Nursing Shift Scheduling Notes Form
Record shift coverage, scheduling notes, and operational details for nursing staff.
Nurse Name
*
First Name
Last Name
Role/Unit
*
Please Select
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Certified Nursing Assistant (CNA)
Charge Nurse
Float Nurse
Unit Secretary
Other (please specify)
Unit/Ward Assignment
*
Please Select
Medical/Surgical
ICU
Emergency
Pediatrics
Maternity
Operating Room
Other (please specify)
Shift Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift Type
*
Day
Evening
Night
Split
On Call
Scheduled Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Scheduled End Time
*
Hour Minutes
AM
PM
AM/PM Option
Actual Coverage
*
Fully Covered
Partially Covered
Not Covered
Handoff Notes
Staffing Concerns
Short Staffed
Overstaffed
High Acuity
Call Outs
No Issues
Other (please specify)
Shift Change Requests
Request to Swap Shift
Request to Leave Early
Request to Extend Shift
Request for Day Off
No Requests
Other (please specify)
Availability for Overtime or Float Coverage
Available for Overtime
Available to Float
Not Available
Additional Comments
Submit Shift Notes
Should be Empty: