Thompson Health Associate Services

ANNUAL SELF-ASSESSMENT FORM

ASSOCIATE NAME:Alice Brocklebank CURRENT JOB TITLE:OB RN

DATE OF LAST EVALUATION:2013DATE OF THIS EVALUATION: 3/25/14

EVALUATOR’S NAME & TITLE:

This form is to be completed by an Associate after considering the supervisor’s comments from the previous review (if applicable), personal career goals, and the department’s strategic goals. Please feel free to use additional space or pages as necessary.

1. List goals that were established in your last review stating whether or not they have been met. If not completed, comment on progress to date.

Become more comfortable with sick babies - done

Take part in simulations - done

2. List additional accomplishments during the last review period that were beyond the established goals.

Trained as a SANE nurse for the ED

1. Comment on how your job has changed over the last review period.

Very busy!! Night nurses have really helped me to become independent by letting me take the reins in the nursery but always being there to help.

1. Indicate where you have made the most progress in your work this year.

I have become independent in the nursery, managing sick babies, starting IVs and drawing blood.

I have managed some emergent OB situations with good results.

5.Where do you think you need to/would like to make any improvements during the upcoming year?

Will be doing the NRP testing this year, and fetal monitoring certification next year

1. How do you plan to make these improvements?
   

Study group for NRP to get ready for the online exam, Deb’s review class for EFM certification

1. List and/or attach any process improvements (DIGs, JDIs, Focused Studies, etc.) and recognitions sent and received (Cheers for Peers, Drops for Your Bucket) during the last review period.
   
2. Do you have any ideas for process improvements (DIGs, JDIs, etc.) for the next year? Do you know of an Associate who should be recognized with a Cheer for Peer or Drop for Your Bucket or a department that deserves a RANSAC?

1. What suggestions do you have as to how your supervisors, co-workers, and/or others can support you in your present job and with future career goals?

1. List 3-5 goalsthat you propose for the coming year.

More simulations (NRP and Code Green)

EFM certification

1. Please indicate any other specific areas that you wish to discuss during your performance assessment meeting.

L:\Forms\Annual Self Assessment Form.doc12/25/2018