Joint Implementation Team:
Templates, Forms and Tools
See also, below: Staff Nurses | Holidays | WRC
Managers
- Evaluations
- Code of Conduct Attestation Statement (Doc)
- Guidelines for Overall Performance Rating (Doc)
- Performance Evaluation Instructions (Doc to be used with the below listed evaluation tools)
- Framework Evaluations:
- RN Peer Input Tool for Annual Evaluation updated 06/2009 (Doc)
- Registered Nurse Level A Annual Evaluation updated 06/2009 (Doc)
- Registered Nurse Level C Annual Evaluation updated 06/2009 (Doc)
- Registered Nurse Level D Annual Evaluation updated 06/2009 (Doc)
- Registered Nurse Level E Annual Evaluation updated 06/2009 (Doc)
- Nurse Practitioner Annual Evaluation (Doc)
- RSAM Evaluations:
- Clinical Care Coordinator Competent Evaluation (Doc)
- Clinical Care Coordinator Expert Evaluation (Doc)
- Clinical Care Coordinator Mastery Evaluation (Doc)
- Clinical Care Coordinator Peer Assessment Tool for Annual Evaluation (Doc)
- Educational Nurse Coordinator Competent Evaluation (Doc)
- Educational Nurse Coordinator Expert Evaluation (Doc)
- Educational Nurse Coordinator Mastery Evaluation (Doc)
- Educational Nurse Coordinator Peer Assessment Tool for Annual Review (Doc)
- Flight Nurse Specialist Competent Evaluation (Doc)
- Flight Nurse Specialist Expert Evaluation (Doc)
- Flight Nurse Specialist Mastery Evaluation (Doc)
- Flight Nurse Specialist Peer Self Assessment Tool for Annual Evaluation (Doc)
- Practice Management Coordinator Competent Evaluation (Doc)
- Practice Management Coordinator Expert Evaluation (Doc)
- Practice Management Coordinator Mastery Evaluation (Doc)
- Practice Management Coordinator Peer Assessment Tool for Annual Evaluation (Doc)
- Mandatory Overtime Reports
- Miscellaneous
- Dispute Process Flowchart
- Dispute Step 1 Worksheet (UMPNC use)
- DRC Checklist
- Problem-Solving Meetings Related to Use of PTO or Use of No-Pay Time
- Process for Reporting & Review of Unit-based Temporary Hours
- Short Term Assignment Agreement 11/16/07
- Signature Form - Decrease Below 20 hrs/week
- Trigger for Next PSM
- UH and CVC-ORs On-Call Bonus Requirements Template
- OR PACU Procedure Areas OnCall Requirements Template
- Health RN RTW w/o Restrictions Process 12/2010
Staff Nurses
- Practice Situation, Inpatient
- Practice Situation, Ambulatory Care
- Paid Time Off (PTO) Donation Program
Holidays
- Contract Payroll Scenarios, Non-Thanksgiving (2008-2011) HTM
- Contract Payroll Scenarios, Thanksgiving (2009-2011) HTM
- Holiday Questions and Answers (2012)
WRC
PURPOSE
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The Workload Review Committee provides a mechanism for nursing management and staff to collaboratively address workload issues. The committee use relevant fiscal, operational, and acuity data and input from nursing staff to proactively address planned changes in care delivery or the work environment, and quickly make recommendations or decisions to respond locally to unanticipated workload or patient care issues. For more details see Article 14.
- OT Log, Inpatient example
- OT Log, Inpatient template
- OT Log, WHB template
- Workload Review Membership Sign-up Form
- Workload Review Committee Template: Agenda
- Workload Review Committee Template: Checklist
- Workload Review Committee Template: AC Checklist
- Workload Review Committee Template: Minutes
- Trigger Thresholds & Required Actions - 2008 Contract
Web Publisher of JIT is Gayle Thompson.
Target Audience: UMHS Nursing | Author/Contact: Linda Bullard | Last reviewed: 3/8/12
