encourages communication among the
group.
3. Properly and safely delegates task
considering the competency of each
group member.
4. Checks on students from time to
time during the exposure.
E. CONTROLLING
1. Ensures safe & proper performance
of nursing actions by each member.
2. Gives comments/feedbacks to
continuously improve student
performance.
3. Communicates w/ CI with regards to
his/her student’s performance/tasks.
4. Completes the performance
evaluation tool of each student under
his/her supervision objectively and
accurately.
Shows attributes of future
professional/leader
1. Reports on duty on time
2. Accepts suggestion & constructive
criticisms.
3. Demonstrates active group
participation.
4. Flexible and adaptive in different
situation.
5. Practice good grooming and
dresses appropriately.
Rubric Score QPI Letter Grade Category
97-100% 3.76-4.00 A Excellent
89-96% 3.26-3.75 A- Very Good
81-88% 2.76-3.25 B Good
72-80% 2.26-2.75 B- Fair
65-71% 1.76-2.25 C Satisfactory
60-64% 1.5-1.75 D Unsatisfactory
60 & below 1.4 & below F Failure
Note
Score=Total Score/Highest Possible Score x 100
Highest Possible Score =
Name and signature of student:__________________________________
Name and signature of Clinical Instructor: __________________________
Date of evaluation:___________