NORZAGARAY

COLLEGE
Municipal Compound,
Poblacion
Norzagaray, Bulacan

RLE ON LEADERSHIP AND MANAGEMENT

(Headnursing)

CHECKLIST OF NURSING TASKS

(To be accomplished by Student Headnurse and Clinical Instructor)

Name of Student Staff Nurse: _______________________ Group & Section: _______ Duration of exposure __________________

This Checklist will facilitate the nurse manager’s supervisory task. This can also be used for endorsement purposes.

WRITE: R-rendered PR-partially rendered NA-Not applicable NR – not rendered

Nam V/S Oral Explana New Signat
e of Order AM Assisti Psych Follo tion of Reques docto Discha Me Referr ure of
Patie ed care/ Turni ROM Bronc ng in Meas Wou o Healt w up therape t for r’s rge ds als studen
nt And Peren ng exerci hial feedin ure nd Spirit h lab utic blood order plan of giv done t
record ial ses Care g I&O Care ual teachi resu diagnos transfu carri care en Staff
ed care care ng lts tic sion ed nurse
procedu out
res

Prepared by: _______________________________________ Noted by: ________________________________

 Student Headnurse Clinical Instructor

NORZAGARAY
COLLEGE
Municipal Compound,
Poblacion
Norzagaray, Bulacan

RLE ON LEADERSHIP AND MANAGEMENT

(Headnursing)

DAILY PATIENT ASSIGNMENT SHEET

(To be accomplished by Student Headnurse, one copy will be posted, one copy for the area Headnurse)

DATE: ________________________ AREA: ________________________

Name of student Room and Name of Patient Diagnosis Patient Care Remarks
bed number Classification
Prepared by: _______________________________________ Noted by: ________________________________
Student Headnurse Clinical Instructor

NORZAGARAY
COLLEGE
Municipal Compound,
Poblacion
Norzagaray, Bulacan

RLE ON LEADERSHIP AND MANAGEMENT

(Headnursing)

VITAL SIGNS AND I & O SHEET

DATE: ________________________ AREA: ________________________

Room & Name of Patient TIME: TIME: INTAKE OUTPUT

bed number
BP PR CR RR T BP PR CR RR T ORAL IV CVP URINE VOM
Prepared by: _______________________________________ Noted by: ________________________________
Student Headnurse Clinical Instructor

NORZAGARAY
COLLEGE
Municipal Compound,
Poblacion
Norzagaray, Bulacan

RLE ON LEADERSHIP AND MANAGEMENT

(Headnursing)

IV MONITORING SHEET

DATE: ________________________ AREA: ________________________

Name of student Room and Name of Patient IVF ON Rate per min IV LEVEL
bed number (ex. DRLR 1L x
8hrs)
Received Endorsed
Prepared by: _______________________________________ Noted by: ________________________________
Student Headnurse Clinical Instructor
NORZAGARAY
COLLEGE
Municipal Compound,
Poblacion
Norzagaray, Bulacan

RLE ON LEADERSHIP AND MANAGEMENT

(Headnursing)

SCHEDULE OF ACTIVITIES
(To be accomplished by Student Headnurse, one copy will be posted, one copy for the area Headnurse)

DATE: ________________________ AREA: ________________________

TIME ACTIVITIES
Prepared by: _______________________________________ Approved by: ________________________________
Student Headnurse Clinical Instructor

Noted by: ____________________________________

NORZAGARAY
COLLEGE
Municipal Compound,
Poblacion
Norzagaray, Bulacan

RLE ON LEADERSHIP AND MANAGEMENT

(Headnursing)

PROBLEM SOLVING PROCESS

DATE: ________________________ AREA: ________________________

Statement of Problem ANALYSIS Alternative Course of Implementation Rationale Evaluation

and cues (Scientific and Action
Situational)
Prepared by: _______________________________________ Noted by: ________________________________
Student Headnurse Clinical Instructor