Nursing

1-2: Unsatisfactory / Needs Significant Improvement: Performance is consistently below minimum acceptable clinical standards. Requires constant supervision and intervention. Frequent major errors (e.g., critical medication errors, missing critical patient changes, significant safety protocol breaches). Significantly compromises patient safety or hinders unit operations.

3-4: Needs Improvement: Performance is inconsistent and often falls below expectations. Requires frequent guidance and correction on clinical reasoning, procedures, or medication administration. Misses common patient needs or changes in condition. Progress is slow even with support. Reliability in clinical tasks is questionable.

5-6: Meets Expectations / Solid Performance: Performance is generally consistent and meets the requirements of a general nurse role. Can perform routine patient assessments and interventions reliably with standard supervision. Identifies common patient needs/problems and follows basic safety protocols and care plans. Administers medications with standard safety checks. Contributes acceptably to patient care and unit workflow.

7-8: Exceeds Expectations in Areas / Strong Performance: Performance often exceeds expectations in specific clinical areas. Highly reliable for most tasks, including some complex patient presentations. Requires minimal routine supervision. Proactive in identifying and addressing complex patient issues or seeking improvements sometimes. Provides valuable clinical insights and recommendations to the care team.

9-10: Consistently Exceeds Expectations / Exceptional Performance: Performance consistently surpasses clinical expectations across all aspects of the role. Acts as a role model and resource for other nurses and healthcare professionals. Highly proactive, takes significant initiative in optimizing patient care, ensuring safety, and improving unit/hospital processes. Consistently delivers high-quality nursing care even in challenging situations.

A1: How would you rate the individual's clinical knowledge and competencies relevant to general nursing practice (e.g., patient assessment across body systems, medication knowledge - dosages, interactions, administration; basic procedures - IV starts, wound care, foley insertion; understanding of common disease processes, vital signs interpretation, EMR use, safety protocols - falls, restraints)?

• 1-2: Has very limited knowledge of basic anatomy, physiology, common medications, or nursing procedures; unable to perform fundamental patient assessments or skills; frequently makes critical errors due to lack of foundational clinical knowledge.

• 3-4: Has difficulty grasping core clinical concepts; requires frequent reminders and correction on medication information, procedures, or assessment findings; struggles with basic EMR functions or vital sign interpretation; slow to learn new skills.

• 5-6: Demonstrates adequate understanding of core clinical competencies for routine patient care; can perform standard assessments and procedures (e.g., IV starts, wound care) with standard supervision; administers common medications with required checks; understands basic disease processes and safety protocols.

• 7-8: Possesses strong clinical knowledge covering a broad range of common and some complex conditions; proficient in advanced assessment techniques and basic procedures; understands the rationale behind interventions and medication use; capable of teaching basic concepts or skills to others.

• 9-10: Is an expert in general nursing clinical knowledge; masters complex patient assessments and skills even in challenging situations; deep understanding of pathophysiology, pharmacology, and evidence-based practice relevant to general medicine; acts as a go-to resource for complex clinical questions and challenging patient cases; proactively seeks to learn advanced techniques and specializations.

A2: How effectively does the individual apply their clinical knowledge and skills in performing accurate patient assessments, administering medications safely using the 5 (or 6/7) rights, monitoring patient status, recognizing changes in condition, performing accurate calculations, documenting findings and interventions precisely, and ensuring patient safety?

• 1-2: Frequently makes errors in assessment, medication administration, or documentation resulting in unsafe care or missed changes in condition; overlooks critical safety steps (e.g., patient identification, medication checks); unable to perform basic calculations; major safety risk.

• 3-4: Makes occasional errors in application; requires frequent checks for accuracy in medication administration or documentation; struggles with recognizing subtle changes in patient condition; needs significant help with dosage calculations or complex procedures.

• 5-6: Applies knowledge and skills to perform routine assessments and care accurately most of the time; administers medications using basic safety checks; monitors patient status adequately; recognizes obvious changes in condition; performs basic calculations correctly; documents routine care accurately.

• 7-8: Consistently applies knowledge for high accuracy in assessment, medication administration, and documentation; adept at recognizing subtle changes in patient condition and interpreting data; proficient in complex calculations; performs advanced procedures skillfully; maintains strong safety practices.

• 9-10: Demonstrates exceptional skill in applying knowledge for near-perfect accuracy across all clinical tasks; identifies potential patient issues or safety risks before they impact care; highly proficient in complex calculations and procedures; consistently provides superior patient assessment, monitoring, and safe interventions; acts as a clinical safety expert.

A3: Is he/she willing and able to quickly adapt to changes, including new hospital policies/procedures, updated protocols (e.g., sepsis, stroke), new equipment/technology (e.g., new EMR features, smart pumps), new medications, or changing patient populations on the unit?

• 1-2: Actively resists learning new procedures, equipment, or policies; refuses to use updated systems or adopt new protocols; provides care based on outdated practices, hindering compliance and safety.

• 3-4: Shows reluctance towards change; takes a long time to become proficient in new methods or systems; requires excessive support and reminders during transitions to new equipment, policies, or protocols.

• 5-6: Accepts change and learns new procedures, policies, or technology at a reasonable pace; becomes competent after standard training; follows new protocols once familiar.

• 7-8: Adapts quickly and positively to changes; shows eagerness to learn new policies, protocols, medications, or equipment; proficient in new practices relatively fast.

• 9-10: Embraces change as an opportunity to improve practice; actively seeks out training on new policies, protocols, and technologies; helps others understand and adapt to changes; becomes an early expert and advocate for new evidence-based practices.

B1: Does the person show enthusiasm and readiness to take on responsibility readily, such as managing a challenging patient assignment, mentoring/precepting new staff/students, volunteering for unit committees (e.g., falls, skin), or assisting with complex patient care needs for colleagues?

• 1-2: Consistently avoids taking on any responsibility beyond basic assigned patients; refuses to help others; shows no interest in contributing to unit improvements or training.

• 3-4: Reluctantly takes on responsibility only when directly assigned (e.g., precepts only when forced); needs to be heavily prompted; shows minimal engagement in extra duties or unit initiatives.

• 5-6: Takes on assigned responsibilities willingly (e.g., managing a standard assignment, assisting colleagues when needed); completes tasks reliably; participates adequately when asked to help with training or unit tasks.

• 7-8: Shows enthusiasm for taking on additional responsibilities (e.g., managing a complex assignment effectively, mentoring new staff/students patiently and effectively); volunteers for or actively participates in unit committees or initiatives.

• 9-10: Actively seeks out opportunities to take on significant responsibility or leadership roles; demonstrates strong initiative in managing complex patient care situations, leading by example on the unit, or championing initiatives for improvement; is a driving force for positive change and support on the unit.

B2: Does he/she maintain consistency of quality and accuracy in patient care, documentation, and task completion, even without direct supervision? Can the person be trusted to independently manage their assigned patient load, administer medications, perform assessments, and follow care plans without constant reminders and checking?

• 1-2: Patient care quality is highly inconsistent; frequently misses critical tasks (meds, assessments); documentation is often missing or provides unsafe information; cannot be trusted to manage patients without constant checking and reminders.

• 3-4: Work is inconsistent; occasionally misses tasks or requires reminders; needs frequent checks on medication administration, documentation, or assessment accuracy; struggles with managing workload independently.

• 5-6: Maintains consistent quality for routine patient care; generally manages a standard patient assignment effectively; can be trusted to perform standard tasks (meds, assessments, documentation) with minimal oversight; follows care plans.

• 7-8: Patient care quality and accuracy are consistently high; reliably manages assigned patient load, including complex assignments; can be trusted to handle most tasks independently from assessment to documentation; meticulous with medication administration and safety checks.

• 9-10: Consistently delivers patient care of exceptional quality and accuracy; always manages assigned load effectively, anticipating needs; is highly reliable and requires virtually no checking for all aspects of their work; documentation is exemplary; acts as a benchmark for dependability, quality, and safety in patient care.

B3: Can the person be trusted to practice within their assigned scope of nursing practice/privileges? Does the person bring to the notice of physicians or supervisors critical patient observations (e.g., significant change in vital signs/mental status, new symptoms, response to interventions), critical lab values, medication errors/near misses, safety incidents (falls, near misses), physician order discrepancies, or patient/family concerns requiring escalation promptly?

• 1-2: Regularly operates outside their defined scope of practice; fails to report severe changes in patient condition, critical lab values, medication errors, or safety incidents; actively hides errors or problems.

• 3-4: Occasionally exceeds scope or makes recommendations outside expertise without consultation; reports some but not all required critical findings or incidents; may delay reporting significant issues.

• 5-6: Generally practices within assigned scope of practice/privileges; reports major changes in patient condition, critical labs, medication errors, and safety incidents as required; follows reporting procedures most of the time.

• 7-8: Consistently practices strictly within scope of practice; reliably and promptly reports all required critical findings (changes in status, critical labs, medication errors/near misses, safety incidents) and significant issues to the appropriate physician or supervisor; understands the importance of accurate and timely communication for patient safety.

• 9-10: Has an exceptional understanding of their scope and limitations, consulting others appropriately; is highly proactive in identifying and immediately reporting any potential issue (subtle changes in patient status, potential medication interactions, protocol deviations), even minor ones that could escalate; acts as a key safeguard in the reporting chain and contributes to improving reporting systems for clinical issues.

B4: Is the person committed to providing the best possible patient care for the institution and go beyond the call of duty when required to support and build their unit and the institution as a whole (e.g., staying late for critical patients, covering shifts in emergencies, participating in hospital-wide safety initiatives)?

• 1-2: Shows no commitment to patient care excellence or the unit's success; only does the absolute minimum required; refuses to help colleagues with workload or challenging patients; avoids participation in any initiatives.

• 3-4: Completes assigned patient care duties but shows little interest in the team or unit goals; rarely helps others with workload; avoids participation in unit/hospital initiatives.

• 5-6: Diligently performs assigned duties; is a reliable team member; contributes positively to daily workflow on the unit; participates adequately in initiatives when asked.

• 7-8: Shows strong commitment to patient care and the unit; willingly supports colleagues with heavy workload or complex patients; actively participates in unit or hospital initiatives like quality improvement or safety audits; represents the unit positively.

• 9-10: Is highly dedicated to enhancing patient care and the unit's functioning; consistently goes above and beyond standard duties to ensure team success and optimal patient care (e.g., staying late without being asked for critical patients, covering shifts last minute); actively champions unit and hospital-wide initiatives; is a positive force for morale and productivity; significantly contributes to the unit's and institution's reputation for excellence in patient care.

C1: How would you rate the individual's attendance and timeliness, including reporting on time for shifts, consistency in avoiding unnecessary absenteeism, flexibility to work different shifts (e.g., covering open shifts), and willingness to put in extra time when urgently needed for patient care continuity or workload peaks?

• 1-2: Frequent unexplained absences or tardiness; highly unreliable for shift coverage; completely inflexible with scheduling.

• 3-4: Occasional issues with attendance or punctuality; sometimes difficult regarding scheduling changes; reluctant to stay extra time to help with workload.

• 5-6: Meets standard attendance and punctuality requirements; is reasonably reliable for scheduled shifts; demonstrates some flexibility for coverage needs.

• 7-8: Excellent attendance and punctuality; highly reliable for all scheduled shifts; willingly flexible with scheduling changes and readily available/works extra time when needed for high patient volume, critical patient needs, or staffing issues.

• 9-10: Perfect or near-perfect attendance and punctuality; exceptionally reliable for shift coverage; highly proactive in helping cover shifts or working extra time during critical patient care needs or emergencies; always available when needed.

C2: Does he/she consistently and accurately follow nursing Standard Operating Procedures (SOPs) and patient care protocols? How well do they document patient assessments, vital signs, medication administration, interventions, patient responses, and communication with the care team in the EMR according to hospital standards?

• 1-2: Consistently ignores or deviates significantly from SOPs/protocols (e.g., fails to follow isolation protocols, incorrect sterile technique, fails to use scanning for meds); documentation in EMR is often missing, inaccurate, or illegible; assessment notes lack essential information; creates major safety/compliance risks due to poor adherence.

• 3-4: Frequently deviates from SOPs/protocols or forgets steps; documentation is often incomplete or unclear (e.g., missing vital signs, incomplete medication notes, vague assessment details); needs frequent reminders about procedures and documentation standards.

• 5-6: Generally follows SOPs/protocols correctly for routine patient care; documentation in EMR is adequate for standard assessments, medication administration, and interventions; complies with most requirements for timely and complete notes.

• 7-8: Consistently follows all relevant SOPs/protocols meticulously; documentation in EMR is accurate, complete, clear, and timely for all patients, including complex cases and non-routine events; understands the importance of thorough documentation for communication, legal compliance, and continuity of care.

• 9-10: Adheres strictly to all SOPs/protocols and often exceeds documentation standards (e.g., provides exceptional detail and clinical rationale in notes, comprehensive assessment documentation); documentation is exemplary and could serve as a training example; proactively identifies potential issues with existing SOPs/protocols or documentation processes and suggests improvements for clarity, consistency, or safety.

C3: How would you rate the individual's efficiency in terms of speed and volume of work completion (e.g., patients managed, medication passes completed, assessments documented, tasks finished) compared to other nurses with similar roles and experience, while consistently maintaining high quality of care and documentation accuracy?

