ICU Nurse Fellowship Evaluation
Comprehensive evaluation form for assessing ICU nurse fellows’ competencies, skills, and professional behaviors during the fellowship program.
Fellow's Full Name
*
First Name
Last Name
Evaluator's Full Name
*
First Name
Last Name
Evaluator's Role/Title
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluation Period
*
Please Select
First Month
Second Month
Third Month
Final Evaluation
Other
Core Competency Assessment
*
Rows
Needs Improvement
Meets Expectations
Exceeds Expectations
Patient Assessment
1
2
3
Critical Thinking & Decision Making
4
5
6
Technical Skills (e.g., ventilator management, IV access)
7
8
9
Medication Administration & Safety
10
11
12
Documentation & Record Keeping
13
14
15
Professional Behaviors
*
Rows
Rarely Demonstrated
Sometimes Demonstrated
Consistently Demonstrated
Communication with Patients/Families
16
17
18
Teamwork & Collaboration
19
20
21
Accountability & Responsibility
22
23
24
Adaptability in High-Stress Situations
25
26
27
Overall Clinical Performance Rating
*
1
2
3
4
5
Strengths Observed
Areas for Improvement
Additional Comments or Recommendations
Submit Evaluation
Should be Empty: