SASED CERTIFIED SCHOOL NURSE POST OBSERVATION FEEDBACK FORM DOMAIN 1: PLANNING AND PREPARATION. Conference Date

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1 DOMAIN 1: PLANNING AND PREPARATION Nurse Conference Date COMPONENTS UNSATISFACTORY BASIC PROFICIENT DISTINGUISHED 1a. School Nursing School Nurse displays little understanding of prerequisite knowledge important for students medical needs and of team issues; she does not have good knowledge of special education. School Nurse displays basic content knowledge of prerequisite learning and pedagogical knowledge, but knowledge is incomplete or inaccurate. School Nurse displays solid content knowledge, planning reflects understanding of relationships and team practices reflect current research on best practices. School Nurse displays extensive content knowledge, actively builds on knowledge of prerequisite relationships, and displays continuing search for best practice. 1b. Students School Nurse displays minimal knowledge of developmental characteristics of age group and is unfamiliar with learning styles, students skills and knowledge, cultural heritage and interests. School Nurse has knowledge of developmental characteristics and general understanding of learning styles while recognizing the value of knowing students skills, interests and cultural heritage. School Nurse displays knowledge of students developmental characteristics, skills, interests and cultural heritage and varies his/her approaches in instruction and planning when appropriate. School Nurse consistently demonstrates and implements knowledge of all appropriate issues regarding the growth, development and instruction of the population served. 1c. Resources School Nurse has limited knowledge of resources available in the community. School Nurse displays awareness of local resources available to teachers, students and families. School Nurse displays awareness of, utilizes, and recommends resources available within the community to teachers, students, and families. School Nurse utilizes and promotes local and state resources and services. School Nurse anticipates requests for preventative and proactive resources and coordinates utilization of resources with teachers, students, and families.

2 DOMAIN 1: PLANNING AND PREPARATION 1d. Local, State, and Federal Policies and Regulations School Nurse displays little understanding of local, state and Federal regulations and policies and/or does not utilize the information. School Nurse displays basic understanding of local, state, and Federal regulations and policies and can adequately utilize the information. School Nurse displays an in-depth understanding of local, state, and Federal regulations and policies. The information is utilized and/or presented in a meaningful and sensitive manner. School Nurse consistently implements, and can clearly explain, local, state, and Federal regulations and policies. The information is utilized and/or presented in a meaningful and sensitive manner. 1e. Characteristics of Students with Exceptionalities School Nurse displays little understanding of the characteristics related to specific disability areas. School Nurse displays basic understanding of the characteristics related to specific disability areas. School Nurse displays an in-depth understanding of the characteristics related to specific disability areas and the effects of cultural and environmental milieu on student and family. School Nurse displays an extensive knowledge of the characteristics related to specific disability areas and the effects of cultural and environmental milieu on student and family. School Nurse teaches about and/or explains such characteristics to others. 1f. Developing Intervention Plans/Goals School Nurse s plans/goals are inappropriate to needs or are unsuitable for students in an educational setting with no student and/or family collaboration and are not measurable. School Nurse s plans/goals are of moderate value, appropriate to an educational setting with limited student and/or family collaboration. Some goals permit viable methods of assessment. School Nurse s plans/goals are of considerable value, appropriate to an educational setting and represent consistent student and/or family collaboration. They provide opportunities for insight and permit viable methods of assessment. School Nurse s plans/goals maximize student growth, and are appropriate to the educational setting, which represents highly effective student and/or family collaboration. Plans/goals encourage opportunities for insight and permits viable methods of assessment. 2

3 DOMAIN 2: HEALTH SERVICES - COLLABORATIVE CONSULTATION ENVIRONMENT COMPONENTS UNSATISFACTORY BASIC PROFICIENT DISTINGUISHED 2a. Collaborating with Students, Parents, School Personnel and Community Agencies School Nurse displays little ability to collaborate with students, parents, school personnel and community agencies. Confidentiality is not adhered to. School Nurse displays basic ability to collaborate with students, parents, school personnel and community agencies; confidentiality is observed. School Nurse is skillful in collaborating with students, parents, school personnel and community agencies while maintaining student confidentiality. School Nurse can identify resources for parents and school personnel. School Nurse is skillful and reflective in collaborating with students, parents, school personnel and community agencies, and maintains student confidentiality. School Nurse acts as a resource for parents and colleagues. 2b. Collaborative Consultation Skills and Creative Problem Solving School Nurse displays little knowledge of collaborative consultation skills and creative problem solving. School Nurse displays basic knowledge of collaborative consultation skills and creative problem solving. School Nurse displays an in-depth knowledge of collaborative consultation skills and creative problem solving. School Nurse reviews, evaluates, and reflects on his/her knowledge of collaborative consultation skills and creative problem solving. 2c. Applying an Inter- Disciplinary Approach to Evaluation and IEP/504 Plan Development School Nurse displays little ability to collaborate with parents, colleagues, and other individuals representing a wide variety of agencies/interests in developing evaluations and IEPs/504 Plans. School Nurse displays basic ability to collaborate with parents, colleagues, and other individuals representing a wide variety of agencies/interests in developing evaluations and IEPs/504 Plans. School Nurse is skillful in collaborating with parents, colleagues, and other individuals representing a wide variety of agencies/interests in developing evaluations and IEPs/504 Plans. School Nurse collaborates effectively with parents, colleagues, and other individuals representing a wide variety of agencies/interests in developing evaluations and IEPs/504 Plans. School Nurse is analytical and reflective of the input from these disciplines. 3