• 1-2: Works significantly slower than peers; output volume (patients managed, tasks completed) is very low; requires excessive time per task, causing significant delays in patient care delivery (e.g., late medications, delayed assessments) and burdening the team.

• 3-4: Slower than most peers; output volume is below average; takes longer than expected to complete tasks, occasionally impacting workflow, sometimes compromising quality for speed.

• 5-6: Works at an average pace comparable to peers; consistently manages an expected volume of patients/tasks for their shift; completes tasks within standard timeframes while maintaining acceptable quality and safety.

• 7-8: Works efficiently and quickly; output volume is above average compared to peers, while consistently maintaining high quality of care and documentation accuracy; manages workload effectively and keeps workflow moving smoothly.

• 9-10: Is exceptionally efficient; output volume is consistently high and sets a benchmark for the team, without ever compromising quality, accuracy, or patient safety; streamlines own work process and helps optimize workflow for others; is a high-productivity nurse who significantly enhances overall unit throughput and patient care capacity.

C4: How would you rate the individual in terms of attention to detail and accuracy in all aspects of nursing work (e.g., patient identification, vital sign measurement, medication preparation/scanning/administration, dosage calculations, documentation of patient status/response), which directly impacts the quality and safety of patient care?

• 1-2: Frequently makes critical errors (e.g., patient misidentification, inaccurate vital signs leading to missed changes, medication errors, incorrect calculations); lacks attention to detail, leading to unsafe patient care and unreliable data.

• 3-4: Makes occasional significant errors or overlooks important details during assessment or task completion (e.g., minor vital sign inaccuracies, incomplete assessment areas, missing medication checks); attention to detail is inconsistent; work often requires correction or follow-up by others due to accuracy issues.

• 5-6: Makes few errors in routine tasks; shows reasonable attention to detail in standard patient care; work is generally accurate for common procedures and documentation; performs required checks adequately.

• 7-8: Makes rare errors; demonstrates strong attention to detail in complex assessments, challenging medication administrations (e.g., drips), and monitoring; high accuracy in calculations, vital signs, and documentation; effectively validates own work and data; catches potential minor issues.

• 9-10: Virtually error-free work output; possesses exceptional attention to detail in all aspects of nursing care; meticulously verifies every step (patient ID, medication checks, calculations, documentation); consistently provides highly accurate and safe care; identifies potential errors made by others (e.g., in orders, data entry); is a champion for accuracy, quality, and patient safety.

D1: Does the person consistently maintain a professional, empathetic, and positive demeanor and positively represent the nursing unit and the hospital when interacting with patients/families, colleagues (nurses, CNAs), physicians, residents, and staff from other departments (therapists, lab, dietary, etc.)?

• 1-2: Displays unprofessional, rude, or disruptive behavior towards patients/families or staff; creates a negative impression of the unit/hospital through interactions (e.g., impatient with patients, arguing with colleagues or other departments); shows disrespect.

• 3-4: Sometimes unprofessional or has a negative attitude; interactions can be difficult or unhelpful (e.g., dismissive towards patient concerns, poor communication with physicians or other disciplines); occasionally represents the unit poorly.

• 5-6: Maintains a professional and empathetic demeanor most of the time; interacts acceptably with patients, families, and other staff; provides standard patient communication; represents the unit appropriately in routine interactions.

• 7-8: Consistently professional, courteous, empathetic, and helpful; has positive interactions with patients/families, colleagues, and staff from other departments; effectively addresses common inquiries or concerns; represents the unit and hospital well.

• 9-10: Acts as a role model for professional and compassionate behavior; consistently maintains a positive, helpful, and calming attitude in all interactions, particularly with distressed or difficult patients/families; is highly respected and sought out by colleagues and other departments for their collaborative approach; significantly enhances the image and reputation of the nursing unit and the hospital.

D2: Does he/ she effectively cooperate and collaborate with team members on the nursing unit (e.g., assisting with patient care tasks, sharing workload, helping with admissions/discharges/transfers)? Do they actively and constructively interact with physicians, therapists, dietitians, social work, and ancillary staff to coordinate patient care, clarify orders, and improve workflows?

• 1-2: Uncooperative on the nursing unit; refuses to assist colleagues with patient care or workload; avoids or actively hinders interactions with other departments (physicians, therapy, lab), causing significant delays and friction in patient care.

• 3-4: Reluctant to collaborate; provides minimal assistance to colleagues; interacts poorly or unhelpfully with other departments when patient care or order issues arise.

• 5-6: Cooperates with team members when needed; provides basic assistance; interacts adequately with other departments for routine coordination or issue resolution.

• 7-8: Actively collaborates and supports nursing team members (e.g., helps with patient care tasks during peak times, assists with admissions/discharges); engages constructively and effectively with physicians and staff from other disciplines during rounds, huddles, and in addressing patient care issues.

• 9-10: Champions teamwork and collaboration both on the nursing unit and across disciplines; proactively assists colleagues and builds strong, trusting relationships with physicians, therapists, and other staff; is an integral and valued part of the interdisciplinary care team, facilitating smooth communication and joint problem-solving that directly impacts patient outcomes.

D3: Does the person constructively engage in resolving disagreements or communication challenges that may arise on the nursing unit or between nursing and medical teams/other services regarding patient care plans, orders, safety concerns, or procedural disagreements?

• 1-2: Avoids conflict or actively escalates it (e.g., arguing with physicians about orders, blaming other disciplines for delays); contributes negatively to tense situations; unable to handle disagreements professionally.

• 3-4: Struggles to handle disagreements; may withdraw or become defensive; can sometimes worsen conflict situations related to patient care issues or inter-departmental communication.

• 5-6: Handles basic disagreements appropriately; doesn't escalate conflicts unnecessarily; participates passively in resolving communication issues regarding patient care or workflow.

• 7-8: Attempts to resolve conflicts constructively (e.g., respectfully discusses differing opinions on care with a physician, clarifies misunderstandings with other departments calmly); communicates effectively to de-escalate situations and find common ground for patient care.

• 9-10: Is highly skilled in navigating difficult conversations related to patient care decisions, safety concerns, or communication breakdowns; proactively addresses potential sources of conflict or communication barriers within the unit or with other departments; acts as a mediator or facilitator to resolve interdisciplinary issues effectively, improving overall patient care coordination and team dynamics.

D4: Is he/she willing and eager to share their clinical knowledge and expertise, guiding, training, or coaching less experienced team members (nurses, students, CNAs), and providing education to patients/families on medication, disease process, or discharge instructions?

• 1-2: Unwilling to help or train others; withholds clinical knowledge or makes it difficult for new staff/students/patients to learn; refuses to provide basic education to patients/families or other staff.

• 3-4: Reluctantly provides minimal assistance or training when directly asked; lacks patience or clarity in explaining clinical concepts or procedures; avoids educational opportunities.

• 5-6: Is willing to train or guide others when assigned or asked directly; provides adequate basic instruction on common procedures or patient education topics.

• 7-8: Shows willingness and interest in clinical training and mentoring; patiently guides less experienced colleagues, students, and CNAs; shares knowledge freely and effectively; provides useful basic education to patients/families upon request or proactively on relevant topics.

• 9-10: Is highly eager and skilled in clinical training, coaching, and patient/family education; actively seeks opportunities to mentor new or less experienced staff; consistently provides impactful, high-quality education to patients/families (improving understanding and compliance); is recognized as a valuable educator and resource for clinical skill development and patient empowerment on the unit and beyond.

E1: Does the individual show eagerness and actively pursue learning opportunities (e.g., staying current with clinical literature/evidence, learning new procedures/equipment, attending CE/conferences, pursuing certifications - specialty, advanced life support) to expand their clinical knowledge and skills?

• 1-2: Shows no interest in staying current with clinical information; avoids training or educational opportunities; resistant to expanding clinical knowledge or skill set.

• 3-4: Shows minimal interest in learning; participates only in mandatory CE; does not seek out new clinical knowledge independently or keep fully current with evidence-based practices.

• 5-6: Is willing to learn about new medications, procedures, or equipment when required for patient care; attends assigned training and completes necessary CE; learns new tasks as needed.

• 7-8: Shows genuine interest in expanding their clinical knowledge and skills; actively seeks out learning opportunities (CE, literature review, workshops, certifications) to stay current with evidence-based practice, new medications, or patient populations; learns new tasks or responsibilities readily.

• 9-10: Is highly passionate about continuous clinical learning; actively pursues board certification or other advanced training; consistently stays ahead of new clinical evidence, guidelines, and best practices; integrates new knowledge into practice and shares with the unit; significantly contributes to the unit's overall expertise and evidence-based care.

E2: Does he/ she proactively take steps to improve nursing processes, patient care delivery, safety measures, or unit efficiency? In the face of a challenge (e.g., a difficult patient case, equipment malfunction, workflow bottleneck), does the person try to find solutions or resolve issues on their own initiative?

• 1-2: Shows no clinical initiative; waits to be told what to do or how to handle problems; ignores problems with patient care or workflow; does not attempt troubleshooting.

• 3-4: Rarely shows initiative; identifies problems (e.g., equipment not working, patient issue) but doesn't attempt solutions; performs minimal troubleshooting steps before asking for help with patient issues or equipment.

• 5-6: Identifies common problems or areas for basic improvement when pointed out; attempts standard troubleshooting steps for common patient issues or equipment problems; participates in minor process improvement efforts.

• 7-8: Proactively identifies opportunities for improving unit workflows, patient safety measures, or care delivery (e.g., suggesting a different way to organize supplies, optimizing a task process); demonstrates initiative in troubleshooting most patient care or equipment issues independently; suggests practical solutions.

• 9-10: Consistently identifies significant opportunities for improving patient care, safety, or unit efficiency; takes initiative to implement improvements (with approval), potentially involving workflow changes, protocol adjustments, or new tools; is highly skilled and proactive in troubleshooting complex or unusual patient problems or system issues, often resolving them independently; acts as a key problem-solver and change agent on the unit.

E3: How often does he/ she come up with new ideas or suggest changes which can improve patient care, safety protocols, unit workflow, or interdisciplinary communication? Do they actively participate in or champion new initiatives related to quality, safety, process optimization, or evidence-based practice on the unit or across the hospital?

• 1-2: Never offers suggestions for improvement; resistant to new ideas or initiatives on the unit.

• 3-4: Rarely offers suggestions, and ideas may be impractical or lack evidence; shows no interest in initiatives.

• 5-6: Offers occasional relevant suggestions for improving unit operations, patient safety, or workflow; participates adequately in team initiatives when asked.

• 7-8: Regularly offers practical and relevant suggestions for improving patient care, safety protocols, or contributing to unit initiatives; actively contributes to unit or hospital-wide initiatives (e.g., participation in a QI project, helping pilot a new product, revising a protocol).

• 9-10: Frequently proposes innovative and impactful ideas for improving patient care, safety, or unit operations; actively champions and drives implementation of new initiatives (e.g., leading a project to improve falls prevention, optimizing a medication administration process, implementing a new patient education strategy); is recognized as a valuable contributor to the unit's and hospital's continuous improvement and innovation efforts.

1-2: Unsatisfactory / Needs Significant Improvement: Performance is consistently below minimum acceptable clinical standards for the ED. Requires constant direct supervision and intervention in patient care. Frequent major errors (e.g., critical medication errors, missing immediate life threats, significant safety protocol breaches). Significantly compromises patient safety or hinders critical workflow in emergencies. Unable to function under pressure.

3-4: Needs Improvement: Performance is inconsistent and often falls below ED expectations. Requires frequent guidance and correction on rapid assessment, critical interventions, or medication administration in urgent situations. Misses common emergent patient needs or critical changes. Struggles to perform effectively under pressure. Reliability in urgent clinical tasks is questionable.

5-6: Meets Expectations / Solid Performance: Performance is generally consistent and meets the requirements of an ED nurse role. Can perform rapid assessments and interventions reliably for common urgent presentations with standard supervision. Identifies common emergent patient needs/problems and follows basic safety protocols and care plans in the ED. Administers medications with standard safety checks, even in urgent situations. Contributes acceptably to patient care and fast-paced unit workflow.

7-8: Exceeds Expectations in Areas / Strong Performance: Performance often exceeds expectations in specific clinical areas under pressure. Highly reliable for most tasks, including some complex or critical patient presentations. Requires minimal routine supervision, especially during busy periods. Proactive in identifying and addressing complex emergent patient issues or seeking improvements. Provides valuable clinical insights and recommendations to the ED care team. Functions effectively under moderate pressure.

9-10: Consistently Exceeds Expectations / Exceptional Performance: Performance consistently surpasses clinical expectations across all aspects of the role in the ED. Acts as a role model and resource for other nurses and healthcare professionals, particularly during critical events. Highly proactive, takes significant initiative in rapid assessment, critical intervention, optimizing patient outcomes, and ensuring safety in high-pressure situations. Functions calmly and effectively under extreme pressure, leading in emergencies. Identifies subtle changes in critically ill patients.

A1: How would you rate the individual's clinical knowledge and competencies relevant to ED nursing practice (e.g., rapid patient assessment, triage principles, recognition of life-threatening conditions, emergency medication knowledge & administration, advanced procedures - ACLS/PALS skills, trauma care, rapid IV access, airway management assistance, interpreting monitors/labs in emergencies, EMR charting in a rapid environment)?

