Performance Review Template Practice Nurse

Template
V3 / July 2020
Performance Review
Practice Nurse
This template is designed to be used together with the Practice Nurse Position Description template, which
outlines the responsibilities and requirements of the role.
Information for the reviewer

Before the performance review, ask the employee to complete the different sections in this document and
return it to you at least two days before the review.
During the review, use this document to record:

• how the employee thinks they have performed against each of their key responsibilities
• feedback or concerns from the employee
• the employee’s career goals for the future
• the goals that you and the employee agree on for the next performance cycle and the support that you will
provide to help the employee achieve their goals (e.g. training).
Information for the employee

Before your performance review, complete the different sections in this document and return it to the reviewer
at least two days before your review.
During your review, you will be able to:

• reflect on your work during the performance cycle
• receive appreciation and recognition for your achievements
• raise problems and resolve issues arising from your work
• discuss your hopes and expectations for the next performance cycle
• set your career goals for the future
• discuss training and development opportunities to improve your performance and further your career.
Page 1 of 6
Template
V3 / July 2020
Practice Nurse performance review
Employee name:
Position responsible to:
Positions with direct responsibility to this position:
Date of this review:
Reviewer name:
Measuring performance against your position description

Practice Nurse position description Employee Reviewer Comments
rating rating
(out of 10) (out of 10)
Key responsibilities – clinical nurse care

• Provide proficient, evidence-based chronic
disease management.
• Conduct preventative screening.
• Demonstrate organisational values including
respect, dignity and cultural safety.
• Plan and manage holistic patient care in
consultation with medical staff while acting as
patient advocate.
• Liaise with hospitals, community agencies
and allied health to coordinate patient care.
• Share innovative practice and work as an
integrated team.
Key responsibilities – general practice environment
• Maintain accurate documentation using
clinical software including recall/reminder
systems, IT and information management.
• Apply knowledge of funding models to deliver
optimal care.
• Implement general practice management
plans and team care arrangements in
consultation with GPs and the
multidisciplinary team.
• Demonstrate understanding of workplace
health and safety principles.
• Ensure quality systems are in place and
reviewed regularly.
• Manage supplies and clinical resources within
budget.
• Ensure clinical governance and safe use of
medicines following federal/state legislation.
Page 2 of 6
Template
V3 / July 2020
Key responsibilities – collaborative practice

• Work as a collaborative member of the
multidisciplinary team, reflecting the values of
the organisation.
• Work as an inclusive member of the clinical
team, providing appropriate mentoring and
guidance for registrars, medical and nurse
students.
• Demonstrate a high level of team work,
support, engagement and communication with
the general practice nursing team.
• Work on quality improvement strategies with
the practice team to bring efficiencies to
practice systems, procedures and clinical
outcomes.
Key responsibilities – professional practice
• Maintain awareness of current legislation to
ensure compliance with all statutory and
regulatory obligations.
• Ensure care is evidence-based and delivered
using clinical guidelines and practice to
underpin competency.
• Use health literacy principles to lead patient
education, community health and outreach
programs as well as health promotion
initiatives.
• Practice within the organisation’s policy and
nursing standards and codes.
• Undertake continuing professional
development.
• Review systems and procedures to ensure
efficient and accessible care.
• Utilise practice data to identify areas for
quality improvement.
• Provide leadership to the nursing team and
other staff.
• Provide direct and indirect supervision, and
mentoring, to ENs within the organisation.
Page 3 of 6
Template
V3 / July 2020
Documentation review Yes No

Evidence of current registration with the Nursing and Midwifery Board of Australia
Evidence of current medical indemnity cover or be eligible for such
Evidence of training in CPR undertaken within the past three years or as otherwise
required by the Nursing and Midwifery Board of Australia
Evidence of a current criminal record screening
Evidence of a current Western Australian Driver’s Licence
Evidence of a current Working with Children Check
Overall performance
Your achievements:
What achievements have given you the greatest satisfaction? How could they be built on?
Your challenges:
What challenges have you experienced? How could they be overcome?
Your obstacles:
Were there any obstacles that prevented you from achieving your goals? How could they be eliminated?
Your job description:

Is your job description still current?
Page 4 of 6
Template
V3 / July 2020
Your opportunities for improvement:

To improve your overall performance, what could be done by management, yourself or others?
Your goals:
What are your goals for the next performance cycle?
Your career:
How do you see your career developing?
How would you rate your overall performance?
1________________ 2________________ 3________________ 4________________ 5________________

Not satisfactory Average Very satisfactory
Professional learning and development plan
Goal/s Action required Date for completion
Additional training needs Reason Comments
Page 5 of 6
Template
V3 / July 2020
Skills to be developed (select as preferred) Attendance Future attendance

Clinical software training
Customer service training and dealing with difficult patients
Infection control and pandemic
Sterilisation
CPR course
MBS item numbers
Cold chain/vaccine management
Wound management
Triage and emergencies
Recall and reminder systems
Pen Clinical Audit Tool
Immunisation
Other
Employee’s comments
Reviewer’s comments
Performance review discussed and accepted

Employee name:
Signature: Date:
Reviewer name:
Signature: Date:
Page 6 of 6

Performance Review Template Practice Nurse

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Information for the reviewer

During the review, use this document to record:

Information for the employee

During your review, you will be able to:

Measuring performance against your position description

Key responsibilities – clinical nurse care

Key responsibilities – collaborative practice

Documentation review Yes No

Your job description:

Your opportunities for improvement:

How would you rate your overall performance?

1 2 3 4 5

Professional learning and development plan

Goal/s Action required Date for completion

Additional training needs Reason Comments

Skills to be developed (select as preferred) Attendance Future attendance

Performance review discussed and accepted

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