Your First Name:  (office use only)

Email:  (office use only, no evaluations will not be posted without an email address for my reference)

Evaluation Hospital Name: 

Hospital Location: 

Evaluation Floor: 

Hospital and unit size as stated.  Yes No

Hospital was clean and well maintained.  Yes No

Physicians treat the nurses with respect and are available when necessary.  Yes No

Continuing Educational opportunities were made available.  Yes No

Ancillary departments were helpful.  Yes No

Dietary department was flexible in providing for special request.  Yes No

Medications were available within a reasonable amount of time.  Yes No

Equipment was available within a reasonable amount of time.  Yes No

Nursing manager was good resource.  Yes No

Other professional nurses were friendly and helpful.  Yes No

Nursing assistants were readily available and adequately helped.  Yes No

Effective communication between caregivers.  Yes No

Patients were properly identified and the identifications were used.  Yes No

Sterile procedure was effectively used as needed.  Yes No

Isolation precautions were used effectively.  Yes No

Nurses were floated only to areas of competency.  Yes No

Facility perceived to be "traveler friendly."  Yes No

Safe nurse to patient ratios are observed.  Yes No

• Operating Room 1:1
• Recovery 1:2
• Intensive Care 1:2
• Emergency  1:4
• Step-Down  1:4
• Telemetry  1:5
• Medical Surgical  1:6
• Psychiatric  1:6

(use your own judgment for other areas)

Concern for patient safety is top priority.  Yes No

I never felt like my license was in danger.  (if you felt like your license was in danger then check no)  Yes No