4 DOMAIN 2: HEALTH SERVICES - COLLABORATIVE CONSULTATION ENVIRONMENT 2d. Managing the School Health Services Materials and supplies are handled inefficiently. School Nurse is aware of components for program services but lacks priority. School Nurse makes little attempt to oversee the Medical/Teaching Assistant. Routines for handling materials and supplies function moderately well. School Nurse implements required programs and usually oversees the Medical/Teaching Assistant in assigned tasks within the realm of qualifications. Routines for handling materials and supplies are smooth with little loss of time. School Nurse implements all required programs, updates policies/procedures as needed, and oversees the Medical/Teaching Assistant effectively. Routines for handling materials and supplies are seamless. School Nurse is knowledgeable of current trends and prioritizes needs and programs as appropriate. School Nurse is superior in managing his/her duties and overseeing the Medical/Teaching Assistant. 2e. Managing Student Behavior Standards of conduct have not been established. School Nurse does not monitor student behavior. Standards of conduct have been established and understood. School Nurse is generally aware of student behavior but may miss the activities of some students. Clear standards of conduct have been established and School Nurse is alert to student behavior at all times. Standards of conduct are clear and situations requiring flexibility and individual expectations are handled well. School Nurse is highly responsive to individual needs. 2f. Establishing appropriate goals for the nursing needs of the individual program. The School Nurse uses resources poorly and is not knowledgeable about equipment leaving classrooms and health office (where appropriate) unsafe. The School Nurse uses resources adequately however, has limited effectiveness. The School Nurse has difficulty with understanding appropriate equipment for the needs of individual students and health office (where appropriate.) The School Nurse will use appropriate resources and provide needed equipment both in classrooms and the health office (where appropriate) to keep students and staff safe. The School Nurse anticipates and plans for the needs of the classroom and health office (where appropriate), making sure that equipment is safe and in working order. 4

5 DOMAIN 3: SCHOOL HEALTH PROGRAMS, SUPPORTS, SERVICES COMPONENTS UNSATISFACTORY BASIC PROFICIENT DISTINGUISHED 3a. Communicating Effectively School Nurse does not utilize process skills (i.e. empathy, genuineness, and warmth) necessary for establishing cooperation, trust, and rapport. Communication is unclear or inaccurate. Directions and procedures are confusing. School Nurse uses process skill when communicating and collaborating to encourage cooperation. Directions and procedures are clear and accurate in communications with students, family and school community. School Nurse uses process skill effectively, resulting in a marked degree of cooperation in communicating and collaborating. School Nurse uses a variety of communication methods and directions and procedures are clear with appropriate details. School Nurse is highly proficient in the use of process skills, resulting in a degree of cooperation in communicating and collaborating that allows for exploration of other concerns in greater depth. Directions and procedures are clear and accurate and School Nurse anticipates possible misunderstandings by using a variety of communication method. 3b. Developing and Implementing Health Plans School Nurse displays little ability to develop and implement health plans (i.e. 504, emergency plans, etc.). School Nurse displays basic ability to develop and implement health plans. School Nurse is skillful and competent in developing and implementing health plans according to the needs and characteristics of the student. School Nurse is skillful and reflective in developing and implementing health plans according to the needs and characteristics of the student. School Nurse shares ideas with colleagues. 3c. Promoting the Health Services Program School Nurse does not attempt to acquaint students, family, or school community of the health services program. School Nurse attempts to acquaint students, family, and school community of the health services program, as well as be a resource for program services. School Nurse continually presents new information to promote the health services program. School Nurse consistently uses creative ways to engage students, family, and school community in the health services program. 5

