Nephrology Fellow 360 Evaluation Form Dialysis Nurses

Nephrology Fellow 360º Evaluation Form

Dialysis Nurses

Fellow’s Name _________________________________________

Date ___________________________________

Please circle the number to the right of the statement that you think best characterizes the fellow’s behavior.

 Communicates effectively with patients, families and healthcare personnel

1 2 3 4 5

 Maintains a compassionate and respectful relationship with patients and their families; responds to their needs

1 2 3 4 5

 Counsels and educates patients and their families

1 2 3 4 5

 Responds to pages within 5 minutes

1 2 3 4 5

 Works cooperatively, collaboratively and respectfully with other members of the healthcare team

1 2 3 4 5

 Maintains a professional appearance and demeanor

1 2 3 4 5

 Demonstrates commitment to ethical principles in providing or withholding care, confidentiality of patient information,

informed consent and business practices

1 2 3 4 5

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Parent category: Medical