POSITION DESCRIPTION / PERFORMANCE EVALUATION

Job Title: Nursing Assistant Supervised by: Director of Nursing

Prepared by: __________________________________ Approved by: ___________________________
Date: ________________________________________ Date: _________________________________

Job Summary: The nursing assistant is responsible for performing tasks which involve direct services for residents
delegated by a registered nurse and performed under the supervision of a registered nurse or licensed practical nurse.

DUTIES AND RESPONSIBILITIES: Performs skills for residents as taught in nursing assistant training program

Performance is clearly outstanding;Performance is superior – it far exceeds standards

E = Excellent
or expectations;Performance is exceptional on a continuous basis.
Performance generally meets or exceeds standards or expectations;Attains all or nearly
G = Good
all of position objectives.
Performance is adequate – it meets standards or expectations, and is developing within
S = Satisfactory
the position.
NI = Needs Improvement Fails to meet one or more job expectations.

U = Unacceptable Performance is below accepted levels;Fails to meet most job expectations.

Demonstrates Competency in the Following Areas: E G S NI U

Assists licensed staff with patient care following directions and precise
manner.

Performs assigned treatment or procedures accurately and with good 5 4 3 2 1

technique.

Makes observations of common changes in patients condition. 5 4 3 2 1

Reports observation to appropriate person. 5 4 3 2 1

Documents observation accurately. 5 4 3 2 1

Collects basic patient data as assigned such as vital signs, oral intake, and 5 4 3 2 1
output, etc.

Assists and accompanies patient in admission, transfer and discharge process. 5 4 3 2 1

Performs direct patient care as assigned to provide for the physical comfort of 5 4 3 2 1
the patient, in accordance with the nursing care plan.

Familiar with duties and performs them accurately, recognizing their 5 4 3 2 1

importance and relationship to patient care.

Responsible for completion of assignments without interference to quality of 5 4 3 2 1

work.

Assists licensed staff in formation of nursing care plan.

Contributes to the revision of the care plan by making suggestions. 5 4 3 2 1

Contributes to the evaluation of the response of the patient to his/her plan. 5 4 3 2 1

Contributes to the revision of the patient care plan according to changing 5 4 3 2 1

needs of the patient.

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Demonstrates Competency in the Following Areas: E G S NI U

Helps assure a clean, safe environment with well-stocked supplies and

functioning equipment.

Reports malfunctioning equipment and safety hazards to appropriate person. 5 4 3 2 1

Assists in keeping stocked supplies clean and up to date. 5 4 3 2 1

Has current knowledge of proper equipment usage. 5 4 3 2 1

Show initiative and sound judgment in routine situations as well as

during emergencies.

Able to perform in an accurate and precise manner in crises and emergency 5 4 3 2 1

situations when time is of the essence.

Able to adapt to change in workload or patient assignments. 5 4 3 2 1

Recognizes and performs duties which need to be performed although not 5 4 3 2 1

directly assigned.

Seeks guidance and direction as necessary for performance of duties. 5 4 3 2 1

Recognizes and responds to priorities in patient care process. 5 4 3 2 1

Maintains CPR skills. 5 4 3 2 1

Prompt reliable and regular in attendance.

Reports to work on time. 5 4 3 2 1

Provides proper notification for absence or tardiness. 5 4 3 2 1

Takes corrective action to prevent recurring absences. 5 4 3 2 1

Appearance and attitude conducive to good working relationship. 5 4 3 2 1

Observes hospital uniform code or dress guidelines and wears ID badge. 5 4 3 2 1

Establishes good rapport with patient, families, and visitors respecting patients’ 5 4 3 2 1
rights to privacy and confidentiality of information.

Provides direction to patients, families and visitors in a courteous, precise 5 4 3 2 1

manner with a positive tone.

Establishes good rapport and working relationships with co-workers, other 5 4 3 2 1

nursing personnel, physicians, and supervisory staff.

