Nurse Manager One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyLEADERSHIP/PATIENT CAREProvide leadership/management in the skilled/Long Term nursing environment(Required) 1 2 3 4 Incorporate advanced analysis, organizational, and problem solving skills to effectively manage staff and residents(Required) 1 2 3 4 Incorporate advanced knowledge of quality improvement, change management techniques and motivational theory to ensure quality of care and resident’s quality of life is maximized(Required) 1 2 3 4 MANAGING DAILY OPERATIONSInitiates quality improvement studies and follow up(Required) 1 2 3 4 Collect data, completing various chart audits and summarizing results for quality improvement(Required) 1 2 3 4 Prepares and submit reports as required for mandated reportables (to state department of health) as well as internal reports for quality assurance purposes(Required) 1 2 3 4 Oversee programs for residents and staff as needed(Required) 1 2 3 4 Ensure that policies and procedures are current and followed by staff(Required) 1 2 3 4 MANAGING WORK TEAMSAct as liaison between staff and committees(Required) 1 2 3 4 Provide individuals and/or teams with direction, encouraging, teamwork and collaboration(Required) 1 2 3 4 Provide consultation to individual and/or team leaders as needed(Required) 1 2 3 4 Delegate, monitors and directs assignments for infection control activities(Required) 1 2 3 4 MANAGING RESOURCESUpdate staff on changes in work or workplace related activities(Required) 1 2 3 4 Ensure adequate personal protective equipment is available and utilized throughout the facility(Required) 1 2 3 4 Plan and organize work to ensure timely task completion and work flow(Required) 1 2 3 4 Make sound, timely decisions with consideration of ramifications(Required) 1 2 3 4 Analyze issues, prioritize problems and involve appropriate individuals to select plan for resolution, anticipating outcomes and managing consequences(Required) 1 2 3 4 Develop and maintain department budget efficiently(Required) 1 2 3 4 INTERPERSONAL RELATIONSProvide formal and informal recognition and rewards for employees for positive performance(Required) 1 2 3 4 Participate in providing instruction to enhance on the job learning related to infection control(Required) 1 2 3 4 Work with medical director and physicians to ensure appropriate transmission standards are in place(Required) 1 2 3 4 Initiate improvement plans needed and supports staff through training and follow up monitoring(Required) 1 2 3 4 UNDERSTANDING OF HEALTHCARE ENVIRONMENT& BUSINESS ECONOMICSClinical practice(Required) 1 2 3 4 Healthcare Policy(Required) 1 2 3 4 Shared Governance(Required) 1 2 3 4 Case Management(Required) 1 2 3 4 Risk Management(Required) 1 2 3 4 Evidence Base Practice(Required) 1 2 3 4 Information and technology(Required) 1 2 3 4 Human Resource management & development(Required) 1 2 3 4 Strategic Management(Required) 1 2 3 4 COMPETENCIESKnowledge/Practice on Admission Procedures(Required) 1 2 3 4 Knowledge/Practice on Discharge Procedures(Required) 1 2 3 4 Knowledge/Practice on Patient Education(Required) 1 2 3 4 Knowledge/Practice on Patient Care Plans(Required) 1 2 3 4 Knowledge/Practice on Medications/IV Therapy(Required) 1 2 3 4 Knowledge/Practice on Cardiac Monitors, IV/Feeding Pumps, Mechanical Ventilators(Required) 1 2 3 4 Knowledge/Practice on CODE/Medical Emergencies(Required) 1 2 3 4 Knowledge/Practice on Precaution (Fall, Fractures, Sternum, Seizures, Pressure Ulcer etc)(Required) 1 2 3 4 Knowledge/Practice on Universal Precautions & Isolations(Required) 1 2 3 4 Knowledge/Practice on PICC & Cental Lines(Required) 1 2 3 4 Use of special pressure relief devices(Required) 1 2 3 4 Knowledge on the following systems & disease processesCardiac(Required) 1 2 3 4 Endocrine(Required) 1 2 3 4 Gastrointestinal(Required) 1 2 3 4 Genitourinary(Required) 1 2 3 4 Neurology(Required) 1 2 3 4 Respiratory(Required) 1 2 3 4 Ortho/Skin/Wound Care(Required) 1 2 3 4 EMREpic(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Eclipsys(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 Other Computerized System(Required) 1 2 3 4 Computerized Physician Order Entry(Required) 1 2 3 4 Bar Coding for Medication Administration(Required) 1 2 3 4 PRIMARILY EXPERIENCEBURN(Required) 1 2 3 4 CRITICAL UNIT(Required) 1 2 3 4 PACU(Required) 1 2 3 4 NEURO(Required) 1 2 3 4 TELE(Required) 1 2 3 4 MED-SURG(Required) 1 2 3 4 ONCOLOGY(Required) 1 2 3 4 ORTHO(Required) 1 2 3 4 RADIOLOGY(Required) 1 2 3 4 OR(Required) 1 2 3 4 ER(Required) 1 2 3 4 POST PARTUM(Required) 1 2 3 4 L&D(Required) 1 2 3 4 PICU(Required) 1 2 3 4 PSYCH(Required) 1 2 3 4 PICU(Required) 1 2 3 4 PEDS(Required) 1 2 3 4 Level I Trauma(Required) 1 2 3 4 Level II Trauma(Required) 1 2 3 4 Level III Trauma(Required) 1 2 3 4 AGE APPROPRIATE CARENewborn/Neonatal (birth – 30 days)(Required) 1 2 3 4 Infant (30 days-1 year)(Required) 1 2 3 4 Toddler (1-3 years)(Required) 1 2 3 4 Preschool (3-5 years)(Required) 1 2 3 4 School Age Children (5-12 years)(Required) 1 2 3 4 Adolescent (12-17 years)(Required) 1 2 3 4 Young Adults (18-44 years)(Required) 1 2 3 4 Middle Adults (45-64 years)(Required) 1 2 3 4 Older Adults (>65 years)(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the 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