• 1-2: Has very limited knowledge of basic emergency conditions, emergency medications, or procedures; unable to perform rapid assessments or fundamental ED skills (e.g., reliable IV access); frequently makes critical errors due to lack of foundational clinical knowledge for urgent situations.

• 3-4: Has difficulty grasping core ED clinical concepts; requires frequent reminders and correction on emergency medication information, critical procedures, or assessment findings in urgent situations; struggles with vital sign interpretation or EMR charting during peak activity; slow to learn rapid skills.

• 5-6: Demonstrates adequate understanding of core clinical competencies for routine ED patient care; can perform standard rapid assessments and procedures (e.g., basic trauma assessment, basic ACLS/PALS roles, reliable IV access) with standard supervision; administers common emergency medications with required checks in urgent situations; understands basic emergency conditions and safety protocols for the ED.

• 7-8: Possesses strong clinical knowledge covering a broad range of emergent and some critical conditions; proficient in advanced rapid assessment techniques and procedures (e.g., assisting with intubation, performing complex wound care, managing challenging IV access); understands the rationale behind emergency interventions and medication use; capable of teaching basic emergency concepts or skills to others; functions effectively under moderate pressure.

• 9-10: Is an expert in ED clinical knowledge and emergency care; masters complex rapid patient assessments and skills even in high-pressure or trauma situations; deep understanding of critical pathophysiology, emergency pharmacology, and evidence-based practice; acts as a go-to resource for complex clinical questions and challenging, critical patient cases; proactively seeks to learn advanced critical care techniques and certifications (e.g., CEN, TNCC).

A2: How effectively does the individual apply their clinical knowledge and skills in performing rapid and accurate patient assessments (including triage), administering emergency medications safely and quickly, monitoring patient status in dynamic situations, recognizing subtle changes in condition (especially deterioration), performing accurate calculations under pressure, documenting findings and interventions precisely and timely, and ensuring patient safety in a high-risk environment?

• 1-2: Frequently makes errors in rapid assessment, medication administration, or documentation resulting in unsafe care or missed critical changes; overlooks critical safety steps (e.g., patient identification in chaos, medication checks under pressure); unable to perform basic calculations accurately in urgent situations; major safety risk to patients and unit flow.

• 3-4: Makes occasional errors in application, resulting in frequent issues in patient care or documentation; requires frequent checks for accuracy in medication administration or documentation under pressure; struggles with recognizing subtle changes in patient condition during busy periods; needs significant help with dosage calculations or complex procedures in emergencies.

• 5-6: Applies knowledge and skills to perform routine rapid assessments and care accurately most of the time; administers medications using basic safety checks even in urgent situations; monitors patient status adequately; recognizes obvious changes in condition; performs basic calculations correctly under moderate pressure; documents routine care accurately and reasonably timely.

• 7-8: Consistently applies knowledge for high accuracy in rapid assessment, medication administration, and documentation; adept at recognizing subtle changes in patient condition and interpreting data under pressure; proficient in complex calculations in urgent situations; performs advanced procedures skillfully; maintains strong safety practices even during high activity.

• 9-10: Demonstrates exceptional skill in applying knowledge for near-perfect accuracy across all clinical tasks in a high-pressure environment; identifies potential patient issues or safety risks before they impact care, especially in critical situations; highly proficient in complex calculations and procedures during emergencies; consistently provides superior rapid assessment, monitoring, and safe interventions; acts as a clinical safety expert and leader during critical events.

A3: Is he/she willing and able to quickly adapt to changes, including new hospital policies/procedures specific to the ED, updated emergency protocols (e.g., stroke, STEMI, trauma), new equipment/technology unique to the ED (e.g., rapid infusion systems, point-of-care testing devices), new emergency medications, or changing patient acuity/volume on the unit?

• 1-2: Actively resists learning new emergency procedures, equipment, or policies; refuses to use updated systems or adopt new protocols (e.g., resistance to new trauma protocol); provides care based on outdated practices in emergency situations.

• 3-4: Shows reluctance towards change; takes a long time to become proficient in new methods or systems; requires excessive support and reminders during transitions to new emergency equipment, policies, or protocols, especially when under pressure.

• 5-6: Accepts change and learns new procedures, policies, or technology relevant to the ED at a reasonable pace; becomes competent after standard training; follows new protocols once familiar, performs adequately under moderate pressure.

• 7-8: Adapts quickly and positively to changes (e.g., learns new rapid infusion pump quickly, adapts to updated stroke protocol smoothly); shows eagerness to learn new ED-specific policies, protocols, medications, or equipment; proficient in new practices relatively fast and can apply them effectively under pressure.

• 9-10: Embraces change as an opportunity to improve emergency care; actively seeks out training on new ED-specific policies, protocols, and technologies (e.g., champions a new airway device, leads training on a new rapid infusion system); helps others understand and adapt to changes, especially during emergencies; becomes an early expert and advocate for new evidence-based ED practices.

B1: Does the person show enthusiasm and readiness to take on responsibility readily, such as managing a challenging patient assignment (high acuity/volume), mentoring/precepting new staff/students in the ED, volunteering for ED committees (e.g., trauma, critical care, equipment), or assisting with complex/critical patient care needs for colleagues during emergencies?

• 1-2: Consistently avoids taking on any responsibility beyond basic assigned patients; refuses to help others during emergencies or with challenging patients; shows no interest in contributing to ED unit improvements or training.

• 3-4: Reluctantly takes on responsibility only when directly assigned (e.g., precepts only when forced); needs to be heavily prompted to manage complex patients or assist in emergencies; shows minimal engagement in extra duties or ED initiatives.

• 5-6: Takes on assigned responsibilities willingly (e.g., managing a standard assignment, assisting colleagues when needed); completes tasks reliably; participates adequately when asked to help with training or ED unit tasks.

• 7-8: Shows enthusiasm for taking on additional responsibilities (e.g., managing a complex assignment effectively, mentoring new staff/students patiently and effectively in the ED environment); volunteers for or actively participates in ED committees or initiatives.

• 9-10: Actively seeks out opportunities to take on significant responsibility or leadership roles, especially during emergencies; demonstrates strong initiative in managing complex patient care situations, leading by example on the unit, or championing initiatives for improvement; is a driving force for positive change and support on the unit, particularly when under pressure.

B2: Does he/she maintain consistency of quality and accuracy in patient care, documentation, and task completion, even during high-pressure situations and without direct supervision? Can the person be trusted to independently manage their assigned patient load (including rapidly changing conditions), administer medications, perform assessments, and follow care plans accurately and timely in the chaotic ED environment?

• 1-2: Patient care quality is highly inconsistent; frequently misses critical tasks (meds, assessments) or provides unsafe care during high activity; documentation is often missing or provides unsafe information; cannot be trusted to manage patients safely or independently under pressure.

• 3-4: Work is inconsistent; occasionally misses tasks or requires reminders, especially when busy; needs frequent checks on medication administration, documentation, or assessment accuracy in urgent situations; struggles with managing workload independently under pressure.

• 5-6: Maintains consistent quality for routine ED patient care; generally manages a standard patient assignment effectively; can be trusted to perform standard tasks (meds, assessments, documentation) with minimal oversight, functions adequately under moderate pressure; follows care plans.

• 7-8: Patient care quality and accuracy are consistently high, even under pressure; reliably manages assigned patient load, including complex assignments and rapidly changing conditions; can be trusted to handle most tasks independently from assessment to documentation in the ED environment; meticulous with medication administration and safety checks.

• 9-10: Consistently delivers patient care of exceptional quality and accuracy, even in the most chaotic situations; always manages assigned load effectively, anticipating needs and prioritizing safely; is highly reliable and requires virtually no checking for all aspects of their work; documentation is exemplary and timely, even under pressure; acts as a benchmark for dependability, quality, and safety in the high-stakes ED environment.

B3: Can the person be trusted to practice within their assigned scope of nursing practice/privileges in the ED? Does the person bring to the notice of physicians or supervisors critical patient observations (e.g., sudden change in vital signs/mental status, new symptoms, response to interventions), critical lab values, medication errors/near misses, safety incidents (falls, near misses, security concerns), physician order discrepancies, or patient/family concerns requiring escalation promptly, even during high-stress situations?

• 1-2: Regularly operates outside their defined scope of practice; fails to report severe changes in patient condition, critical lab values, medication errors, or safety incidents, especially in emergencies; actively hides errors or problems.

• 3-4: Occasionally exceeds scope or makes recommendations outside expertise without consultation; reports some but not all required critical findings or incidents, especially when busy; may delay reporting significant issues (e.g., acute deterioration, medication errors) due to pressure or oversight.

• 5-6: Generally practices within assigned scope of practice/privileges; reports major changes in patient condition, critical labs, medication errors, and safety incidents as required; follows reporting procedures most of the time, even when moderately busy.

• 7-8: Consistently practices strictly within scope of practice; reliably and promptly reports all required critical findings (changes in status, critical labs, medication errors/near misses, safety incidents) and significant issues to the appropriate physician or supervisor, understands the importance of accurate and timely communication for patient safety, even under pressure.

• 9-10: Has an exceptional understanding of their scope and limitations, consulting others appropriately, especially in emergencies; is highly proactive in identifying and immediately reporting any potential issue (subtle changes in patient status, potential medication interactions, safety concerns, protocol deviations), even minor ones that could escalate, regardless of unit activity; acts as a key safeguard in the reporting chain and contributes to improving reporting systems for clinical issues in the ED.

B4: Is the person committed to providing the best possible emergency patient care for the institution and go beyond the call of duty when required to support and build their unit and the institution as a whole (e.g., staying late for critical patients/transfers, covering shifts in emergencies, participating in ED-specific or hospital-wide safety/process improvement initiatives)?

• 1-2: Shows no commitment to patient care excellence or the ED unit's success; only does the absolute minimum required; refuses to help colleagues with workload or challenging/critical patients, especially during peak times.

• 3-4: Completes assigned patient care duties but shows little interest in the team or unit goals; rarely helps others with workload or complex/critical patients; avoids participation in unit/hospital initiatives.

• 5-6: Diligently performs assigned duties; is a reliable team member; contributes positively to daily workflow on the unit; participates adequately in initiatives when asked.

• 7-8: Shows strong commitment to patient care and the ED unit; willingly supports colleagues with heavy workload or complex/critical patients, especially during busy periods; actively participates in unit or hospital initiatives like quality improvement or safety audits relevant to the ED; represents the unit positively.

• 9-10: Is highly dedicated to enhancing emergency patient care and the ED unit's functioning; consistently goes above and beyond standard duties to ensure team success and optimal patient care, especially in critical situations (e.g., staying late without being asked for critical patients/transfers, picking up last-minute shifts during emergencies); actively champions unit and hospital-wide initiatives relevant to emergency care; is a positive force for morale and productivity, particularly during high-stress times; significantly contributes to the unit's and institution's reputation for excellence in emergency patient care.

C1: How would you rate the individual's attendance and timeliness, including reporting on time for shifts, consistency in avoiding unnecessary absenteeism, flexibility to work different shifts (e.g., covering open shifts, adapting to surge), and willingness to put in extra time when urgently needed for critical patient care continuity or workload peaks (e.g., trauma, mass casualty, overcrowding)?

• 1-2: Frequent unexplained absences or tardiness; highly unreliable for shift coverage, particularly during expected busy times or emergencies; completely inflexible with scheduling.

• 3-4: Occasional issues with attendance or punctuality; sometimes difficult regarding scheduling changes or responding to urgent needs; reluctant to stay extra time to help with workload in the ED.

• 5-6: Meets standard attendance and punctuality requirements; is reasonably reliable for scheduled shifts; demonstrates some flexibility for coverage needs and urgent situations.

• 7-8: Excellent attendance and punctuality; highly reliable for all scheduled shifts; willingly flexible with scheduling changes and readily available/works extra time when needed for high patient volume, critical patient needs, or staffing issues.

• 9-10: Perfect or near-perfect attendance and punctuality; exceptionally reliable for shift coverage, especially during high-volume periods or emergencies; highly proactive in helping cover shifts or working extra time during critical patient care needs or unexpected surges/disasters; always available when needed in the fast-paced ED.

C2: Does he/she consistently and accurately follow ED-specific nursing Standard Operating Procedures (SOPs) and patient care protocols? How well do they document rapid assessments, vital signs, medication administration, interventions, patient responses, and communication with the care team in the EMR according to ED standards and timelines?

• 1-2: Consistently ignores or deviates significantly from ED SOPs/protocols (e.g., fails to follow rapid triage protocols, incorrect emergency medication administration technique, fails to use scanning for meds); documentation in EMR is often missing, inaccurate, or illegible; assessment notes lack essential immediate information; creates major safety/compliance risks due to poor adherence, especially under pressure.

• 3-4: Frequently deviates from SOPs/protocols or forgets steps, especially when busy; documentation is often incomplete, unclear, or delayed (e.g., missing vital signs, incomplete medication notes, vague assessment details); needs frequent reminders about ED-specific procedures and documentation standards.

• 5-6: Generally follows ED SOPs/protocols correctly for routine patients; documentation in EMR is adequate and reasonably timely for standard assessments, medication administration, and interventions; complies with most requirements for notes in the ED environment.