Keeps working knowledge current and changes when the need arises.

Attends staff meetings on regular basis . 5 4 3 2 1

Attends in service education 2 hours per month. 5 4 3 2 1

Demonstrates understanding of emergency procedures, fire drills, evacuation 5 4 3 2 1

procedures and internal/external disaster plans and procedures.

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Professional Requirements: E G S NI U

Adheres to dress code, appearance is neat and clean. 5 4 3 2 1

Completes annual in service education requirements. 5 4 3 2 1

Maintains regulatory requirements, including all state and federal regulations. 5 4 3 2 1

Adheres to the Group I level of HIPAA Minimum Necessary Standard when 5 4 3 2 1
using, disclosing or requesting Protected Health Information (PHI).
Reports to work on time and as scheduled. 5 4 3 2 1

Wears identification while on duty. 5 4 3 2 1

Attends annual performance review 5 4 3 2 1

Works at maintaining a good rapport and a cooperative working relationship 5 4 3 2 1

with physicians, departments and staff.

Represents the organization in a positive and professional manner. 5 4 3 2 1

Attends committee, CQI and management meetings, as appropriate. 5 4 3 2 1

Resolves personnel concerns at the departmental level, utilizing the grievance 5 4 3 2 1

process as required.

Ensures compliance with policies and procedures regarding department 5 4 3 2 1

operations, fire, safety and infection control.

Effectively and consistently communicates administrative directive to personnel 5 4 3 2 1

and encourages interactive departmental meetings and discussions.

Complies with all organizational policies regarding ethical business practices. 5 4 3 2 1

Communicates the mission, ethics and goals of the facility, as well as the focus 5 4 3 2 1
statement of the department.

Total Points ___ ___ ___ ___ ___

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Education/Experience Requirements:

• Able to communicate effectively in English, both verbally and in writing.

• Self motivated and willingness to learn & be trained.

• Current CPR, ACLS, & PALS required within 1 year.

• Ability to work cooperatively with medical staff, patients and families.

Physical Demands:

• Able to lift up to but not limited to 40 lbs.

• For physical demands of position, including vision, hearing, repetitive motion and environment, see following
description.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential
functions of the position without compromising patient care.

=======================================================================================

I have received, read and understand the Position Description/Performance Evaluation above.

Name/Signature Date Signed

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 DESCRIPTION OF
PHYSICAL DEMANDS
JOB TITLE: Nursing Assistant DEPARTMENT: Nursing
NAME: # HOURS/WORKDAY: 8
DEVELOPED BY: DATE DEVELOPED: 1/7/05
MANAGER SIGNATURE: DATE:

CHECK APPROPRIATE BOX FOR EACH OF THE FOLLOWING ITEMS TO BEST DESCRIBE THE EXTENT OF THE SPECIFIC
ACTIVITY PERFORMED BY THE STAFF MEMBERS IN THIS POSITION

This job requires exposure to the following environmental conditions.

PHYSICAL DEMANDS Show the amount of time by checking the appropriate boxes below.
On-the-job time is spent in the following physical activities  Amount of Time 
Show the amount of time by checking the appropriate boxes below. None Up to 1/3 to 2/3 and
 Amount of Time  1/3 1/2 more
None up to 1/3 to 2/3 and Wet, humid conditions (non-weather): X
1/3 1/2 more Work near moving mechanical parts: X
Stand: X Fumes or airborne particles: X
Walk: X Toxic or caustic chemicals: X
Sit: X Outdoor weather conditions: X
Talk or hear: X Extreme cold (non-weather): X
Use hands to finger, handle or feel: X Extreme heat (non-weather): X
Push/Pull: X Risk of electrical shock: X
Stoop, kneel, crouch or crawl: X Work with explosives: X
Reach with hands and arms: X Risk of radiation: X
Taste or smell: X Vibration: X

This job requires that weight be lifted or force be exerted. Show how The typical noise level for the work environment is:
much and how often by checking the appropriate boxes below. Check all that apply.

