UTMB SCHOOL OF NURSING
Student Professionalism Survey

All employees of the University of Texas Medical Branch are held to the highest standards of professional behavior. Students are evaluated on professional behavior in all classroom, laboratory, and patient care interactions. This evaluation form asks for your OVERALL perceptions of the professional behavior of faculty.

Please complete this evaluation on the clinical instructors and/or course faculty with whom you have had meaningful contact during your time as a student in the School of Nursing. Please DO NOT identify yourself or the persons you are evaluating on this form.

Please provide the following information:

PROGRAM

Nurse Practitioner
Nurse Midwifery
Baccalaureate Nursing
Nursing Doctoral
Flexible Option Track

OVERALL perception of faculty

	Consistently	Frequently	Occasionally	Never	Not Applicable
1. Faculty input is valued at the SON.
2. Faculty are treated with respect and courtesy.
3. I observed my clinical instructor making derogatory statements about other nurses, nurses' aides or other healthcare professionals.
4. I observed my clinical instructor making derogatory statements about a patient or a patient's family.
5. I observed my clinical instructor inappropriately withholding or intentionally giving incorrect information to a patient, family member or other member of the healthcare team.
6. I observed my clinical instructor using derogatory terminology / inappropriate language in professional settings.
7. I observed my clinical instructor discussing confidential information in an inappropriate setting.
8. I observed my clinical instructor treating a patient differently because of the patient's socioeconomic background, race, ethnicity, religion or sexual preference.
9. I observed my clinical instructor /faculty treating students in a disrespectful or demeaning manner.
10. I observed my clinical instructor/course faculty treating other healthcare professionals in a disrespectful or demeaning manner.
11. I observed my clinical instructor/course faculty being unwilling to take responsibility for a personal error.
12. I observed my clinical instructor/course faculty being unaware, unable or unwilling to admit to a lack of knowledge during times of uncertainty.
13. I observed my clinical instructor indiscriminately using costly and limited supplies and resources carelessly.
14. I observed my supervising clinical instructor/ course faculty acting as a role model for professionalism.

Please provide examples of the following:

1. Exemplary professional behaviors that you have observed demonstrated by faculty.

2. Behaviors that you considered unprofessional by faculty.

OVERALL perception of Students

This is also an opportunity for you to speak to the behaviors of your peers (other students).

1. Exemplary professional behaviors that you have observed demonstrated by other students.

2. Behaviors that you considered unprofessional by other students.

OVERALL PERCEPTION of Staff

1. Please describe any exemplary professional behaviors that you have observed being demonstrated by staff:

2. Please describe any behaviors that you considered unprofessional by staff:

PLEASE CHECK 5 (FIVE) WORDS WHICH, IN YOUR PERCEPTION, BEST EXEMPLIFY PROFESSIONALISM:

Respect
Honesty
Courtesy
Fairness
Optimism

Accountability
Compassion
Integrity
Empathy
Competence

	Consistently	Frequently	Occasionally	Never	Not Applicable
1. Students' input is valued in the SON.
2. Students are treated with respect and courtesy by other students.
3. I observed a student making derogatory statements about others in professional settings.
4. I observed a student using derogatory terminology / inappropriate language in professional settings.
5. I observed a student discussing confidential information in an inappropriate setting.
6. I observed a student treating a person differently because of socioeconomic background, race, ethnicity, religion or sexual preference.
7. I observed a student treating others in a disrespectful or demeaning manner.
8. I observed a student being unwilling to take responsibility for a personal error.
9. I observed a student acting as a role model for professionalism.

	Consistently	Frequently	Occasionally	Never	Not Applicable
1. Staff's input is valued in the SON.
2. Staff is treated with respect and courtesy.
3. I observed a staff member making derogatory statements about others in professional settings.
4. I observed a staff member using derogatory terminology / inappropriate language in professional settings.
5. I observed a staff member discussing confidential information in an inappropriate setting.
6. I observed a staff member treating a person differently because of socioeconomic background, race, ethnicity, religion or sexual preference.
7. I observed a staff member treating others in a disrespectful or demeaning manner.
8. I observed a staff member being unwilling to take responsibility for a personal error.
9. I observed a staff member acting as a role model for professionalism.

UTMB SCHOOL OF NURSING Student Professionalism Survey