Employment Reference Form

Reference Given Bernadette Balajadia Relationship Nursing Supervisor

by: with Candidate:
Candidate Name: Divina Gracia Gonzales Position Staff Nurse
applied for:

Date of Commencement: November 8, 2018 Date of Leaving (if applicable): October 6, 2021

Reason for Leaving: End of Contract

Job Title: Nurse Specialist

Main duties:

***Provides direct patient care to assigned patient population and ensures that safe and appropriate care is
delivered to the patients.

1. Follows the hospital mission, vision, and values.

2. Follows all hospital policies and procedures, guidelines and protocols and all Saudi Arabian laws related
to patient care practices.
3. Assess patient’s health problems and needs. Develops and implements nursing care plans based on the
patient’s needs and nursing process.
4. Assists physicians during their rounds and monitors execution of physician’s orders.
5. Administers medications according to prescribed orders and timing, and according to policy and
procedure.
6. Understand and uses the patient classification system including the patient acuity in organizing work.
7. Monitors patient’s vital signs including pain and assesses patient’s response to treatment.
8. Maintains proper documentation, accurate and complete medical record.
9. Uses supplies, instruments and equipment judiciously and safely and promptly reports to the
Charge/Head Nurse or Maintenance Department for any failure or malfunctioning equipment, and
reduction of supply inventory.
10. Guides other nurses and nursing students on the proper use, care of, and maintenance of equipment,
instruments and materials.
11. Contributes to the development, implementation and evaluation of unit activities.
12. Acts as a preceptor to new or redeployed nurses.
13. Participates in and supports training and development of nursing students and interns.
14. Acknowledges limitations of competence and refuses cases which are delegated beyond the limitations of
the service area.
15. Requests assistance from an immediate supervisor when needed.
16. Attends relevant in-service continuing educational programs.
17. Performs other duties as assigned.

Any additional responsibilities:

Roles in Quality and Patient Safely:

1. Competent to perform all nursing procedures according to area of specialty in order to provide high
standard patient care for assigned patients and evaluation outcome of care.
2. Provides high standard patient care for assigned patients and evaluation outcome of care.
3. Participates in unit-based performance improvement activities.
4. Assesses the needs of individuals, families, and/or communities including assessment of individuals
home and/or work environments to identify potential health of safety problems.

Roles in Person-Centered Care:

1. Ensures provision of holistic and person-centered care to patients and families that are respectful of and
responsive to individual preferences, experiences, and needs and values.
2. Participate in promoting individuality and innovation in the delivery of care.
3. Communicate effectively with patient/family members and other health care provider.
 4. Collaborate in department improvement efforts.
5. Provide care with good attitude and communicate with compassion.

Roles in Disaster Management:

1. Oriented on his role as per internal and external disaster plans.
2. Attend annual safety in-service education and training.
3. Ensures his/her cooperation and participation on regular safely drills.

Roles in Patient and Family Education:

1. Instructs patients/ family and others on health education, disease prevention and develops health
improvement programs.
2. Supports patient education activities.
3. Ensures and participates in the patient and family education.

Roles in Patient and Family Rights and Responsibility:

1. Ensures protection of patient’s confidentiality and security of patient’s files at all times.
2. Contributes towards an atmosphere of mutual trust, acceptance, respect and is receptive and courteous
to all patients through cooperation in team efforts and willingness to assist of patents and health care
members.
3. Liaises with the multidisciplinary team including Social Worker, Duty Manger to ensure that appropriate
arrangement are made in reaching patients’ relatives when necessary and for patients transferred to
other units or hospitals.
4. Acts as an advocate in the implementation and compliance of the patient’s rights and responsibilities
policy.

Was the individual punctual? Was the individual reliable?

Please comment on attendance

How many days absence due to sickness in the last 2 years?

Over how many occasions?

Is this individual subject to a live or pending investigation, warning, sanction or disciplinary?

If yes, please give details

How would you describe the individuals working relationship with others?

Would you re-employ the applicant?

Please comment on individual’s suitability for this position, using a separate sheet for additional supporting
information if necessary.

I declare that, to the best of my knowledge, the information given above is true and correct, and that I am
authorised to provide this reference.
Signed Name Date