• 7-8: Consistently follows all relevant ED SOPs/protocols meticulously, even under pressure; documentation in EMR is accurate, complete, clear, and timely for all patients, including complex cases and critical events; understands the importance of thorough and timely documentation for communication, legal compliance, and continuity of care in the ED.

• 9-10: Adheres strictly to all ED SOPs/protocols and often exceeds documentation standards (e.g., provides exceptional detail and clinical rationale in rapid notes, comprehensive critical event documentation); documentation is exemplary and timely, even in chaotic situations; proactively identifies potential issues with existing SOPs/protocols or documentation processes specific to the ED and suggests improvements for clarity, consistency, or safety.

C3: How would you rate the individual's efficiency in terms of speed and volume of work completion (e.g., patients triaged, patients managed, medication passes completed, assessments documented, tasks finished) compared to other ED nurses with similar roles and experience, while consistently maintaining high quality of care and documentation accuracy in a rapid environment?

• 1-2: Works significantly slower than peers; output volume (patients managed, tasks completed) is very low; requires excessive time per patient, causing significant delays in patient care delivery (e.g., delayed triage, delayed meds) and hindering ED patient flow.

• 3-4: Slower than most peers; output volume is below average; takes longer than expected to complete tasks, occasionally impacting patient flow or timeliness of care, sometimes compromising quality/safety for speed.

• 5-6: Works at an average pace comparable to peers in the ED; consistently manages an expected volume of patients/tasks for their assignment; completes tasks within standard timeframes while maintaining acceptable quality and safety under moderate pressure.

• 7-8: Works efficiently and quickly; output volume is above average compared to peers, while consistently maintaining high quality of care and documentation accuracy in a rapid environment; manages workload effectively and keeps patient flow moving smoothly.

• 9-10: Is exceptionally efficient; output volume is consistently high and sets a benchmark for the team, without ever compromising quality, accuracy, or patient safety, even in chaotic situations; streamlines own work process and helps optimize workflow for others; is a high-productivity nurse who significantly enhances overall ED throughput and patient care capacity, especially during surges.

C4: How would you rate the individual in terms of attention to detail and accuracy in all aspects of ED nursing work (e.g., rapid patient identification, precise vital sign measurement, accurate emergency medication preparation/scanning/administration, correct dosage calculations under pressure, detailed documentation of rapid assessments/interventions/patient response), which directly impacts diagnostic accuracy, speed of care, and patient safety in a critical environment?

• 1-2: Frequently makes critical errors (e.g., patient misidentification under pressure, inaccurate vital signs leading to missed emergencies, medication errors, incorrect calculations in urgent situations); lacks attention to detail, leading to unsafe patient care and unreliable data in critical moments.

• 3-4: Makes occasional significant errors or overlooks important details during rapid assessment or task completion (e.g., minor vital sign inaccuracies, incomplete assessment areas, missing medication checks under pressure); attention to detail is inconsistent; work often requires correction or follow-up by others due to accuracy issues.

• 5-6: Makes few errors in routine tasks; shows reasonable attention to detail in standard ED patient care; work is generally accurate for common procedures and documentation; performs required checks adequately, especially when moderately busy.

• 7-8: Makes rare errors; demonstrates strong attention to detail in rapid assessments, challenging emergency medication administrations, and monitoring; high accuracy in calculations, vital signs, and documentation, even under pressure; effectively validates own work and data; catches potential minor issues.

• 9-10: Virtually error-free work output; possesses exceptional attention to detail in all aspects of ED nursing care, especially during critical events; meticulously verifies every step (patient ID, medication checks, calculations, documentation); consistently provides highly accurate and safe care; identifies potential errors made by others (e.g., in orders, data entry) in the rapid environment; is a champion for accuracy, quality, and patient safety in the high-stakes ED.

D1: Does the person consistently maintain a professional, empathetic, and calm demeanor and positively represent the ED unit and the hospital when interacting with patients/families (who are often distressed, anxious, or in pain), colleagues (nurses, techs), physicians (ED docs, specialists), paramedics, and staff from other departments (lab, radiology, etc.) during emergencies and high activity?

• 1-2: Displays unprofessional, rude, or disruptive behavior towards patients/families or staff, especially under pressure; creates a negative impression of the unit/hospital through interactions (e.g., impatience with distressed patients, arguing with colleagues or other departments); shows disrespect.

• 3-4: Sometimes unprofessional or has a negative attitude; interactions can be difficult or unhelpful (e.g., dismissive towards patient/family concerns, poor communication with physicians or other disciplines when busy); struggles to maintain composure under pressure; occasionally represents the unit poorly.

• 5-6: Maintains a professional and empathetic demeanor most of the time; interacts acceptably with patients, families, and other staff, even when moderately busy; provides standard patient communication; represents the unit appropriately in routine interactions and during common urgent situations.

• 7-8: Consistently professional, courteous, empathetic, and helpful, even under significant pressure; has positive interactions with patients/families, colleagues, and staff from other departments; effectively addresses common inquiries or concerns; maintains composure during urgent situations; represents the unit and hospital well.

• 9-10: Acts as a role model for professional, compassionate, and calm behavior in a chaotic environment; consistently maintains a positive, helpful, and supportive attitude in all interactions, particularly with distressed patients/families and during critical events; is highly respected and sought out by colleagues and other departments for their collaborative approach and ability to function effectively under extreme pressure; significantly enhances the image and reputation of the ED unit and the hospital.

D2: Does he/ she effectively cooperate and collaborate with team members on the ED unit (e.g., assisting with patient care tasks during surges, sharing workload, helping with critical patients/procedures)? Do they actively and constructively interact with physicians, specialists, paramedics, and ancillary staff to coordinate patient care, clarify orders, manage flow, and improve communication in a rapid environment?

• 1-2: Uncooperative on the ED unit; refuses to assist colleagues with patient care or workload, especially during emergencies; avoids or actively hinders interactions with other departments (physicians, paramedics, lab, radiology), causing significant delays and friction in emergency care.

• 3-4: Reluctant to collaborate; provides minimal assistance to colleagues, particularly when busy; interacts poorly or unhelpfully with other departments when patient care or order issues arise in urgent situations.

• 5-6: Cooperates with team members when needed; provides basic assistance; interacts adequately with other departments for routine coordination or issue resolution, functions acceptably under moderate pressure.

• 7-8: Actively collaborates and supports ED nursing team members (e.g., helps with patient care tasks during peak times, assists with admissions/discharges/transfers efficiently); engages constructively and effectively with physicians, specialists, paramedics, and staff from other disciplines during huddles, emergencies, and in addressing patient care issues.

• 9-10: Champions teamwork and collaboration both on the ED unit and across disciplines, especially in high-pressure situations; proactively assists colleagues and builds strong, trusting relationships with physicians, paramedics, and other staff; is an integral and valued part of the interdisciplinary emergency care team, facilitating smooth communication and joint problem-solving that directly impacts rapid patient assessment, intervention, and outcomes.

D3: Does the person constructively engage in resolving disagreements or communication challenges that may arise on the ED unit or between ED nursing and medical teams/other services regarding patient care plans, orders, safety concerns, or procedural disagreements, especially under pressure?

• 1-2: Avoids conflict or actively escalates it (e.g., arguing with physicians about orders in front of patients, blaming other disciplines for delays); contributes negatively to tense situations; unable to handle disagreements professionally, particularly when under pressure.

• 3-4: Struggles to handle disagreements; may withdraw or become defensive; can sometimes worsen conflict situations related to patient care issues or inter-departmental communication, especially when busy.

• 5-6: Handles basic disagreements appropriately; doesn't escalate conflicts unnecessarily; participates passively in resolving communication issues regarding patient care or workflow, functions adequately under moderate pressure.

• 7-8: Attempts to resolve conflicts constructively (e.g., respectfully discusses differing opinions on care with a physician, clarifies misunderstandings with other departments calmly), even under pressure; communicates effectively to de-escalate situations and find common ground for patient care.

• 9-10: Is highly skilled in navigating difficult conversations related to urgent patient care decisions, safety concerns, or communication breakdowns in the chaotic ED environment; proactively addresses potential sources of conflict or communication barriers within the unit or with other departments; acts as a mediator or facilitator to resolve interdisciplinary issues effectively, improving overall patient care coordination and team dynamics under extreme pressure.

D4: Is he/she willing and eager to share their clinical knowledge and expertise, guiding, training, or coaching less experienced team members (nurses, students, techs), and providing education to patients/families on ED processes, minor treatment plans, or discharge instructions, even during busy shifts?

• 1-2: Unwilling to help or train others; withholds clinical knowledge or makes it difficult for new staff/students/patients to learn; refuses to provide basic education to patients/families or other staff, especially when busy.

• 3-4: Reluctantly provides minimal assistance or training when directly asked; lacks patience or clarity in explaining clinical concepts or procedures, especially under pressure; avoids educational opportunities.

• 5-6: Is willing to train or guide others when assigned or asked directly; provides adequate basic instruction on common procedures or patient education topics, functions adequately under moderate pressure.

• 7-8: Shows willingness and interest in clinical training and mentoring; patiently guides less experienced colleagues, students, and techs, even during busy shifts; shares knowledge freely and effectively; provides useful basic education to patients/families upon request or proactively on relevant topics.

• 9-10: Is highly eager and skilled in clinical training, coaching, and patient/family education, especially in the ED context; actively seeks opportunities to mentor new or less experienced staff; consistently provides impactful, high-quality education to patients/families (improving understanding and compliance) and other staff (e.g., teaching a quick skill); is recognized as a valuable educator and resource for clinical skill development and patient empowerment on the unit and beyond, even in high-stress situations.

E1: Does the individual show eagerness and actively pursue learning opportunities (e.g., staying current with emergency clinical literature/evidence, learning new ED procedures/equipment, attending CE/conferences relevant to emergency care, pursuing certifications - CEN, trauma, critical care) to expand their clinical knowledge and skills for the ED?

• 1-2: Shows no interest in staying current with emergency clinical information; avoids training or educational opportunities; resistant to expanding clinical knowledge or skill set for the ED.

• 3-4: Shows minimal interest in learning; participates only in mandatory CE; does not seek out new clinical knowledge independently or keep fully current with evidence-based practices for emergency care.

• 5-6: Is willing to learn about new medications, procedures, or equipment when required for ED patient care; attends assigned training and completes necessary CE; learns new tasks as needed.

• 7-8: Shows genuine interest in expanding their ED clinical knowledge and skills; actively seeks out learning opportunities (CE, literature review, workshops, certifications) to stay current with evidence-based practice, new medications, or patient populations encountered in the ED; learns new tasks or responsibilities readily.

• 9-10: Is highly passionate about continuous clinical learning for emergency care; actively pursues board certification or other advanced training relevant to the ED; consistently stays ahead of new clinical evidence, guidelines, and best practices for emergency and critical care; integrates new knowledge into practice and shares with the unit; significantly contributes to the unit's overall expertise and evidence-based emergency care.

E2: Does he/ she proactively take steps to improve ED nursing processes, patient care delivery, safety measures, or unit efficiency, especially in high-pressure situations? In the face of a challenge (e.g., a difficult patient case, equipment malfunction during emergency, workflow bottleneck during surge), does the person try to find solutions or resolve issues on their own initiative?

• 1-2: Shows no clinical initiative; waits to be told what to do or how to handle problems; ignores problems with patient care or workflow; does not attempt troubleshooting beyond basic steps, especially during emergencies.

• 3-4: Rarely shows initiative; identifies problems (e.g., equipment not working, patient issue) but doesn't attempt solutions; performs minimal troubleshooting steps before asking for help with patient issues or equipment, especially when busy.

• 5-6: Identifies common problems or areas for basic improvement when pointed out; attempts standard troubleshooting steps for common patient issues or equipment problems; participates in minor process improvement efforts on the unit, functions adequately under moderate pressure.

• 7-8: Proactively identifies opportunities for improving ED workflows, patient safety measures, or care delivery (e.g., suggesting a different way to organize supplies for rapid access, optimizing a task process during surge); demonstrates initiative in troubleshooting most patient care or equipment issues independently, even under pressure; suggests practical solutions.

• 9-10: Consistently identifies significant opportunities for improving emergency patient care, safety, or unit efficiency; takes initiative to implement improvements (with approval), potentially involving workflow changes, protocol adjustments, or new tools; is highly skilled and proactive in troubleshooting complex or unusual patient problems or system issues, often resolving them independently, even during critical events; acts as a key problem-solver and change agent on the unit.

E3: How often does he/ she come up with new ideas or suggest changes which can improve emergency patient care, safety protocols, unit workflow, or interdisciplinary communication in the ED? Do they actively participate in or champion new initiatives related to quality, safety, process optimization, or evidence-based practice on the unit or across the hospital?

• 1-2: Never offers suggestions for improvement; resistant to new ideas or initiatives on the unit.

• 3-4: Rarely offers suggestions, and ideas may be impractical or lack evidence; shows no interest in initiatives.

• 5-6: Offers occasional relevant suggestions for improving unit operations, patient safety, or workflow; participates adequately in team initiatives when asked.

