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RN Supervisor

RN Supervisor

  • Date Format: MM slash DD slash YYYY
  • Self-Assessment Rating Scale:

    No Experience
    Theory or observation only during the past 12 months

    Limited Experience
    Performed less than 12 times within the past 12 months and may need a review

    Experienced
    Performed at least once per month within the past 12 months and may need minimal assistance

    Highly Skilled
    Performed on at least a weekly basis over the past 12 months; proficient
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Working with Patients in Isolation
    Working with Patients in Restraints
    Patient/Family Teaching
    Patient Identification
    Specialty Beds
    End of Life Care/Palliative Care
    Knowledge of "Do Not Use Abbreviations"
    Do you have Charge/Supervisor Experience?
    Knowledge of Current Joint Commission National Patient Safety Goals
    Knowledge/Familiarity with HCAHPS Scores
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Durable Medical Equipment (DME)
    Managed Care
    SNF/Long Term Care
    Home Health
    Hospice
    Outpatient
    Physician Office
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Concepts of Capital Budgeting
    Department/Unit Budgeting
    Recruitment Techniques
    Interview Techniques
    Labor Laws Pertaining to Hiring
    Orientation of New Employees
    Knowledge of Quality Improvement/Performance Improvement Tools
    Patient Safety
    Workplace Safety
    Promotion of Interdepartmental Communication
    Performance Management
    Staff Development
    Coaching and Mentoring
    Project Management
    Business Development
    Developing Strategic Plans
    Developing Operational Plans
    Cultural Competence
    Personal Growth and Development
    Ethical Behavior and Practice
    Professional Association Involvement
    Conflict Management
    Team Dynamics
    Mediation/Coaching
    TJC Standards
    OSHA Standards
    Risk Management/Service Utilization
    Local Department of Health
    State Department of Health
    Sitter Services
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Infant (Birth - 1 year)
    Preschooler (ages 2-5 years)
    Childhood (ages 6-12 years)
    Adolescents (ages 13-21 years)
    Young Adults (ages 22-39 years)
  • By signing below, I attest that the information contained above is accurate to the best of my knowledge, and that I am the individual completing this form. I further authorize the Company to release this Qualification List to the Client facilities in accordance with the consideration of employment as a Healthcare Professional with those facilities.