RN House Supervisor Skills Checklist

Age SpecificProficiencyFrequency

Infant (Birth to 1 year)

1

2

3

4

1

2

3

4

Toddler (1-3 years)

1

2

3

4

1

2

3

4

Pre-school (3-6 years)

1

2

3

4

1

2

3

4

School Age (6-12 years)

1

2

3

4

1

2

3

4

Adolescent (12-18 years)

1

2

3

4

1

2

3

4

Young Adult (18-30 years)

1

2

3

4

1

2

3

4

Mature Adult (30-60 years)

1

2

3

4

1

2

3

4

Elderly (>60 years)

1

2

3

4

1

2

3

4

HR MANAGEMENT

STAFF PERFORMANCEProficiencyFrequency

Periodic and annual
performance evaluations

1

2

3

4

1

2

3

4

Employee performance
improvement plans

1

2

3

4

1

2

3

4

Career and succession planning

1

2

3

4

1

2

3

4

FEDERAL/STATE LAWS AND
ORGANIZATIONAL POLICIESProficiencyFrequency

Recruitment/Hiring

1

2

3

4

1

2

3

4

Interviewing

1

2

3

4

1

2

3

4

Termination

1

2

3

4

1

2

3

4

Leave of Absences (e.g.
medical, disability, FMLA)

1

2

3

4

1

2

3

4

Hours/Wages (e.g. overtime)

1

2

3

4

1

2

3

4

Accommodations (e.g. disability)

1

2

3

4

1

2

3

4

Staff scope of practice (e.g.
licensure)

1

2

3

4

1

2

3

4

Mandated reporting (e.g. abuse,
disease)

1

2

3

4

1

2

3

4

Controlled substance diversion

1

2

3

4

1

2

3

4

Fitness for duty

1

2

3

4

1

2

3

4

UNIT AND STAFF MANAGEMENT

UNIT STAFFINGProficiencyFrequency

Staffing by (NHPPD, acuity, skill
mix)

1

2

3

4

1

2

3

4

Flexing, floating, on-call policies

1

2

3

4

1

2

3

4

Charge RN duties

1

2

3

4

1

2

3

4

Scheduling

1

2

3

4

1

2

3

4

LEADERSHIPProficiencyFrequency

Conflict resolution strategies

1

2

3

4

1

2

3

4

Promote staff engagement and
retention

1

2

3

4

1

2

3

4

Promote cultural competence
and humility

1

2

3

4

1

2

3

4

Change management facilitator

1

2

3

4

1

2

3

4

Team building

1

2

3

4

1

2

3

4

Facilitation/Collaboration with
others (e.g. physicians, other
departments, outside agencies)

1

2

3

4

1

2

3

4

Patient/Family issues

1

2

3

4

1

2

3

4

Ethical dilemmas

1

2

3

4

1

2

3

4

Mentorship/Coaching

1

2

3

4

1

2

3

4

Staff/Patient advocate

1

2

3

4

1

2

3

4

Educator

1

2

3

4

1

2

3

4

Conduct staff meetings

1

2

3

4

1

2

3

4

Create unit goals aligned with
organizational strategic goals

1

2

3

4

1

2

3

4

CLINICAL OPERATIONSProficiencyFrequency

Development of unit
policies/procedures

1

2

3

4

1

2

3

4

Development/Evaluation of
orientation programs

1

2

3

4

1

2

3

4

Promote use of EBP and
research

1

2

3

4

1

2

3

4

Utilization of supplies/resources

1

2

3

4

1

2

3

4

Analyze workflows for efficiency

1

2

3

4

1

2

3

4

Regulatory compliance(e.g.
OSHA, HIPAA, CMS)

1

2

3

4

1

2

3

4

Crisis management during
emergencies

1

2

3

4

1

2

3

4

FISCAL MANAGEMENT

MANAGE AND EVALUATE
UNIT PRODUCTIVITYProficiencyFrequency

Nursing hours per patient day

1

2

3

4

1

2

3

4

Nurse to patient ratios

1

2

3

4

1

2

3

4

Staff skill mix

1

2

3

4

1

2

3

4

Patient acuity

1

2

3

4

1

2

3

4

Staffing models

1

2

3

4

1

2

3

4

Annual average daily census
(ADC)

1

2

3

4

1

2

3

4

MANAGE UNIT FINANCES
AND BUDGETProficiencyFrequency

Capital budgeting

1

2

3

4

1

2

3

4

Calculating ROI

1

2

3

4

1

2

3

4

Calculating ROA

1

2

3

4

1

2

3

4

New program assessment

1

2

3

4

1

2

3

4

Payroll process for staff

1

2

3

4

1

2

3

4

Revenue and expense
forecasting

1

2

3

4

1

2

3

4

Reporting on budget variance

1

2

3

4

1

2

3

4

Cost-benefit analysis

1

2

3

4

1

2

3

4

Evaluation of productivity

1

2

3

4

1

2

3

4

Balance sheets

1

2

3

4

1

2

3

4

Direct/Indirect costs

1

2

3

4

1

2

3

4

Variable/Fixed Cost

1

2

3

4

1

2

3

4

FINANCIAL IMPACT
OF REGULATIONS
AND PAYMENTProficiencyFrequency

Payer mix (Medicare, Medicaid,
managed care, third-party
providers)

1

2

3

4

1

2

3

4

Diagnosis-related group (DRG)
classifications

1

2

3

4

1

2

3

4

International Classification
of Diseases (ICD)-9 & 10 codes

1

2

3

4

1

2

3

4

PERFORMANCE IMPROVEMENT
AND QUALITY

IMPLEMENT PROCESSESProficiencyFrequency

PDCA

1

2

3

4

1

2

3

4

Root cause analysis (RCA)

1

2

3

4

1

2

3

4

Failure Mode Effects analysis
(FMEA)

1

2

3

4

1

2

3

4

QI/PI projects

1

2

3

4

1

2

3

4

EBP models

1

2

3

4

1

2

3

4

Data analysis/trends

1

2

3

4

1

2

3

4

Dashboard reporting

1

2

3

4

1

2

3

4

Benchmarking

1

2

3

4

1

2

3

4

Charts reviews (concurrent,
retrospective)

1

2

3

4

1

2

3

4

EVALUATE AND MANAGE
METRICSProficiencyFrequency

Staff satisfaction

1

2

3

4

1

2

3

4

Patient satisfaction

1

2

3

4

1

2

3

4

Nurse-sensitive indicators:
Structure, process, outcome
(e.g. falls, CAUTI, RN
workforce)

1

2

3

4

1

2

3

4

Core measures

1

2

3

4

1

2

3

4

Error, events, and incidences

1

2

3

4

1

2

3

4

Staff injuries

1

2

3

4

1

2

3

4

Length of stay (LOS)

1

2

3

4

1

2

3

4

Staff turnover/retention

1

2

3

4

1

2

3

4

RISK MANAGEMENT AND
SAFETYProficiencyFrequency

Promote “Just Culture” for error
reporting

1

2

3

4

1

2

3

4

Continuous readiness

1

2

3

4

1

2

3

4

TJC National Patient Safety
Goals

1

2

3

4

1

2

3

4

Error prevention strategies

1

2

3

4

1

2

3

4

TECHNOLOGYProficiencyFrequency

Use of EHR for reporting, data
analysis, and workflow

1

2

3

4

1

2

3

4

Medication/ADC reports

1

2

3

4

1

2

3

4

Modalities for presentations
(e.g. Powerpoint ,Excel)

1

2

3

4

1

2

3

4

Years Experience in Clinical Speciality :

Most recent facility worked at :

I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Proficiency : -	1 = Never Performed	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always