Please fill in all fields.

Select your response under the appropriate heading. Use the following scale as a guide:

5 = Very Effective
4 = Effective
3 = Uncertain
2 = Ineffective
1 = Poor

A. How effective was the independant study (video & handbook ) in helping you to understand the following:

• 1. The underlying goals of the Georgia Southern University School of Nursing preceptor course.  *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 2. Your role as a preceptor.  *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 3. The role of the preceptee (student). *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 4. The role of the faculty liaison. *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 5. What is expected of the student in terms of incorporating management theory in the clinical setting. 5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 6. How to handle conflict if it occurs in the preceptor/preceptee relationship.  *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 7. The preceptors role in evaluating the students clinical performance.  *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor
• 8. Your legal and educational responsibilities. *5 = Very Effective4 = Effective3 = Uncertain2 = Ineffective1 = Poor

• B. The teaching/learning methods used were useful *

  YesNoNo Opinion

C. Short Answers

• 1. List any questions that you have that were not answered in the video or the Preceptor Handbook. *
• 2. List any changes you would like to see in the independant study. *
• 3. Please list any additional comments or enter "none" in the text field. *

D. After completing the preceptor training independent study and reading the Preceptor Handbook, do you feel adequately prepared to begin your role as a Preceptor? YesNoNo Opinion

SIGN-IN INFORMATION FOR GNA CONTACT HOURS Approved by the Georgia Nurses' Assocation for 3.0 hours*

• Name for Certificate *
• Home Address *
• City *
• State *
• Zip *
• Phone *
• Title *
• Organization

* Note for preceptors who would like Contact Hours: Contact Hours can be only awarded if the completed sign-in and evaluation forms are submitted.