Midterm Nursing Student Evaluation Form
Use this form to assess a nursing student’s performance at midterm in the clinical setting.
Student and Evaluation Details
Student Name
*
Student ID or Class Identifier
Evaluator/Preceptor Name
*
Evaluator Role/Title
*
Course / Clinical Rotation Name
*
Clinical Unit / Site
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Midterm Context
*
Midterm
Week 4
Week 5
Week 6
Other
Clinical Performance Assessment
Clinical performance rating
*
Rows
Unsatisfactory
Needs Improvement
Satisfactory
Excellent
Attendance and punctuality
1
2
3
4
Professionalism
5
6
7
8
Communication with patients
9
10
11
12
Communication with staff
13
14
15
16
Critical thinking
17
18
19
20
Technical/clinical skills
21
22
23
24
Patient safety practices
25
26
27
28
Documentation/charting
29
30
31
32
Teamwork/collaboration
33
34
35
36
Time management
37
38
39
40
Readiness for midterm progression
41
42
43
44
Attendance and punctuality
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Professionalism
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Communication with patients
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Communication with staff
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Critical thinking
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Technical and clinical skills
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Patient safety practices
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Documentation and charting
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Teamwork and collaboration
*
Unsatisfactory
1
2
3
Excellent
4
1 is Unsatisfactory, 4 is Excellent
Strengths, Improvement Plan, and Overall Evaluation
Strengths / Comments
Areas for Improvement
Goals / Action Plan for Second Half of Term
Overall Midterm Recommendation / Progress Status
*
On Track
Needs Improvement
At Risk
Overall Evaluator Comments
Submit Evaluation
Should be Empty: