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Skills Checklists

Before you can begin applying for NurseChoice assignments, you need to complete a skills checklist. Required by hospitals, this mandatory form highlights your skills, proficiencies and experience in your specialty. The quickest and easiest way to complete your skills checklist is online. Just select your specialty from the list below, enter the necessary information on the form and click to submit. Once we receive your completed skills checklist you will be one step closer to finding a rewarding travel assignment that meets your needs.

Healthcare Leadership Competencies Assessment

Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name* Middle Name Last Name*
E-Mail Address* Phone Number*
1. No experience; requires education, training and supervision
2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent
4. Expert level; can teach/supervise others
1 2 3 4
Build collaborative relationships
Generating informal power
Organizational structure and relationship
Practice and value shared decision making
1 2 3 4
Active listening skills
Communicate organizational mission, vision, objectives, and priorities
Manage meetings, presentations, reports and projects
Present data analysis results to decision makers
Professional written communication
Provide and receive constructive feedback
Diversity and inclusion sensitivity
Service recovery
1 2 3 4
Cultivate and lead high performance teams
Vision development and implementation
Emotional intelligence
Human capital management/staffing
Mediation, negotiation, and dispute resolution
1 2 3 4
Change management
Cultivating adaptability
Create culture of accountability for self/others
Drive for personal/professional growth
Leadership styles/techniques
Mindful decision making
Promote continuous learning/improvement
Recruitment and retention
Regulatory labor management (EEOC, OSHA, ADA, Labor Bureau)
1 2 3 4
Evidence-based management practice
Levels of healthcare along the continuum of care
Managed care models, structures, and environment
Payor sources/program (HEDIS, HCAPS)
Administrative regulations (DNC, TJC, OIG, CMS, NCQA)
Balance competing priorities, metrics and needs
1 2 3 4
Budgets- Financial acumen
Data analytics
Demonstrate critical thinking and analysis
High Reliability Organization (HRO)
Innovation & resourcefulness
Just Culture
Promote/apply problem-solving methods
Business planning acumen
The functions of organizational policies and procedures
Value of branding in marketing
1 2 3 4
Bar Coding for Medication Administration
Computer Physician Order Entry
Other: Specify
Other: Specify
EMR Conversion
CERTIFICATIONS (Current at time of completing this form)
Fellow of the American College of Healthcare Executives (FACHE)
Nurse Executive (NE-BC)
Nurse Executive, Advanced (NEA-BC)
Certified in Executive Nursing Practice (CENP)
Certified Nurse Manager and Leader (CNML)
Clinical Nurse Leader (CNL)
Other: Specify
Other: Specify
Healthcare Leadership Competencies Assessment, version 2

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided, will result in being ineligible to travel with AMN. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

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