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University of San Jose  – RecoletosCollege of Nursing

Head Nursing Program

Unit Case Load Profile

Room/Bed No. Clinical Picture Patient Classification

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University of San Jose  – RecoletosCollege of Nursing

Head Nursing Program

Logbook of Activities

Date:_____________ Shift:_______________ Area of Assignment:___________________

Time Activities Rationale

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University of San Jose  – RecoletosCollege of Nursing

Medication List Form

Bed No. Patients Medication and Time to be given

Prepared by: Submitted to:

 _____________________________________ _____________________________Head Nursing Student (Medication Nurse) Supervising Clinical Instructor

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University of San Jose  – RecoletosCollege of Nursing

Head Nursing Program

 Assignment Plan

Date:_____________ Shift:_____________ Area of Assignment:____________________

Head Nurse/Charge Nurse on Duty:________________________________________________

Staff Nurse on Duty:____________________________________________________________

Nurse Aid:____________________________________________________________________ Ancillary Personnel:____________________________________________________________

Clinical Instructor:______________________________________________________________

Student Nurses:_______________________________________________________________

Personnel Activities Time

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University of San Jose  – RecoletosCollege of Nursing

Head Nursing Program

Teaching Plan

Student Nurse Facilitator:_____________________________ Date & Venue:_____________

 Activity:___________________________________________

Subject Matter (Content and Scope): ____________________________________________________________________________ 

 ____________________________________________________________________________

Value Theme:________________________________________________________________

References:

 ____________________________________________________________________________ 

 ____________________________________________________________________________ 

 ____________________________________________________________________________

Learning Objectives:

Cognitive:____________________________________________________________________ 

 ____________________________________________________________________________ 

 ____________________________________________________________________________ 

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