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1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Director of Nursing – Skills Checklist
This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Age of Patients Cared For
Newborn/Neonate (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age Child (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (over 79+ years)
*
0
1
2
3
4
5
Leadership
Communicates effectively with residents, families, significant others, and other team members
*
0
1
2
3
4
5
Communicates effectively with peers, physicians, and state agencies
*
0
1
2
3
4
5
Coordinates resident care to the multidisciplinary team via meetings
*
0
1
2
3
4
5
Provides updated resident information to physicians, resident, family, legal, consultants, State agencies in accordance with regulations and/or standards
*
0
1
2
3
4
5
Knowledgeable and able to execute human recourse policies as applicable to a variety of people issues
*
0
1
2
3
4
5
Delegates as appropriate
*
0
1
2
3
4
5
Actions demonstrate excellent customer service skills and builds relationships with families and associates
*
0
1
2
3
4
5
Monitors the progress of others
*
0
1
2
3
4
5
Technical
Assesses and monitor staff compliance of infection control and safety programs
*
0
1
2
3
4
5
Demonstrates excellent technical skills and judgement
*
0
1
2
3
4
5
Assesses and monitors accuracy of Facility Scoredcard and CMS quality indicator date and initiates corrective action as indicated
*
0
1
2
3
4
5
Actively participates and contributes to facility meetings and process improvement activities
*
0
1
2
3
4
5
Promotes survey preparedness at all times
*
0
1
2
3
4
5
Demonstrates basic working knowledge of computer and modules and management reports
*
0
1
2
3
4
5
Demonstrates basic understanding of quality event investigating and reporting process
*
0
1
2
3
4
5
Maintains a current knowledge of LTC Federal and state regulations including Medicare, Madicaid, and JCAHO as applicable
*
0
1
2
3
4
5
Ensure that RAI functions are completed timely for all residents
*
0
1
2
3
4
5
Provides and monitors the effectiveness of clinical orientation and ongoing training to all associates
*
0
1
2
3
4
5
Problem Solving
Utilizes the nursing process to structure care to individual resident's needs
*
0
1
2
3
4
5
Demonstrates the ability to assess and interpret data about the resident's status and ensure timely interventions are executed
*
0
1
2
3
4
5
Collaborates with DNS/Consultants on identified areas of noncompliance and implements necessary corrective actions
*
0
1
2
3
4
5
Effectively troubleshoots and ensures allocation of staffing resources to meet the needs of the residents
*
0
1
2
3
4
5
Demonstrates understanding of census as it relates to HOL, expense control, and budgeted PPD
*
0
1
2
3
4
5
Assesses and monitors discharge, rehospitalization patterns and implements corrective action as indicated
*
0
1
2
3
4
5
Professional Knowledge and Skills
National Patient Safety Goals
*
0
1
2
3
4
5
Age Specific Care
*
0
1
2
3
4
5
Population Based Care
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Automated Med Dispensing System
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*