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Nurse Reference Form Template

Cody Hussar, a Charge Nurse at 4300 Unit Hospital, provided a reference for Inna Stresz, an RN Med Surg Float with experience in Medical Telemetry. Inna has been employed since March 2021, has charge experience, and is noted for her dependability, effective communication, and professionalism. The reference indicates a strong recommendation for rehire.

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Precious Angelique Malacat
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4 views1 page

Nurse Reference Form Template

Cody Hussar, a Charge Nurse at 4300 Unit Hospital, provided a reference for Inna Stresz, an RN Med Surg Float with experience in Medical Telemetry. Inna has been employed since March 2021, has charge experience, and is noted for her dependability, effective communication, and professionalism. The reference indicates a strong recommendation for rehire.

Uploaded by

Precious Angelique Malacat
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Reference Form

Reference Information
Name:
Cody Hussar
Position/Title:
Charge Nurse
Facility Name:
4300 Unit Hospital - Cross Country Healthcare
City and State:
Rochester, NY
Phone Number:
(585) 993-2822
Email:
codyhussar@[Link]

Applicant’s Information
Applicant’s Name:
Inna Stresz
Position(s) Held:
RN Med Surg Float/ Medical Telemetry
Travel Assignment (Yes/No):
Yes
Clinical Specialty:
Medical Telemetry/ Med/ Surg/ Float Pool
Employment Dates:(From and To)
March 2021- present
Average Patient:
7- 10
Charge Experience (Yes/No):
YES
Supervisory Experience (Yes/No):
NO
Would you rehire (Yes/No):
YES

Performance and Attributes


Experience Scale: 1 -N/A 2 – Below Standard 3 – Meets Standard 4 – Above Standard

1 2 3 4
Provides competent clinical care following facility policies and procedures
Communicates effectively w/ patients, families and staff
Completes accurate documentation of patient care
Ability to communicate with staff
Attendance and punctuality
Flexibility and adaptability
Overall professionalism
Comments/Recommendations:

Inna is very dependable, easy to work with and a reliable nurse. She can work under
pressure and would always try to reach out if there's anything she wanted to clarify.

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