6 DOMAIN 3: SCHOOL HEALTH PROGRAMS, SUPPORTS, SERVICES 3d. Flexibility and Responsiveness School Nurse adheres to intervention plan in spite of student s participation level, does not set appropriate service priorities, and assumes no responsibility for providing services when space, student availability and equipment is not optimal. School Nurse demonstrates moderate responsiveness to students needs and interests, inconsistently sets appropriate service priorities, and is somewhat flexible in providing services given the constraints of the school environment. School Nurse adjusts intervention plan to be responsive to student s needs and interests, consistently sets appropriate service priorities, and is flexible and persistent in providing services given the constraints of the school environment. School Nurse is consistently responsive to student s needs and interests, sets appropriate services priorities and demonstrates creativity and persistence in providing services given the constraints of the school environment. 3e. Involvement in Building and Departmental Teams School Nurse does not participate in or attend team meetings when required. Participation at meetings undermines team process/climate. School Nurse participates in team meetings, but may need some supervision and direction about participation. School Nurse participates actively, consistently, and constructively in team meetings. School Nurse attends team meetings; anticipates and plans for team needs through staff education and providing appropriate information for staff regarding individual student needs.. 3f. Providing Consultation to Staff School Nurse does not understand staff concerns, does not provide timely, useful or practical strategies, and fails to evaluate implementation and effectiveness of consultation. School Nurse demonstrates basic understanding of staff needs. School Nurse collects information about interventions in a timely manner that allows program adjustment as needed. School Nurse demonstrates a thorough understanding of staff needs, facilitates the development of clear and concise strategies that are timely and effective. School Nurse integrates evaluation with the design of the consultation so that data collection and program adjustment are ongoing processes. Staff actively seeks the involvement of the School Nurse in solving problems. School Nurse facilitates data collection that permits staff to make ongoing evaluation and necessary modifications. Consultation is ongoing. 6

7 DOMAIN 4: PROFESSIONAL RESPONSIBILITIES COMPONENTS UNSATISFACTORY BASIC PROFICIENT DISTINGUISHED 4a. Reflecting on Intervention School Nurse does not reflect on the effectiveness of the intervention or propose ideas as to how it may be improved. School Nurse s reflection on the intervention is generally accurate and global suggestions as to how it might be improved are offered. School Nurse reflects accurately on intervention, citing general impact and makes specific suggestions about how it might be improved. School Nurse s reflection on the intervention is highly accurate and perceptive. School Nurse draws on extensive knowledge and experience to assess and suggest alternative interventions. 4b. Decision Making School Nurse is not alert to student s needs, which contribute to practices that result in some students being ill served. School Nurse makes decisions based on limited consideration or unsupported by data. School Nurse s attempts to serve students are based on best information but may be inconsistent. Decisions are data driven and reflect student needs. School Nurse makes genuine and successful efforts to ensure that all students are well served. Decisionmaking is guided by best practice and interest of the student and decisions consistently show good judgment. School Nurse participates in team decisionmaking. School Nurse takes a leadership role in team decision-making, setting high standards. School Nurse is highly proactive in helping ensure that all students are served. 4c. Maintaining Accurate Records School Nurse does not keep up-todate health information on all students in the building. Records are unavailable or documentation is not completed in a timely manner. School Nurse usually keeps up-to-date health information on all students in the building. Most documentation records and reports are available and done in a timely manner. School Nurse is proficient at keeping upto-date health information on all students and reviews new students records in a timely manner. Parents are notified within state s time frame regarding students who are behind schedule for immunizations, if indicated. Data is easily retrievable. School Nurse is outstanding in keeping upto-date health information on all students and will contact parents readily to clarify any inconsistencies; all students have immunizations current or a waiver in place, if indicated. School Nurse consistently evaluates and updates policies and procedures related to management of health records and procedures. 7

8 DOMAIN 4: PROFESSIONAL RESPONSIBILITIES 4d. Complying with Procedural Guidelines School Nurse repeatedly disregards timelines or fails to adhere to procedural safeguards. School Nurse is attentive to timelines and adheres to procedural safeguards. School Nurse works with school-based teams and parents to ensure that all procedural safeguards are consistently followed. School Nurse conducts training with school staff to ensure understanding, collaboration and compliance with timelines and procedural safeguards. 4e. Communicating with Families School Nurse provides little information, does not show respect and understanding to parents on the phone or when picking up ill/injured students, avoids parent contact. School Nurse communicates but offers little information. Interactions with parents are respectful but School Nurse may need some assistance with difficult situations. School Nurse provides frequent information and interactions with parents are respectful and friendly. School Nurse can usually handle very difficult situations without assistance. School Nurse provides frequent information and treats parents with respect and empathy. School Nurse is outstanding in handling difficult situations with parents and facilitates the best interest of students. 4f. Contributing to SASED Peer Relationships School Nurse does not become involved in SASED committees, events or projects. School Nurse s relationships with colleagues are negative and/or self-serving. School Nurse participates in SASED committees, events or projects when specifically requested. School Nurse s relationships are cordial and professional. School Nurse participates actively in SASED committees, events or projects. School Nurse maintains positive relationships with colleagues. School Nurse makes a substantial contribution to SASED. School Nurse assumes a leadership role with colleagues and participates in team/department decision-making. 4g. Growing and Developing Professionally School Nurse does not participate in professional development activities, even when the activities are clearly necessary for the development of special educator skills. School Nurse s participation in professional development activities is limited to attendance at required activities. School Nurse participates actively in a variety of professional development activities and utilizes the new skills/information appropriately. School Nurse makes a substantial contribution to SASED and the profession through such activities as action research, supporting new staff, and actively pursues professional development. 8

9 Nurse s Comments: My signature indicates that I have read the evidence and comments, participated in a Pre and Post Observation Conference and received a copy of the rubric. It does not mean that I am in agreement. Nurse s Signature Date Administrator s Signature Date 9

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