• 7-8: Regularly offers practical and relevant suggestions for improving patient care, safety protocols, or contributing to unit initiatives; actively contributes to unit or hospital-wide initiatives (e.g., participation in a QI project relevant to the ED, helping pilot a new product for rapid use, revising a protocol).

• 9-10: Frequently proposes innovative and impactful ideas for improving emergency patient care, safety, or unit operations; actively champions and drives implementation of new initiatives (e.g., leading a project to improve rapid assessment, optimizing a medication administration process for efficiency/safety, implementing a new communication strategy during codes); is recognized as a valuable contributor to the unit's and hospital's continuous improvement and innovation efforts for emergency care.

1-2: Unsatisfactory / Needs Significant Improvement: Performance is consistently below minimum acceptable standards for leadership, management, or education. Requires constant direct supervision and intervention. Frequent major issues (e.g., poor resource management, significant staff performance issues unresolved, ineffective training programs, major compliance gaps on unit/in program). Significantly compromises unit/department function, staff development, or patient care quality.

3-4: Needs Improvement: Performance is inconsistent and often falls below expectations. Requires frequent guidance and correction on management decisions, educational strategies, or staff support. Struggles with common operational challenges or delivering effective training. Progress is slow even with support. Reliability in managing responsibilities is questionable.

5-6: Meets Expectations / Solid Performance: Performance is generally consistent and meets the requirements of the administrative/education role. Can perform routine management tasks (staffing, scheduling, basic budget oversight) and/or education tasks (delivering standard programs, orienting staff) reliably with standard supervision. Identifies common operational/education issues and follows basic policies/procedures. Contributes acceptably to unit/department function and staff development goals.

7-8: Exceeds Expectations in Areas / Strong Performance: Performance often exceeds expectations in specific areas of leadership, management, or education. Highly reliable for most tasks, including some complex operational issues or program development. Requires minimal routine supervision. Proactive in identifying and addressing issues or seeking improvements sometimes. Provides valuable insights on operations, staff performance, or education needs. Functions effectively under moderate pressure.

9-10: Consistently Exceeds Expectations / Exceptional Performance: Performance consistently surpasses expectations across all aspects of the role. Acts as a role model and resource for other leaders, managers, and educators. Highly proactive, takes significant initiative in optimizing unit/department operations, fostering staff development, enhancing quality outcomes, and improving education programs. Consistently delivers high-impact leadership and educational support.

A1: How would you rate the individual's knowledge and competencies relevant to nursing leadership, management, and/or education (e.g., management principles, HR processes, budgeting basics, policy development, performance management, adult learning principles, instructional design, curriculum development, competency assessment methods, evidence-based practice translation)?

• 1-2: Has very limited knowledge of basic management or education concepts; unable to perform fundamental tasks like creating a basic schedule/budget or planning a simple orientation session; frequently makes critical errors due to lack of foundational leadership/education knowledge.

• 3-4: Has difficulty grasping core management or education concepts; requires frequent reminders and correction on procedures like performance reviews or using learning management systems; struggles with basic financial reports or assessing staff competency; slow to learn new leadership/education skills.

• 5-6: Demonstrates adequate understanding of core management and education concepts relevant to the role; can perform standard leadership tasks (e.g., basic staffing/scheduling decisions) and/or education tasks (e.g., delivering standard content, evaluating learning); understands basic financial concepts and standard training methods.

• 7-8: Possesses strong knowledge covering a broad range of management and education concepts; proficient in advanced management tasks (e.g., complex scheduling, basic budget analysis) and/or education tasks (e.g., developing new educational materials, implementing new learning strategies); understands the evidence basis behind management/education decisions; capable of teaching basic leadership/education concepts to others.

• 9-10: Is an expert in their area's management and/or education competencies (depending on role focus); masters complex budget planning, strategic staffing, performance management, and/or innovative educational program development, advanced competency assessment, evidence-based policy development; acts as a go-to resource for complex leadership/education questions; proactively seeks to learn advanced techniques and certifications.

A2: How effectively does the individual apply their knowledge and skills to manage unit/department operations, develop/deliver education programs, assess staff performance/competency, manage resources (staff, budget, supplies), translate evidence into practice, support strategic goals, and address operational/educational challenges?

• 1-2: Frequently makes errors in management decisions or education program content/delivery resulting in poor outcomes (e.g., staffing issues, ineffective training, budget overages); unable to perform accurate staff evaluations or assess learning needs; overlooks critical operational or educational gaps; significantly hinders unit/department function and staff development.

• 3-4: Makes occasional errors in application, resulting in frequent corrections or unresolved issues; requires frequent checks for accuracy in reports or training materials; struggles with managing resources effectively or adapting education for different learners; needs significant help with addressing complex staff or program issues.

• 5-6: Applies knowledge and skills to perform routine management and/or education tasks accurately most of the time; manages standard operational workflows and/or delivers common education programs effectively; follows basic policies and procedures for staff management and/or education; addresses common operational and/or educational challenges adequately.

• 7-8: Consistently applies knowledge for high accuracy and effectiveness in management and/or education; adept at managing moderately complex operational issues (e.g., addressing scheduling challenges, implementing process improvements) and/or developing/delivering specialized education; proficient in performance management and/or advanced competency assessment; provides valuable insights and recommendations to support goals.

• 9-10: Demonstrates exceptional skill in applying knowledge for superior effectiveness and impact; consistently identifies potential operational issues, staff development needs, or educational gaps before they become major problems; highly proficient in complex problem-solving, strategic resource management, and/or developing/implementing innovative and highly effective education programs; contributes significantly to improving unit/department performance, staff competency, and organizational outcomes.

A3: Is he/she willing and able to quickly adapt to changes, including new hospital policies/structure, technology (EMR updates, learning platforms, staffing software), regulatory requirements (e.g., nursing standards, accreditation updates), evidence-based practices, staffing models, educational methodologies, or organizational priorities?

• 1-2: Actively resists learning new policies, systems, regulations, or methodologies; refuses to use updated tools or adopt new approaches; provides management/education based on outdated practices, hindering compliance and progress.

• 3-4: Shows reluctance towards change; takes a long time to become proficient in new policies, systems, or methodologies; requires excessive support and reminders during transitions to new operational procedures, technology, or educational strategies.

• 5-6: Accepts change and learns new policies, systems, regulations, or methodologies at a reasonable pace; becomes competent after standard training; follows new standards once familiar.

• 7-8: Adapts quickly and positively to changes; shows eagerness to learn new operational approaches, technology features, regulatory updates, or educational techniques; proficient in applying new practices relatively fast.

• 9-10: Embraces change as an opportunity to improve management, education, and organizational function; actively seeks out training on new policies, systems, regulations, and methodologies; helps others (staff, colleagues) understand and adapt to changes; becomes an early expert and advocate for new evidence-based practices and organizational priorities.

B1: Does the person show enthusiasm and readiness to take on responsibility readily, such as leading operational initiatives, managing complex projects (e.g., unit expansion, new program launch), developing new education programs/policies, mentoring/coaching managers or educators, or representing the department/service on high-level committees?

• 1-2: Consistently avoids taking on any leadership or education responsibility beyond basic assigned tasks; refuses to help others with complex issues or training; shows no interest in contributing to unit/department initiatives or strategic goals.

• 3-4: Reluctantly takes on responsibility only when directly assigned; needs to be heavily prompted to lead initiatives or participate in projects/committees; shows minimal engagement in extra duties related to management or education.

• 5-6: Takes on assigned responsibilities willingly (e.g., managing a unit's daily operations, leading a standard project, developing basic training materials); completes tasks reliably; participates adequately when asked to help with mentoring or committees.

• 7-8: Shows enthusiasm for taking on additional leadership and/or education responsibilities (e.g., managing a challenging unit, effectively mentoring managers/educators, leading a significant project or committee); volunteers for or actively participates in departmental or hospital-wide initiatives.

• 9-10: Actively seeks out opportunities to take on significant responsibility or leadership roles; demonstrates strong initiative in managing complex operational/staff issues, leading high-impact projects (e.g., implementing a new care model, developing a hospital-wide education program), or championing strategic initiatives; is a driving force for organizational progress and excellence.

B2: Does he/she maintain consistency of quality and accuracy in management decisions, financial oversight, policy implementation, program delivery, staff evaluations, and documentation, even without direct supervision? Can the person be trusted to independently manage unit/department/program operations, meet deadlines, and ensure compliance?

• 1-2: Management decisions are inconsistent; frequently misses deadlines for budgets, staff evaluations, or program delivery; unit/department operations are unreliable or education programs are ineffective; cannot be trusted to manage responsibilities independently.

• 3-4: Work is inconsistent; occasionally misses deadlines or requires reminders; needs frequent checks on financial reports, staff documentation, or training effectiveness; struggles with managing responsibilities independently.

• 5-6: Maintains consistent quality for routine management and/or education tasks; generally meets deadlines for standard reports, staff reviews, and/or program delivery; can be trusted to manage unit/department/program with some oversight; follows policies.

• 7-8: Quality and accuracy are consistently high; reliably meets deadlines for most tasks, including complex reports, budget submissions, and/or program launches; can be trusted to handle most responsibilities independently from initiation to completion; meticulous with documentation and compliance oversight.

• 9-10: Consistently delivers work of exceptional quality and efficiency; always meets or exceeds deadlines for critical reports, budget management, staff evaluations, and/or program initiatives; is highly reliable and requires virtually no checking for all aspects of their work; documentation is exemplary; acts as a benchmark for dependability, quality, and compliance in administration and education.

B3: Can the person be trusted to stay within their assigned leadership/management authority, policy-making scope, and education role boundaries? Does the person bring to the notice of supervisors major operational issues, significant staff performance concerns, budget variances, regulatory non-compliance risks, critical training needs, safety issues identified through oversight/education, or any other significant issues promptly?

• 1-2: Regularly operates outside their defined scope or authority; fails to report severe staff issues, budget problems, or compliance risks; actively hides errors or problems.

• 3-4: Occasionally exceeds authority (e.g., making decisions outside scope); reports some but not all required incidents (e.g., minor budget variances missed); may delay reporting significant issues (e.g., unresolved staff conflict, potential regulatory non-compliance).

• 5-6: Generally operates within assigned authority; reports major operational issues, significant staff concerns, budget variances, and compliance risks as required; follows reporting procedures most of the time.

• 7-8: Consistently operates strictly within scope of authority; reliably and promptly reports all required major operational issues, significant staff performance/conduct concerns, budget variances, regulatory non-compliance risks, critical training needs, and safety issues identified through management or education to the appropriate supervisor/leadership; understands the importance of accurate and timely communication for effective oversight and risk management.

• 9-10: Has an exceptional understanding of their authority limits and organizational impact; is highly proactive in identifying and immediately reporting any potential issue (subtle staff concerns, emerging budget issues, potential compliance gaps, critical gaps in knowledge/skill identified), even minor ones that could escalate; acts as a key safeguard in leadership and education and contributes to improving reporting systems.

B4: Is the person committed to the success of their unit/department/service, staff development, quality of care, and organizational goals, and when required, go beyond standard duties to support staff, drive improvement initiatives, mentor colleagues, or contribute to strategic planning?

• 1-2: Shows no commitment to the unit/department's success or staff development; only does the absolute minimum required tasks; refuses to help staff with complex issues or participate in initiatives.

• 3-4: Completes assigned duties but shows little interest in team/department goals or staff development; rarely helps others; avoids participation in initiatives.

• 5-6: Diligently performs assigned duties; is a reliable leader/educator; contributes positively to daily workflow; participates adequately in initiatives when asked.

• 7-8: Shows strong commitment to their unit/department, staff development, and organizational goals; willingly supports staff with complex issues or challenges; actively participates in unit/departmental or hospital-wide initiatives like quality improvement or strategic planning tasks; represents their area positively.

• 9-10: Is highly dedicated to enhancing unit/department performance, staff competency, and organizational outcomes; consistently goes above and beyond standard duties to support staff, champion initiatives, mentor others, and drive strategic goals; is a positive force for morale and productivity; significantly contributes to the unit's/department's and institution's reputation for excellence.

C1: How would you rate the individual's attendance and timeliness, including reporting on time for shifts/meetings, consistency in avoiding unnecessary absenteeism, flexibility to adjust schedule for urgent operational needs (e.g., staffing issues, critical incidents), program delivery schedules, project deadlines, or emergency response support, and willingness to put in extra time when urgently needed?

• 1-2: Frequent unexplained absences or tardiness; highly unreliable for meetings or critical operational/education schedules; completely inflexible with scheduling or responding to urgent needs.

• 3-4: Occasional issues with attendance or punctuality; sometimes difficult regarding scheduling changes or urgent operational/education needs; reluctant to stay extra time to help with workload or crises.

• 5-6: Meets standard attendance and punctuality requirements; is reasonably reliable for scheduled shifts/meetings/programs; demonstrates some flexibility for operational needs or urgent situations.

• 7-8: Excellent attendance and punctuality; highly reliable for all scheduled responsibilities and critical deadlines; willingly flexible with scheduling changes and readily available/works extra time when needed for urgent operational issues, program delivery, or project milestones.

• 9-10: Perfect or near-perfect attendance and punctuality; exceptionally reliable for covering critical operational or educational functions; highly proactive in helping cover needs or working extra time during critical events, staff issues, or emergencies; always available when needed for essential leadership/education support.

