Charge Nurse Readiness Evaluation Form
Use this form to evaluate a nurse’s preparedness for charge nurse responsibilities, including leadership, communication, prioritization, delegation, and readiness to manage unit operations.
Candidate Information
Candidate Full Name
*
First Name
Last Name
Employee ID / Staff Identifier
Department / Unit
*
Please Select
Emergency
ICU
Med-Surg
Telemetry
Surgical
Pediatrics
Labor & Delivery
Operating Room
Other
Current Role / Title
*
Years of Nursing Experience
*
Years in Current Unit
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Readiness Evaluation
Prior charge nurse experience
*
Yes
No
Limited
Frequency of charge coverage
*
Regularly
Occasionally
Rarely
Never
Leadership confidence
*
1
2
3
4
5
Staffing and assignment management confidence
*
Not confident
1
2
3
4
5
6
7
8
9
Highly confident
10
1 is Not confident, 10 is Highly confident
Communication and escalation effectiveness
*
Needs improvement
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Needs improvement, 10 is Excellent
Policy and procedure knowledge
*
1
2
3
4
5
Prioritization and decision-making under pressure
*
Needs support
1
2
3
4
5
6
7
8
9
Exceptional
10
1 is Needs support, 10 is Exceptional
Delegation skills
*
Needs support
1
2
3
4
5
6
7
8
9
Highly effective
10
1 is Needs support, 10 is Highly effective
Conflict resolution ability
*
Needs support
1
2
3
4
5
6
7
8
9
Highly effective
10
1 is Needs support, 10 is Highly effective
Emergency response readiness
*
Not ready
1
2
3
4
5
6
7
8
9
Fully ready
10
1 is Not ready, 10 is Fully ready
Evaluator Summary
Overall Readiness Status
*
Ready
Ready with Support
Not Yet Ready
Key Strengths
Development Areas
Recommended Training or Mentoring Actions
Shadowing on shift
Coaching on delegation
Leadership communication refresher
Clinical prioritization mentoring
Documentation support
Other
Evaluator Name and Title
*
First Name
Middle Name
Last Name
Evaluator Signature
*
Submit Evaluation
Submit Evaluation
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