Very Quiet
Loud Noise
 Amount of Time 
Quiet
Very Loud Noise
None up to 1/3 to 2/3 and x
Moderate Noise
1/3 1/2 more
Up to 10 pounds: X Hearing:
Up to 25 pounds: X x
Ability to hear alarms on equipment
Up to 50 pounds: X x
Ability to hear patient call
Up to 100 pounds: X x
Ability to hear instructions from physician/department staff
More than 100 pounds:
REPETITIVE MOTION ACTIONS
This job has special vision requirements. Check all that apply.  Number of Hours 
Repetitive use of foot control 0 1-2 3-4 5-6 7+
x
Close Vision (clear vision at 20 inches or less) A. Right only
x
Distance Vision (clear vision at 20 feet or more) B. Left Only
x
Color Vision (ability to identify and distinguish colors) C. Both X
x
Peripheral Vision (ability to observe an area that can Repetitive use of hands
be seen up and down or to the left and right while A. Right only
eyes are fixed on a given point)
B. Left Only
x
Depth Perception (three-dimensional vision; ability
C. Both X
to judge distances and spatial relationships)
x
Ability to Adjust Focus (ability to adjust eye to Grasping: simple/light
bring an object into sharp focus) A. Right only

No Special Vision Requirements B. Left Only
C. Both X
Specific demands not listed: ________________________________ Grasping: firm/heavy
_______________________________________________________ A. Right only
_______________________________________________________ B. Left Only
C. Both X
_______________________________________________________
Fine Dexterity
_______________________________________________________ A. Right only
_______________________________________________________ B. Left Only
C. Both X
Note: Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions of
this position.

WORK ENVIRONMENT
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 PERFORMANCE EVALUATION CONTINUATION PAGE

Staff Member: ___________________________________ Job Title: ________________________

Performance Evaluation Score:

# of total points achieved 240 – 152 points = Excellent 100% merit increase
151 – 144 = Good 100% merit increase
___________ 143 – 96 = Satisfactory 75% merit increase
95 – 48 = Needs Improvement 50% merit increase
47 – 0 = Unacceptable 25% merit increase

Supervisors’ Comments:

Recommended Goals/Actions:

Staff Member Comments:

Actions Recommended by Supervisor: Current Wage: _____________ New Wage: __________

Performance Review Only
Cost of Living Increase: __________

Next Performance Review on: __________
Salary Increase: __________

Acknowledgement of Job Description
Total Increase: __________

Salary Increase Denied

____________________________________________ __________________________
Staff Member Signature Date

____________________________________________ __________________________
Supervisor Signature Date

____________________________________________ __________________________
Administrative Signature Date

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 PERSONNEL MEMBER
ANNUAL PROFESSIONAL PERFORMANCE AND COMPETENCY EVALUATION

As a member of our facilities personnel team, your comments and input are important to both our
continuing development and quality provision of patient care and services. Your continued professional
growth and job satisfaction are primary goals of the hospital. The administrative team and your
department supervisor are interested in your comments regarding the following:
1 - 5
(1 = poor, 5 = excellent)

1. How would you rate your current job satisfaction level?

2. How would you rate your current job performance?

3. How would you rate the organization’s provision of personnel benefits?

4. How would you rate the organization’s provisions for personnel continuing education?

5. How would you rate the organization’s physical working environment?

6. How would you rate the organization’s emotional working environment?

7. List your professional goals:

8. List any departmental goals that may differ from professional goals (include educational and
performance goals):

9. Is there anything the organization can do to help you achieve any of these goals?

10. If so, please describe:

11. Comments you feel may assist the organization with improving personnel satisfaction levels:

Note: This organization pledges to utilize information provided for the sole purpose of improving
personnel satisfaction and assisting the author with achievement of advanced personal and/or
professional growth.