C2: Does he/she consistently and accurately follow departmental policies, HR procedures, financial protocols, education program standards, documentation guidelines, and relevant regulatory requirements? How well do they document management decisions, staff performance/conduct, program plans/evaluations, policy updates, meeting minutes, and other administrative/education records according to organizational standards?

• 1-2: Consistently ignores or deviates significantly from policies/procedures (e.g., mishandles HR issues, fails to follow budget protocols, does not follow education standards); documentation is often missing, inaccurate, or illegible; creates major operational, HR, financial, education, or compliance risks due to poor adherence.

• 3-4: Frequently deviates from policies/procedures or forgets steps; documentation is often incomplete or unclear (e.g., missing details in staff files, vague meeting minutes, incomplete program evaluations); needs frequent reminders about procedures and documentation standards.

• 5-6: Generally follows policies/procedures correctly for routine tasks; documentation is adequate for standard administrative and/or education activities; complies with most requirements for timely and complete documentation.

• 7-8: Consistently follows all relevant policies/procedures meticulously; documentation is accurate, complete, clear, and timely for all tasks, including complex issues and decisions; understands the importance of thorough documentation for oversight, compliance, and continuity.

• 9-10: Adheres strictly to all policies/procedures and often exceeds documentation standards (e.g., provides exceptional detail and rationale in staff files, comprehensive program documentation, clear and actionable meeting minutes); documentation is exemplary and could serve as a training example; proactively identifies potential issues with existing policies/procedures or documentation processes and suggests improvements for clarity, consistency, or compliance.

C3: How would you rate the individual's efficiency in terms of speed and volume of work completion (e.g., reports completed, staff evaluations finalized, program sessions delivered, projects managed, issues resolved) compared to other leaders/educators with similar roles and experience, while consistently maintaining high quality of leadership, education, and oversight?

• 1-2: Works significantly slower than peers; output volume (reports, evaluations, program delivery) is very low; requires excessive time per task, causing significant delays in operational oversight, staff management processes, or education delivery.

• 3-4: Slower than most peers; output volume is below average; takes longer than expected to complete tasks, occasionally impacting workflow or timeliness of crucial processes, sometimes compromising quality for speed.

• 5-6: Works at an average pace comparable to peers; consistently completes an expected volume of tasks for their role; completes tasks within standard timeframes while maintaining acceptable quality and oversight.

• 7-8: Works efficiently and quickly; output volume is above average compared to peers, while consistently maintaining high quality of leadership, education, and oversight; manages workload effectively and keeps key processes moving smoothly.

• 9-10: Is exceptionally efficient; output volume is consistently high and sets a benchmark for the team, without ever compromising quality, accuracy, or compliance; streamlines own work process and helps optimize workflow for others; is a high-productivity leader/educator who significantly enhances overall departmental throughput and effectiveness.

C4: How would you rate the individual in terms of attention to detail and accuracy in all aspects of their work (e.g., financial reports, policy wording, staff documentation - evaluations, disciplinary actions; program materials, data analysis for decision-making, regulatory submissions), which directly impacts operational effectiveness, staff equity, program quality, and compliance?

• 1-2: Frequently makes critical errors (e.g., inaccurate financial data, errors in policy wording leading to confusion/risk, significant errors in staff evaluations/documentation, inaccurate data analysis for decisions); lacks attention to detail, leading to operational failures, staff issues, ineffective programs, and major compliance risks.

• 3-4: Makes occasional significant errors or overlooks important details during report preparation, documentation, or program material development (e.g., minor errors in reports, incomplete staff notes, typos in materials); attention to detail is inconsistent; work often requires correction or follow-up by others due to accuracy issues.

• 5-6: Makes few errors in routine tasks; shows reasonable attention to detail in standard processes; work is generally accurate for common administrative and/or education tasks; performs required checks adequately.

• 7-8: Makes rare errors; demonstrates strong attention to detail in complex reports, sensitive staff documentation, and program materials; high accuracy in data analysis for decision-making; validates own work effectively; catches potential minor issues.

• 9-10: Virtually error-free work output; possesses exceptional attention to detail in all aspects of leadership and education work; meticulously verifies every detail (numbers, wording, data points, staff history); consistently produces highly accurate and reliable outcomes; identifies potential errors made by others (e.g., staff documentation errors, errors in reports from other departments); is a champion for accuracy, quality, and compliance in all their responsibilities.

D1: Does the person consistently maintain a professional, supportive, and positive demeanor and positively represent Nursing Administration/Education, the nursing department, and the hospital when interacting with staff (direct reports/learners), colleagues in Nursing Administration/Education, other department managers/directors, physicians, hospital leadership, and external partners (e.g., schools of nursing)?

• 1-2: Displays unprofessional, unsupportive, or disruptive behavior towards staff or colleagues; creates a negative impression of the department/hospital through interactions (e.g., micromanaging, negativity towards staff, arguing with other managers); shows disrespect.

• 3-4: Sometimes unprofessional or has a negative attitude; interactions can be difficult or unhelpful (e.g., poor communication with staff, struggles to provide constructive feedback, uncooperative with other departments); occasionally represents the department poorly.

• 5-6: Maintains a professional and supportive demeanor most of the time; interacts acceptably with staff, colleagues, other managers, and leadership; represents the department appropriately in routine interactions.

• 7-8: Consistently professional, courteous, supportive, and helpful; has positive interactions with staff (building trust and rapport), colleagues, other managers, and leadership; effectively addresses common inquiries or concerns; represents the department and hospital well.

• 9-10: Acts as a role model for professional, supportive, and collaborative leadership/education; consistently maintains a positive, empowering, and helpful attitude in all interactions; is highly respected and sought out by staff, colleagues, other managers, and leadership for their collaborative approach, problem-solving skills, and ability to build relationships; significantly enhances the image and reputation of the department and the hospital.

D2: Does he/ she effectively cooperate and collaborate with team members within Nursing Administration/Education (e.g., sharing information, joint problem-solving, peer support)? Do they actively and constructively interact with staff (direct reports/learners), other department managers, hospital leadership, and support services (HR, Finance, IT, Quality) to manage operations, address staff needs, develop/deliver education, and improve workflows?

• 1-2: Uncooperative within the leadership/education team; refuses to assist colleagues with workload or complex issues; avoids or actively hinders interactions with staff or other departments, causing significant operational delays, staff dissatisfaction, or ineffective problem-solving.

• 3-4: Reluctant to collaborate; provides minimal assistance to colleagues or staff; interacts poorly or unhelpfully with other departments when addressing operational, staff, or education issues.

• 5-6: Cooperates with team members when needed; provides basic assistance; interacts adequately with staff and other departments for routine operational or educational coordination or issue resolution.

• 7-8: Actively collaborates and supports Nursing Administration/Education team members (e.g., co-leads projects, peer supports, shares expertise); engages constructively and effectively with staff and other departments during meetings, rounding, and in addressing operational issues, staff concerns, or education needs.

• 9-10: Champions teamwork and collaboration both within Nursing Administration/Education and across departments; proactively assists colleagues and builds strong, trusting relationships with staff, other managers, leadership, and support services; is an integral and valued part of the organizational structure, facilitating smooth communication and joint problem-solving that directly impacts operational efficiency, staff satisfaction, and quality outcomes.

D3: Does the person constructively engage in resolving disagreements or communication challenges that may arise within the Nursing Administration/Education team, with staff (direct reports/learners), or between Nursing Administration/Education and other hospital departments regarding operational issues, resource allocation, staff performance, policy interpretation, or educational content/delivery?

• 1-2: Avoids conflict or actively escalates it (e.g., arguing with staff or other managers, blaming others); contributes negatively to tense situations; unable to handle disagreements professionally.

• 3-4: Struggles to handle disagreements; may withdraw or become defensive; can sometimes worsen conflict situations related to operational issues, staff performance, or inter-departmental disagreements.

• 5-6: Handles basic disagreements appropriately; doesn't escalate conflicts unnecessarily; participates passively in resolving communication issues regarding operational, staff, or educational matters.

• 7-8: Attempts to resolve conflicts constructively (e.g., calmly discusses operational issues with another manager, addresses staff concerns respectfully, clarifies policy interpretation with HR/compliance); communicates effectively to de-escalate situations and find common ground for resolution.

• 9-10: Is highly skilled in navigating difficult conversations related to complex operational, staff, or inter-departmental issues; proactively addresses potential sources of conflict or communication barriers within the team, with staff, or with other departments; acts as a mediator or facilitator to resolve complex issues effectively, improving overall team dynamics, staff satisfaction, and inter-departmental relationships.

D4: Is he/she willing and eager to share their knowledge and expertise, guiding, training, or coaching staff (direct reports, learners), colleagues in Nursing Administration/Education, or managers on leadership/management/education best practices, policies, or operational procedures?

• 1-2: Unwilling to help or train others; withholds knowledge or makes it difficult for staff/colleagues to learn; expresses frustration when asked for help.

• 3-4: Reluctantly provides minimal assistance or training when directly asked; lacks patience or clarity in explaining concepts or procedures; avoids educational opportunities.

• 5-6: Is willing to train or guide others when assigned or asked directly; provides adequate basic instruction on common policies, procedures, or management/education tasks.

• 7-8: Shows willingness and interest in training and mentoring staff, colleagues, or managers; patiently guides less experienced individuals; shares knowledge freely and effectively on policies, procedures, and management/education best practices.

• 9-10: Is highly eager and skilled in training, coaching, and mentoring; actively seeks opportunities to mentor and develop staff, colleagues, and future leaders/educators; contributes to developing training programs or improving professional development processes; is recognized as a valuable educator, coach, and resource for skill development and career growth across the nursing department.

E1: Does the individual show eagerness and actively pursue learning opportunities (e.g., staying current with leadership/management/education literature, learning new operational/education methodologies/systems, attending conferences/webinars, pursuing advanced degrees/certifications in nursing leadership/education/management) to expand their knowledge and skills?

• 1-2: Shows no interest in staying current with leadership, management, or education practices; avoids training or educational opportunities; resistant to personal or professional development.

• 3-4: Shows minimal interest in learning; participates only in mandatory training/CE; does not seek out new knowledge independently regarding new methodologies, systems, or best practices.

• 5-6: Is willing to learn about new policies, systems, or methodologies when required for their role; attends assigned training and completes necessary CE; learns new tasks as needed.

• 7-8: Shows genuine interest in expanding their knowledge and skills; actively seeks out learning opportunities (certifications, conferences, workshops, self-study) to stay current with best practices in nursing leadership, management, and/or education; learns new tasks or responsibilities readily.

• 9-10: Is highly passionate about continuous professional development; actively pursues advanced degrees or certifications relevant to their area; consistently stays ahead of new trends, research, and best practices in nursing administration and education; integrates new knowledge into practice and shares with the team and department; significantly contributes to the department's overall expertise and effectiveness.

E2: Does he/ she proactively take steps to improve operational processes, staff performance management, resource utilization, education program effectiveness, or overall unit/department function? In the face of a challenge (e.g., a recurring staffing issue, a budget constraint, a gap in staff competency), does the person try to find solutions or resolve issues on their own initiative?

• 1-2: Shows no leadership/education initiative; waits to be told what to do; ignores problems with operations, staff performance, or education outcomes; does not attempt troubleshooting or problem-solving beyond basic steps.

• 3-4: Rarely shows initiative; identifies problems (e.g., staffing issues, training gaps) but doesn't attempt solutions; performs minimal troubleshooting steps before asking for help with complex operational or education issues.

• 5-6: Identifies common problems or areas for basic improvement when pointed out; attempts standard troubleshooting steps for common operational issues or education challenges; participates in minor process improvement efforts.

• 7-8: Proactively identifies opportunities for improving operational workflows, staff performance, resource management, or education program delivery (e.g., suggesting a better staffing model, optimizing a process, developing a new competency assessment); demonstrates initiative in researching and resolving most complex operational or education issues independently; suggests practical solutions.

• 9-10: Consistently identifies significant opportunities for improving unit/department operations, staff performance, resource utilization, or education program effectiveness hospital-wide; takes initiative to implement improvements (with approval), potentially involving workflow changes, policy revisions, or developing innovative programs/tools; is highly skilled and proactive in troubleshooting complex or unusual operational or education problems, often resolving them independently; acts as a key problem-solver and change agent in the department and across the institution.

E3: How often does he/ she come up with new ideas or suggest changes which can improve operational efficiency, staff engagement/retention, quality outcomes, safety culture, educational program effectiveness, or resource management? Do they actively participate in or champion new initiatives related to process improvement, policy development, program innovation, strategic planning, or fostering a learning environment?

• 1-2: Never offers suggestions for improvement; resistant to new ideas or initiatives in administration or education.

• 3-4: Rarely offers suggestions, and ideas may be impractical or lack basis; shows no interest in initiatives.

• 5-6: Offers occasional relevant suggestions for improving operations, staff support, or education programs; participates adequately in team initiatives when asked.

• 7-8: Regularly offers practical and relevant suggestions for improving operational processes, staff development strategies, or educational programs; actively contributes to departmental or hospital-wide initiatives (e.g., participation in a QI project, helping pilot a new staffing model, developing a new policy or educational material).

