Al-Zaytoonah University of Jordan ‫عـة الـزيتـونــــة األردنيــة كلية‬

Faculty of Nursing ‫التمريض‬

Shift Assignment Form / Administration and Leadership in Nursing - Practical Training

QF03/0620-3.0 E
Procedures/ Faculty of Nursing

Shift Assignment Form

Student's Name Area of Training
Student's ID. Number Department
Teacher's Name Date of Submission
Total score according to scoring system (2.5/2.5)

QF03/0620 - Page 1 / 3
 Al-Zaytoonah University of Jordan ‫عـة الـزيتـونــــة األردنيــة كلية‬
Faculty of Nursing ‫التمريض‬

Shift Assignment Form / Administration and Leadership in Nursing - Practical Training

QF03/0620-3.0 E
Procedures/ Faculty of Nursing

Student's Name: ID' No.: Date: …../…. /….. Shift: A shift

Department: ER Name of head nurse: RN. Thabit Al-Aqtash
Unit Capacity: 16beds No. of Patients: 10 No of Admissions: 3 Transfer in No.:1
Nurses No.: 4 nurses No. of Discharges: 1 Transfer out No.1
Patient's Room No. Assigned Nurse Nurse's Break Special Assignment Comments
Room 1 Wael ( incharge) 12:00 Check Emergency cart
Room 2 P. N Huda 12:30 Organize transferring the Transfer the patient out and receive a transfer in patient
patients
Room 3 R. N Maha 12:30 Check medication patch for
24 hrs
Room 4 R. N Abed 13:00 Attend Dr. round, Check Check all new orders for all patients
Narcotic cabinet,
Room 5 P. N Mohammad 12:00 dressing change and check
vital sign and the giving of
medicines

Teacher Signature and Date: Student Signature_

Student's Name Area of Training

Student's ID. Number Date of Submission
QF03/0620 - Page 2 / 3
 Al-Zaytoonah University of Jordan ‫عـة الـزيتـونــــة األردنيــة كلية‬
Faculty of Nursing ‫التمريض‬

Shift Assignment Form / Administration and Leadership in Nursing - Practical Training

QF03/0620-3.0 E
Procedures/ Faculty of Nursing
Teacher's Name Department

QF03/0620 - Page 3 / 3
 Al-Zaytoonah University of Jordan ‫عـة الـزيتـونــــة األردنيــة كلية‬
Faculty of Nursing ‫التمريض‬

Shift Assignment Form / Administration and Leadership in Nursing - Practical Training

QF03/0620-3.0 E
Procedures/ Faculty of Nursing

Shift Assignment Scoring Sheet

Items Ideal Points Actual Student’s Points
Unit Statistical Report 2 points
Appropriate decision making 2 points
Nurses to patients ratio 2 points
Special task assignment 1 point
Completion of nurses distribution to assignment 2 points
Collaboration with unit head nurse & team 1 point
Total 10

Teacher Signature and Date: Student Signature and Date:

QF03/0620 - Page 4 / 3