RELATED LEARNING EXPERIENCE

Leadership and Management

(Head Nursing)
Medication Sheet
(To be accomplished by Student Head Nurse)
Clinical Area: _____________________ Date/Shift: _______________________

Student Room # Patient’s Name Age/Sex Diagnosis Medication Dosage Frequency Time Due
Staff
Nurse

Prepared by: __________________ Noted by: _______________________

(Student Head Nurse) (Clinical Instructor)
 COLLEGE OF NURSING
RELATED LEARNING EXPERIENCE
Leadership and Management
(Head Nursing)

SCHEDULE OF ACTIVITIES
(To be accomplished by Student Head Nurse)

Clinical Area: _____________________ Date/Shift: _______________________

Time Activities

Prepared by: __________________ Noted by: _______________________

(Student Head Nurse) (Clinical Instructor)
 COLLEGE OF NURSING
RELATED LEARNING EXPERIENCE
Leadership and Management
(Head Nursing)

IVF MONITORING SHEET

(To be accomplished by Student Head Nurse)

Clinical Area: _____________________ Date/Shift: _______________________

Student Staff Room Patient’s IVF & Rate Medicine Time & Time Follow- Time &
Nurse # Name Amount of Added Amount Due up IVF Amount
Flow Received Endorsed

Prepared by: __________________ Noted by: _______________________

(Student Head Nurse) (Clinical Instructor)
 COLLEGE OF NURSING
RELATED LEARNING EXPERIENCE
Leadership and Management
(Head Nursing)

IVF MONITORING SHEET

(To be accomplished by Student Head Nurse)

Clinical Area: _____________________ Date/Shift: _______________________

Student Room Patient’s Age/Sex Diagnosis Medication Dosage Frequency Time Due
Staff Nurse # Name

Prepared by: __________________ Noted by: _______________________

(Student Head Nurse) (Clinical Instructor)
 COLLEGE OF NURSING
RELATED LEARNING EXPERIENCE
Leadership and Management
(Head Nursing)

ENDORSEMENT SHEET
(To be accomplished by Student Head Nurse)

Clinical Area: _____________________ Date/Shift: _______________________

Room # ENDORSEMENT
Patient’s Name: IVF’s:
Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory

Intake and Output Treatment:

Diet:
Contraptions Remarks

Patient’s Name: IVF’s:

Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory
Intake and Output Treatment:

Diet:
Contraptions Remarks

Patient’s Name: IVF’s:

Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory

Intake and Output Treatment:

Diet:
Contraptions Remarks

Patient’s Name: IVF’s:

Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory

Intake and Output Treatment:

Diet:
Contraptions Remarks

Patient’s Name: IVF’s:

Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory

Intake and Output Treatment:

Diet:
Contraptions Remarks

Patient’s Name: IVF’s:

Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory

Intake and Output Treatment:

Diet:
Contraptions Remarks
 Patient’s Name: IVF’s:
Age:
Diagnosis:
Gender:
Attending Physician:
Vital Signs:

Procedures/Laboratory

Intake and Output Treatment:

Diet:
Contraptions Remarks

Prepared by: __________________ Noted by: _______________________

(Student Head Nurse) (Clinical Instructor)
 COLLEGE OF NURSING
RELATED LEARNING EXPERIENCE
Leadership and Management
(Head Nursing)
VITAL SIGNS and INPUT/OUTPUT SHEET
(To be accomplished by Student Head Nurse)

Clinical Area: _____________________ Date/Shift: _______________________

Room # Patients Tim Intake Outp

Name e ut
BP PR R T ORAL IVF Urine Drainag BM
R e

Prepared by: __________________ Noted by: _______________________

(Student Head Nurse) (Clinical Instructor)
 COLLEGE OF NURSING
RELATED LEARNING EXPERIENCE
Leadership and Management
(Head Nursing)
DAILY PATIENT ASSIGNMENT SHEET
(To be accomplished by Student Head Nurse)

Clinical Area: _____________________ Date/Shift: _______________________

Student Staff Room # Patients Age Sex Diagnosis Patient Care

Nurse Name Classification
System
Prepared by: __________________ Noted by: _______________________
(Student Head Nurse) (Clinical Instructor)