• 9-10: Frequently proposes innovative and impactful ideas for improving operations, staff performance, education, quality, or resource management; actively champions and drives implementation of new initiatives (e.g., leading a project to implement a new retention strategy, developing a specialized education program, optimizing resource allocation); is recognized as a valuable contributor to the department's and institution's continuous improvement and innovation efforts.

1-2: Unsatisfactory / Needs Significant Improvement: Performance is consistently below minimum acceptable standards for supporting quality/safety on the unit. Requires constant direct supervision and intervention. Frequently misses critical safety issues on the unit, fails to follow quality procedures, or provides incorrect information to peers. Significantly hinders unit-level quality improvement efforts or creates compliance risks.

3-4: Needs Improvement: Performance is inconsistent and often falls below expectations in supporting unit quality/safety. Requires frequent guidance and correction on quality procedures, data collection, or educating peers. Misses common safety concerns or compliance issues on the unit. Progress is slow even with support. Reliability in quality-related tasks is questionable.

5-6: Meets Expectations / Solid Performance: Performance is generally consistent and meets the requirements of the Nursing Quality/Link Nurse role. Can perform routine unit-level quality/safety tasks reliably with standard supervision (e.g., participating in unit audits, educating peers on common policies). Identifies common quality/safety issues on the unit and follows basic procedures. Contributes acceptably to unit-level quality improvement efforts.

7-8: Exceeds Expectations in Areas / Strong Performance: Performance often exceeds expectations in specific areas of unit-level quality/safety. Highly reliable for most tasks, including some complex audits or educating on nuanced policies. Requires minimal routine supervision for quality tasks. Proactive in identifying and addressing quality/safety issues on the unit or seeking improvements sometimes. Provides valuable insights on unit-specific quality/safety challenges.

9-10: Consistently Exceeds Expectations / Exceptional Performance: Performance consistently surpasses expectations across all aspects of the Nursing Quality/Link Nurse role. Acts as a role model and resource for peers, unit leadership, and the central Quality team on unit-specific quality/safety matters. Highly proactive, takes significant initiative in identifying opportunities, implementing changes on the unit, and fostering a unit culture of safety and quality. Significantly contributes to improving quality performance and compliance on their unit and informing hospital-wide initiatives.

A1: How would you rate the individual's knowledge and competencies relevant to the Nursing Quality/Link Nurse role (e.g., hospital/unit-specific policies & procedures, safety bundles - falls, CAUTI, CLABSI; incident reporting process, basic quality metrics for the unit, basic auditing techniques, understanding of relevant regulatory requirements impacting the unit)?

• 1-2: Has very limited knowledge of unit-specific policies, safety bundles, or quality procedures; requires constant step-by-step guidance for fundamental quality tasks (e.g., how to report an incident, what data to collect); frequently makes critical errors due to lack of foundational knowledge.

• 3-4: Has difficulty grasping core unit-level quality/safety concepts; requires frequent reminders and correction on unit policies, safety bundles, or data collection methods; struggles with understanding common audit criteria; slow to learn quality-related processes for the unit.

• 5-6: Demonstrates adequate understanding of core competencies for routine unit-level quality/safety tasks; can participate in standard unit audits, understand common safety bundles, and follow the incident reporting process with standard supervision; knows where to find unit-specific policies.

• 7-8: Possesses strong knowledge covering a broad range of unit-specific quality/safety topics and policies; proficient in performing complex unit audits, understanding nuanced safety bundles, and effectively using quality-related systems (e.g., for incident reporting, data entry); capable of explaining quality concepts or policies to others.

• 9-10: Is an expert in unit-level quality/safety knowledge; masters understanding and applying complex unit policies and safety bundles; deep knowledge of best practices relevant to their unit's patient population; acts as a go-to resource for unit-specific quality/safety questions; proactively seeks to learn advanced quality methodologies and regulatory requirements impacting their unit.

A2: How effectively does the individual apply their quality/safety knowledge and skills in identifying potential quality or safety issues on the unit, educating peers on best practices/policies/safety initiatives, monitoring compliance with protocols, collecting accurate data for unit-level metrics, and contributing to safety/quality improvement initiatives on the unit?

• 1-2: Frequently misses critical safety issues or compliance failures on the unit; unable to effectively educate peers or apply audit criteria; data collected is often inaccurate or incomplete; significantly hinders unit-level quality improvement efforts.

• 3-4: Makes occasional errors in application (e.g., missing safety concerns during rounds, incomplete audits, unclear education); requires frequent checks for accuracy in monitoring or data collection; struggles with translating complex policies into practical terms for peers; needs significant help in contributing to unit initiatives.

• 5-6: Applies knowledge and skills to perform routine quality/safety monitoring and audits accurately most of the time; educates peers on common policies/procedures; follows basic procedures for data collection; contributes adequately to unit-level QI initiatives when asked.

• 7-8: Consistently applies knowledge for high accuracy and effectiveness in unit-level quality/safety tasks; adept at identifying a wide range of potential issues (including subtle ones) during rounds/audits; provides clear, practical, and evidence-based education to peers; proficient in monitoring compliance and collecting accurate data; effectively contributes to unit QI project implementation.

• 9-10: Demonstrates exceptional skill in applying knowledge for superior effectiveness; consistently identifies potential unit-level issues or compliance gaps before they become major problems; highly proficient in performing detailed audits, collecting comprehensive data, and developing/delivering highly impactful education/training for peers; contributes significantly to improving unit performance and patient safety through their insights and actions.

A3: Is he/she willing and able to quickly adapt to changes, including new unit protocols, updated hospital policies/procedures impacting the unit, new safety bundles, changes in incident reporting systems, new quality/safety initiatives or methodologies introduced by the central Quality department?

• 1-2: Actively resists learning about changes in policies, safety bundles, or quality processes; refuses to use updated systems or adopt new protocols; provides outdated information to peers, hindering compliance and safety.

• 3-4: Shows reluctance towards change; takes a long time to become proficient in new policies, safety bundles, or quality procedures; requires excessive support and reminders during transitions.

• 5-6: Accepts change and learns new policies, procedures, safety bundles, or systems relevant to quality at a reasonable pace; becomes competent after standard training; follows new standards once familiar.

• 7-8: Adapts quickly and positively to changes relevant to quality/safety on the unit; shows eagerness to learn about new policies, bundles, initiatives, or quality methodologies; proficient in applying new practices and educating peers relatively fast.

• 9-10: Embraces change as an opportunity to improve unit-level quality and safety; actively seeks out information and training on all changes; helps others (peers, new staff) understand and adapt to changes; becomes an early expert and advocate for new evidence-based practices and quality initiatives on the unit.

B1: Does the person show enthusiasm and readiness to take on responsibility readily for unit-level quality/safety tasks, such as managing specific unit-level quality projects (e.g., reducing falls on the unit), leading safety huddles, conducting unit audits, training staff on quality/safety protocols, or acting as the primary liaison with the central Quality department for unit issues?

• 1-2: Consistently avoids taking on any quality-related responsibility beyond basic expectations; refuses to help others with audits or data collection; shows no interest in contributing to unit-level quality improvement.

• 3-4: Reluctantly takes on quality responsibility only when directly assigned (e.g., performs an audit only when mandated); needs to be heavily prompted; shows minimal engagement in unit-level quality initiatives.

• 5-6: Takes on assigned unit-level quality/safety responsibilities willingly (e.g., conducting routine audits, participating in safety huddles); completes tasks reliably; participates adequately when asked to help with training or projects.

• 7-8: Shows enthusiasm for taking on additional unit-level quality responsibilities (e.g., managing a specific QI project for the unit, effectively training new staff on unit safety policies, actively engaging with the central Quality team); volunteers for or actively participates in unit-level quality initiatives.

• 9-10: Actively seeks out opportunities to take on significant responsibility or leadership roles related to unit quality/safety; demonstrates strong initiative in managing complex unit QI projects, leading impactful safety initiatives on the unit, or acting as an exceptional liaison between the unit and central Quality; is a driving force for quality improvement on their unit.

B2: Does he/she maintain consistency of quality and accuracy in performing quality/safety rounds/audits, collecting data, educating peers, and documenting findings, even without direct supervision on these tasks? Can they be trusted to independently follow unit-level quality procedures and contribute reliably to monitoring unit performance?

• 1-2: Quality of quality-related work is highly inconsistent (inaccurate audits, incomplete data, incorrect information shared); frequently misses deadlines for audits or reports; cannot be trusted to perform quality tasks without constant checking and reminders; makes frequent critical errors (e.g., missing major non-compliance).

• 3-4: Work is inconsistent; occasionally misses deadlines for quality tasks or requires reminders; needs frequent checks on data accuracy or adherence to audit criteria; struggles with managing quality tasks independently.

• 5-6: Maintains consistent quality for routine unit-level quality/safety tasks; generally meets deadlines for audits and data collection; can be trusted to follow procedures for standard quality monitoring and documentation with minimal oversight.

• 7-8: Quality and accuracy in quality-related work are consistently high; reliably meets deadlines for most tasks, including complex audits or data sets; can be trusted to handle most quality tasks independently from initiation to completion; meticulous with data collection, auditing, and documentation.

• 9-10: Consistently delivers quality-related work of exceptional quality and accuracy; always meets or exceeds deadlines; is highly reliable and requires virtually no checking for all aspects of their unit quality work; documentation is exemplary; acts as a benchmark for dependability and accuracy in unit-level quality functions.

B3: Can the person be trusted to stay within their assigned role/authority as a Link Nurse (e.g., educating, monitoring, advocating for compliance, reporting issues)? Does the person bring to the notice of unit leadership or the central Quality team significant safety concerns observed on the unit, trends identified during unit audits, failures in compliance with unit/hospital protocols, or any other critical quality issues promptly?

• 1-2: Regularly operates outside their defined scope (e.g., making mandates, overstepping authority); fails to report severe safety concerns observed, critical compliance failures, or audit findings; actively hides errors or problems.

• 3-4: Occasionally exceeds authority; reports some but not all required incidents (e.g., minor compliance issues missed); may delay reporting significant issues like persistent non-compliance or identified trends.

• 5-6: Generally operates within assigned authority; reports major safety concerns, compliance issues, and trends identified as required; follows reporting procedures most of the time.

• 7-8: Consistently operates strictly within scope of practice; reliably and promptly reports all required significant safety concerns observed, trends identified during audits, failures in compliance, and any other critical quality issues to the appropriate unit leadership or the central Quality team; understands the importance of accurate and timely communication for risk mitigation and unit improvement.

• 9-10: Has an exceptional understanding of their role's scope and influence; is highly proactive in identifying and immediately reporting any potential issue (subtle safety concerns, potential compliance gaps, emerging negative trends), even minor ones that could escalate; acts as a key safeguard in unit-level quality and contributes to improving reporting systems and unit practices.

B4: Is the person committed to promoting a culture of quality, safety, and continuous improvement on their unit and, when necessary, go beyond standard duties to support colleagues, drive unit-level initiatives, engage with hospital-wide quality efforts, or contribute positively to the unit's and institution's reputation for patient safety?

• 1-2: Shows no commitment to unit quality or safety culture; only does the absolute minimum required quality tasks; refuses to help colleagues with quality issues or participate in initiatives.

• 3-4: Completes assigned quality duties but shows little interest in promoting quality/safety on the unit; rarely helps others outside direct assignment; avoids participation in unit initiatives.

• 5-6: Diligently performs assigned quality tasks; is a reliable team member; contributes positively to unit-level quality efforts; participates adequately in unit initiatives when asked.

• 7-8: Shows strong commitment to promoting quality and safety on their unit; willingly supports colleagues with quality questions or issues; actively participates in unit initiatives like QI projects or safety audits; engages constructively with hospital-wide quality efforts; represents the unit positively.

• 9-10: Is highly dedicated to fostering a strong culture of quality and safety on their unit; consistently goes above and beyond standard quality duties to champion best practices, support unit initiatives, educate peers, and serve as an exemplary liaison with central Quality; is a positive force for promoting a proactive safety culture at the unit level; significantly contributes to the unit's and institution's reputation for excellence in patient safety.

C1: How would you rate the individual's attendance and timeliness, including reporting on time for shifts/meetings (including quality-specific ones), consistency in avoiding unnecessary absenteeism, flexibility to attend meetings or complete quality tasks outside of direct patient care time, and willingness to put in extra time when urgently needed for investigations, audits, or compliance deadlines related to quality?

• 1-2: Frequent unexplained absences or tardiness for shifts or quality meetings/deadlines; highly unreliable for quality task completion; completely inflexible with scheduling quality-related activities.

• 3-4: Occasional issues with attendance or punctuality; sometimes difficult regarding scheduling quality-related tasks/meetings; reluctant to put in extra time for quality workload.

• 5-6: Meets standard attendance and punctuality requirements; is reasonably reliable for scheduled shifts and quality meetings/tasks; demonstrates some flexibility for urgent quality needs.

• 7-8: Excellent attendance and punctuality for all responsibilities; highly reliable for all scheduled shifts and quality-related commitments; willingly flexible with scheduling and readily available/works extra time when needed for urgent investigations, audits, or compliance deadlines.

• 9-10: Perfect or near-perfect attendance and punctuality; exceptionally reliable for shifts and all quality-related commitments; highly proactive in completing quality tasks and working extra time during critical periods; always available when needed for essential quality support on the unit.

