Michigan Medicine | University of Michigan



Framework RN Peer Input Tool for Annual Evaluation: Professional RelationshipsPeer feedback for (RN name): Directions: 5615305138430Target Audience: Nursing at Michigan | Author/Contact: Mark Kempton | Last reviewed: August 201700Target Audience: Nursing at Michigan | Author/Contact: Mark Kempton | Last reviewed: August 2017Evaluatee to send behavior portions to peers who you would like feedback fromClinical Skills and Knowledge is to be completed by another RNPeers should indicate within the last column the level they feel is appropriate for the Evaluatee on each rowPeers are encouraged to support their views with concrete examplesPeers should complete the peer review within 7 Days and return electronically to the Manager/Designee and EvaluateeDOMAIN: Professional Relationships: An intentional interactive relationship with the health care team that is marked by mutual regard, trust, and active engagement. ACDEPeer should designate appropriate level belowCollaboration with the Health Care TeamRecognizes role of each member of the health care teamAware of importance of team collaboration and with guidance begins to initiate collaborative communication.Initiates referralsRecognizes the impact of one’s behavior on othersInitiates, recognizes and values professional collaborative communication and the positive effect on patient outcomesIdentifies and utilizes collaborative resources.Monitors referralsIs sought out by members of the multi-disciplinary health care team.Frequently initiates consults with health care teamActively collaborates with other health professionals in delivering careRecognizes need and calls for team conferenceActs as resource to nursing and health care teamThrough shared values and a clear professional identity, demonstrates and role models an interdisciplinary collaborative approach to patient careParticipates and/or leads team care conference.Valuing Teams/TeamworkIdentifies self as member of nursing and health care teamsBegins to generate trust, respect, and compassion within the workgroupTakes responsibility for developing beginning team relationshipsSeeks assistance with resolving conflictMeets professional commitments consistentlyAsks for and accepts help when neededAcknowledges when conflict existsFunctions as an independent and supportive team memberProvides assistance to othersDemonstrates empathy and compassion in interactions with team membersApproaches conflict situations in a constructive mannerFosters mutual regard, respect, and trustDemonstrates flexibilityCreates conditions and relationships that promote creative, innovative, and positive processes and outcomesRole models behaviors that demonstrate compassion and caringFosters other’s development of conflict resolution skillsDemonstrates active engagement to enhance patient care and promote a positive workplaceDemonstrates team values that orient people to care about performance and success of othersRecognizes value of conflict in individual and organization learning and growthValuing of Diversity in TeamAware of and values diversity in all members of the health care teamRecognizes own biases and begins to demonstrate empathy as a member of the health care teamSeeks to learn about and optimize the unique contribution inherent in the diversity and culture of each individual on the health care team.Role models and helps to establish group norms that promote valuing of all health care team membersDepends on diversity of workforce to enrich and build great places to work.DelegationFunctions as part of nursing team; able to describe and begin to use 5 Rights of Delegation when delegating to UAP:- Right task - Right circumstances - Right person - Right communication - Right supervision and EvaluationRecognizes value of nurse-to-nurse delegationReadily able to delegate to UAP according to the 5 Rights of Delegation.Facilitates continuity of care and nursing workflow through nurse-to-nurse delegation.Recognizes and values interdependent relationships.Recognizes strengths of other team members that would benefit the patient and the team—aligns skill sets of individual nurses/UAP to specific patientsSuccessfully organizes and coordinates multiple activities, requests, and needsDevelops work process that maximize team workAdaptable, flexible, and consistently effective in delegationDemonstrates foresight in anticipating and planning to meet patient and family concernsPlease describe a time when you saw me at my very best. What qualities did I display in this domain??Please provide your input regarding opportunities for my personal and/or professional growth?I have completed the Peer Feedback Class as required by the UMPNC contract, paragraph 28E, for participation in the peer review process.Name:Date:Format Revised 4/2016 ................
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