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Target Audience: Nursing at Michigan | Contact: Kathy Dunnuck | Reviewed: 2/4/21
Nursing Performance Evaluation Instructions
For Clinical Care Coordinators
Obtain peer feedback from at least 3 peers covering all domains
Be sure that all Clinical Care Coordinator domains are covered. At least one peer must be an RN who has completedpeer feedback/review education. Peer who reviews the Clinical Thinking and Judgment domain must be an RN.
Ask peers to complete feedback within 7 days
Tips for inviting peers to provide feedback:
Emailing peers? Send each peer an email and specify which domains to evaluate. Form link:Clinical Care Coordinator Peer Feedback Form | Tips: Peer Feedback Invitation - Suggested Email Content
Asking in person? Refer peers to the Nursing Performance Evaluations website for links/instructions.
Complete Self-Evaluation within 3 weeks Download (save) form to your computer or network drive first. Read red alert box below. Email completed
form to your unit Clinical Nursing Director or Supervisor. Save a copy for your records.
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Clinical Care Coordinator Self-Evaluation Form
Meet 1:1 with your unit
Clinical Nursing Director
or Supervisor Date set by unit. Complete items
above prior to the 1:1 meeting.
NEW!
Fillable PDF Forms
Download form here or at link below to get started.
MISSION To advance health to serve Michigan and the world.
VISION Our discoveries change care; our care changes lives.
VALUES Caring | Innovation | Inclusion | Integrity | Teamwork
Download (save) the PDF form to your computer, flash drive or H drive first!
Tip Sheet | VideoThere are various ways to save - such as
Download or using the Disk icon.
Include the nurse’s name and the year in the new file name. Example
DO NOT fill form from Chrome/Edge/etc. - your responses may not save.
After downloading/saving, close the website view of the form. Go to
File Explorer from your computer’s Start menu to open and fill the form - this
opens the form in Adobe Acrobat.
ALERT! Save form to your computer or H drive first.
Use the Adobe Acrobat program to open and complete the form.