C2: Does he/she consistently and accurately follow quality/safety-related procedures (e.g., using audit tools, completing data forms, following incident reporting steps)? How well do they document their quality activities, findings from audits/rounds, communications related to quality/safety, and contributions to unit initiatives according to departmental/hospital standards?

• 1-2: Consistently ignores or deviates significantly from quality SOPs/procedures (e.g., fails to use audit tools correctly, incomplete data forms); documentation of quality activities is often missing, inaccurate, or illegible; creates major compliance or data integrity risks due to poor adherence.

• 3-4: Frequently deviates from quality SOPs or forgets steps; documentation of quality activities is often incomplete or unclear (e.g., missing audit findings, vague notes on actions taken); needs frequent reminders about quality procedures and documentation standards.

• 5-6: Generally follows quality SOPs/procedures correctly for routine tasks; documentation of quality activities is adequate for standard audits and monitoring; complies with most requirements.

• 7-8: Consistently follows all relevant quality SOPs/procedures meticulously; documentation of quality activities is accurate, complete, clear, and timely for all tasks, including complex audits or incident reviews; understands the importance of thorough documentation for analysis, compliance, and communication.

• 9-10: Adheres strictly to all quality SOPs/procedures and often exceeds documentation standards (e.g., provides exceptional detail on audit findings, comprehensive notes on educational sessions); documentation is exemplary and could serve as a training example; proactively identifies potential issues with existing quality procedures or documentation processes specific to the unit and suggests improvements for clarity, consistency, or compliance.

C3: How would you rate the individual's efficiency in terms of speed and volume of completing unit-level quality/safety tasks (e.g., number of audits completed, amount of data collected, staff educated, issues followed up on) in addition to their regular duties, compared to expectations for the role, while consistently maintaining high accuracy and quality in their quality work?

• 1-2: Works significantly slower than expected on quality tasks; output volume is very low; requires excessive time per task, causing significant delays in identifying issues or contributing to unit QI efforts.

• 3-4: Slower than expected on quality tasks; output volume is below average; takes longer than expected to complete audits or collect data, occasionally impacting the timeliness of unit quality monitoring.

• 5-6: Works at an average pace comparable to expectations for the combined role; consistently completes an expected volume of unit-level quality/safety tasks; completes tasks within standard timeframes while maintaining acceptable quality and accuracy in their quality work.

• 7-8: Works efficiently and quickly on quality tasks; output volume is above average compared to expectations, while consistently maintaining high accuracy and quality in their quality work; manages balancing clinical and quality workload effectively.

• 9-10: Is exceptionally efficient in completing unit-level quality/safety tasks; output volume is consistently high and sets a benchmark for the combined role, without ever compromising quality, accuracy, or compliance in their quality work; streamlines own work process for quality tasks and helps optimize quality workflows for the unit; is a high-productivity individual who significantly enhances overall unit quality monitoring and improvement speed.

C4: How would you rate the individual in terms of attention to detail and accuracy in all aspects of their unit-level quality/safety work (e.g., accurate data collection during audits, precise application of audit criteria, careful review of unit incidents for trends, accurate documentation of findings), which directly impacts the reliability of findings and effectiveness of improvement efforts on the unit?

• 1-2: Frequently makes critical errors in quality tasks (e.g., inaccurate data that invalidates audit results, missing critical details in unit incident reviews); lacks attention to detail, leading to unreliable findings and ineffective unit improvements.

• 3-4: Makes occasional significant errors or overlooks important details during audits or data collection; attention to detail is inconsistent; quality-related work often requires correction or follow-up by others due to accuracy issues.

• 5-6: Makes few errors in routine quality tasks; shows reasonable attention to detail in standard unit quality procedures; work is generally accurate for common audits and data collection; performs required checks adequately.

• 7-8: Makes rare errors; demonstrates strong attention to detail in complex audits or data sets; high accuracy in identifying subtle trends in unit incidents; effectively validates own quality work; catches potential minor issues.

• 9-10: Virtually error-free work output in quality tasks; possesses exceptional attention to detail in all aspects of unit-level quality work; meticulously verifies every detail (data points, audit criteria, incident facts); consistently produces highly accurate and reliable findings; identifies potential errors made by others (e.g., in initial incident reports, in unit data entry); is a champion for accuracy and quality in all unit quality functions.

D1: Does the person consistently maintain a professional and objective demeanor and positively represent quality/safety initiatives and the hospital when interacting with peers, colleagues on the unit, unit leadership, and members of the central Quality team?

• 1-2: Displays unprofessional, biased, or disruptive behavior towards peers (e.g., during education or audit feedback); creates a negative impression of unit quality efforts or the central Quality department; shows disrespect.

• 3-4: Sometimes unprofessional or has a negative attitude when performing quality tasks; interactions can be difficult or unhelpful (e.g., perceived as accusatory during feedback); occasionally represents unit quality efforts poorly.

• 5-6: Maintains a professional and objective demeanor most of the time; interacts acceptably with peers, unit leadership, and the central Quality team; represents unit quality efforts appropriately in routine interactions.

• 7-8: Consistently professional, courteous, and objective; has positive and constructive interactions with peers (providing feedback supportively), unit leadership, and the central Quality team; effectively addresses common quality/safety questions or concerns; represents unit quality efforts and the central Quality department well.

• 9-10: Acts as a role model for professional, objective, and supportive behavior in promoting quality and safety on the unit; consistently maintains a positive, helpful, and non-punitive attitude in all interactions related to quality and safety; is highly respected and sought out by peers, unit leadership, and central Quality for their collaborative approach and insights; significantly enhances the image and effectiveness of unit quality efforts and fosters trust.

D2: Does he/ she effectively cooperate and collaborate with peers on the unit to implement quality/safety practices, gather data, and participate in unit initiatives? Do they actively and constructively interact with unit leadership and the central Quality department to share information, address unit-specific issues, and support QI initiatives (both unit-level and hospital-wide)?

• 1-2: Uncooperative with peers on unit quality tasks; refuses to assist colleagues with data collection or implementing changes; avoids or actively hinders interactions with unit leadership or central Quality, causing significant delays and friction in QI efforts.

• 3-4: Reluctant to collaborate on unit quality tasks; provides minimal assistance to peers or unit leadership; interacts poorly or unhelpfully with central Quality when sharing information or seeking support.

• 5-6: Cooperates with peers on unit quality tasks when needed; provides basic assistance; interacts adequately with unit leadership and central Quality for routine data sharing or issue resolution.

• 7-8: Actively collaborates and supports peers on unit quality initiatives (e.g., helping with data collection, engaging staff in changes); engages constructively and effectively with unit leadership to identify/address issues and with the central Quality department to share unit insights and implement hospital-wide initiatives.

• 9-10: Champions teamwork and collaboration on unit quality efforts; proactively assists peers and builds strong, trusting relationships with unit leadership and the central Quality team; is an exceptional liaison, effectively communicating unit needs and progress to central Quality and advocating for/implementing hospital-wide initiatives on the unit; is an integral part of the unit's and hospital's quality structure, facilitating smooth communication and joint problem-solving.

D3: Does the person constructively engage in resolving disagreements or communication challenges that may arise on the unit regarding quality/safety practices, policy compliance, or audit findings, or between the unit and the central Quality department regarding data or interpretations?

• 1-2: Avoids conflict or actively escalates it (e.g., arguing with peers about compliance, blaming others for audit findings); contributes negatively to tense situations; unable to handle disagreements professionally.

• 3-4: Struggles to handle disagreements; may withdraw or become defensive when faced with resistance to change or challenging findings; can sometimes worsen conflict situations related to unit quality issues.

• 5-6: Handles basic disagreements appropriately; doesn't escalate conflicts unnecessarily; participates passively in resolving communication issues regarding unit quality practices or findings.

• 7-8: Attempts to resolve conflicts constructively (e.g., calmly discusses non-compliance issues with a peer supportively, clarifies data interpretations with central Quality respectfully); communicates effectively to de-escalate situations and find common ground for improvement.

• 9-10: Is highly skilled in navigating difficult conversations related to safety events, non-compliance, or challenging audit findings on the unit; proactively addresses potential sources of conflict or communication barriers within the unit or with central Quality; acts as a mediator or facilitator to resolve unit-level quality issues effectively, fostering a culture of learning and improvement rather than blame.

D4: Is he/she willing and eager to share their quality/safety knowledge and expertise, guiding, training, or coaching peers and new staff on unit-specific best practices, policies, the importance of quality initiatives, and how to use relevant quality tools (e.g., incident reporting)?

• 1-2: Unwilling to help or train others on quality/safety; withholds knowledge or makes it difficult for new staff to learn about unit quality efforts; refuses to provide education to peers.

• 3-4: Reluctantly provides minimal assistance or training when directly asked; lacks patience or clarity in explaining quality concepts or unit policies; avoids educational opportunities.

• 5-6: Is willing to train or guide others when assigned or asked directly; provides adequate basic instruction on common quality tools or unit policies.

• 7-8: Shows willingness and interest in quality/safety training and mentoring; patiently guides peers and new staff on unit-specific best practices and policies; shares knowledge freely and effectively on quality concepts and tools.

• 9-10: Is highly eager and skilled in training and coaching peers on unit quality/safety; actively seeks opportunities to mentor new or less experienced staff; consistently provides impactful, high-quality education to peers (e.g., during huddles, informal sessions); develops effective educational approaches for the unit; is recognized as a valuable educator and resource for fostering unit-level quality culture.

E1: Does the individual show eagerness and actively pursue learning opportunities (e.g., staying current with quality/safety literature/regulations relevant to the unit, learning new QI methodologies, attending quality training/webinars, engaging with central Quality resources) to expand their knowledge and skills in Nursing Quality?

• 1-2: Shows no interest in staying current with quality/safety information; avoids quality training or educational opportunities; resistant to expanding knowledge or skill set in unit quality.

• 3-4: Shows minimal interest in learning about quality; participates only in mandatory training; does not seek out new knowledge independently regarding quality practices relevant to their unit.

• 5-6: Is willing to learn about new quality tools, policies, or methodologies when required for their role; attends assigned training and completes necessary learning tasks.

• 7-8: Shows genuine interest in expanding their quality/safety knowledge and skills relevant to their unit; actively seeks out learning opportunities (training, resources from central Quality, literature review) to stay current with evidence-based practices and methodologies; learns new quality tasks or responsibilities readily.

• 9-10: Is highly passionate about continuous learning in Nursing Quality; actively seeks out advanced training or certification opportunities relevant to quality/safety; consistently stays ahead of new research, guidelines, and best practices impacting their unit; integrates new quality knowledge into practice and shares with the team; significantly contributes to the unit's overall quality expertise.

E2: Does he/ she proactively identify opportunities to improve patient safety, compliance with protocols, or quality processes on their unit? Do they demonstrate initiative in investigating minor quality issues or gathering initial information independently before escalating?

• 1-2: Shows no quality initiative; waits to be told what to do for quality tasks; ignores problems with safety or compliance on the unit; does not attempt to investigate minor issues.

• 3-4: Rarely shows initiative in identifying quality problems; identifies obvious issues but doesn't attempt to investigate or gather initial information; performs minimal steps in troubleshooting unit-level quality issues before asking for help.

• 5-6: Identifies common quality/safety problems on the unit when pointed out or through routine monitoring; attempts standard steps for investigating basic unit-level issues; participates in minor unit quality improvement efforts.

• 7-8: Proactively identifies opportunities for improving unit safety, compliance, or quality processes (e.g., noticing a trend in incidents, suggesting a workflow change to improve compliance); demonstrates initiative in investigating most minor unit-level quality issues independently or gathering comprehensive initial information before escalating; suggests practical solutions for the unit.

• 9-10: Consistently identifies significant opportunities for improving unit safety, compliance, or quality processes; takes initiative to investigate complex unit-level issues thoroughly and proposes effective solutions; is highly skilled and proactive in identifying potential risks or areas for improvement based on observations and data; acts as a key problem-solver and change agent for quality on the unit.

E3: How often does he/ she come up with new ideas or suggest changes which can improve patient safety, workflow, policy compliance, or quality of care on their unit? Do they actively participate in or champion new quality/safety initiatives on the unit or help implement hospital-wide initiatives effectively at the unit level?

• 1-2: Never offers suggestions for unit quality improvement; resistant to new ideas or initiatives related to quality/safety on the unit.

• 3-4: Rarely offers suggestions for unit quality improvement, and ideas may be impractical or lack basis; shows no interest in unit quality initiatives.

• 5-6: Offers occasional relevant suggestions for improving unit quality or safety; participates adequately in unit quality initiatives when asked.

• 7-8: Regularly offers practical and relevant suggestions for improving patient safety, workflow, or compliance on the unit; actively contributes to unit quality initiatives (e.g., participating in a unit QI project, helping implement a new protocol).

• 9-10: Frequently proposes innovative and impactful ideas for improving patient safety, workflow, or quality of care on their unit; actively champions and drives implementation of new unit quality initiatives (e.g., leading a unit effort to improve documentation compliance, implementing a peer-to-peer safety check); effectively champions and facilitates the implementation of hospital-wide quality initiatives at the unit level; is recognized as a valuable contributor to the unit's continuous improvement and innovation efforts.