Placement HS Evaluation Survey

The following survey has been developed to assist in evaluating the clinical placement that you provided through the program.

The survey should take 5 minutes to complete.

The responses to this survey may form part of the evaluation of the program, however, the data will be reported as a group response and will not be individually identified.

Thank you for your participation in this survey.
Kylie Martin
Maternity Connect Program Manager

	Strongly disagree	Disagree	Agree	Strongly agree
Had formulated their learning objectives	Had formulated their learning objectives Strongly disagree	Had formulated their learning objectives Disagree	Had formulated their learning objectives Agree	Had formulated their learning objectives Strongly agree
Had read the orientation information that had been sent prior to placement	Had read the orientation information that had been sent prior to placement Strongly disagree	Had read the orientation information that had been sent prior to placement Disagree	Had read the orientation information that had been sent prior to placement Agree	Had read the orientation information that had been sent prior to placement Strongly agree
Understood their role as a midwife/nurse in a different organisation	Understood their role as a midwife/nurse in a different organisation Strongly disagree	Understood their role as a midwife/nurse in a different organisation Disagree	Understood their role as a midwife/nurse in a different organisation Agree	Understood their role as a midwife/nurse in a different organisation Strongly agree

Strongly disagree

Disagree

Agree

Strongly agree

Had formulated their learning objectives

Had formulated their learning objectives Strongly disagree

Had formulated their learning objectives Disagree

Had formulated their learning objectives Agree

Had formulated their learning objectives Strongly agree

Had read the orientation information that had been sent prior to placement

Had read the orientation information that had been sent prior to placement Strongly disagree

Had read the orientation information that had been sent prior to placement Disagree

Had read the orientation information that had been sent prior to placement Agree

Had read the orientation information that had been sent prior to placement Strongly agree

Understood their role as a midwife/nurse in a different organisation

Understood their role as a midwife/nurse in a different organisation Strongly disagree

Understood their role as a midwife/nurse in a different organisation Disagree

Understood their role as a midwife/nurse in a different organisation Agree

Understood their role as a midwife/nurse in a different organisation Strongly agree

	Strongly disagree	Disagree	Agree	Strongly Agree
Was enthusiastic and willing to learn	Was enthusiastic and willing to learn Strongly disagree	Was enthusiastic and willing to learn Disagree	Was enthusiastic and willing to learn Agree	Was enthusiastic and willing to learn Strongly Agree
Achieved their learning objectives	Achieved their learning objectives Strongly disagree	Achieved their learning objectives Disagree	Achieved their learning objectives Agree	Achieved their learning objectives Strongly Agree
Performed at a competent level for their years of experience	Performed at a competent level for their years of experience Strongly disagree	Performed at a competent level for their years of experience Disagree	Performed at a competent level for their years of experience Agree	Performed at a competent level for their years of experience Strongly Agree
Required considerable time to feel comfortable with the new environment	Required considerable time to feel comfortable with the new environment Strongly disagree	Required considerable time to feel comfortable with the new environment Disagree	Required considerable time to feel comfortable with the new environment Agree	Required considerable time to feel comfortable with the new environment Strongly Agree

Strongly disagree

Disagree

Agree

Strongly Agree

Was enthusiastic and willing to learn

Was enthusiastic and willing to learn Strongly disagree

Was enthusiastic and willing to learn Disagree

Was enthusiastic and willing to learn Agree

Was enthusiastic and willing to learn Strongly Agree

Achieved their learning objectives

Achieved their learning objectives Strongly disagree

Achieved their learning objectives Disagree

Achieved their learning objectives Agree

Achieved their learning objectives Strongly Agree

Performed at a competent level for their years of experience

Performed at a competent level for their years of experience Strongly disagree

Performed at a competent level for their years of experience Disagree

Performed at a competent level for their years of experience Agree

Performed at a competent level for their years of experience Strongly Agree

Required considerable time to feel comfortable with the new environment

Required considerable time to feel comfortable with the new environment Strongly disagree

Required considerable time to feel comfortable with the new environment Disagree

Required considerable time to feel comfortable with the new environment Agree

Required considerable time to feel comfortable with the new environment Strongly Agree

	Strongly disagree	Disagree	Agree	Strongly agree
Prior to placement	Prior to placement Strongly disagree	Prior to placement Disagree	Prior to placement Agree	Prior to placement Strongly agree
During placement	During placement Strongly disagree	During placement Disagree	During placement Agree	During placement Strongly agree
Following placement	Following placement Strongly disagree	Following placement Disagree	Following placement Agree	Following placement Strongly agree

Strongly disagree

Disagree

Agree

Strongly agree

Prior to placement

Prior to placement Strongly disagree

Prior to placement Disagree

Prior to placement Agree

Prior to placement Strongly agree

During placement

During placement Strongly disagree

During placement Disagree

During placement Agree

During placement Strongly agree

Following placement

Following placement Strongly disagree

Following placement Disagree

Following placement Agree

Following placement Strongly agree

Placement HS Evaluation Survey

Question Title

* 1. Name of your Health Service

Question Title

* 2. Midwife/Nurse's Name (that completed MCP)

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* 3. The midwife/nurse was prepared for the clinical placement.

Question Title

* 4. The midwife/nurse:

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* 5. Orientation was provided by:

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* 6. Did an educator meet with the midwife/nurse on every shift to determine if their learning needs were being met?

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* 7. Did the Clinical Support Partnership work effectively?

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* 8. Do you feel that you understood the requirements for the midwife/nurse in the program?

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* 9. Are there any improvements, suggestions or comments you would like to make about the program?