Termination Scale Acknowledgement Name * First Name Last Name Email * The Following point system is used to determine termination as a result of Do Not Sends. 1Point ◘ Attitude / lack of professionalism / customer service 2 Points ◘ Clinical Incompetence – poor clinical performance ◘ Poor time management ◘ Medication Error ◘ Documentation Deficiencies Lack of Compassion 3 Points ◘ Danger to patient. ◘ No call, No Show. ◘ Departing facility before end of shift secondary to dissatisfaction with assignment. ◘ Do Not Send from any Travel Assignment regardless of origin. 5 Points ◘ Illegal Behavior (Includes false identity; falsified documentation, use of or distribution of controlled substances etc.) ◘ PT. abandonment. When nurse is under investigation for above behavior they will be considered terminated until exonerated from all accusations. ◘ Error resulting in Pt. Death or Permanent physical or mental damage. ◘ Self-terminating travel assignment without proper notice to facility or Staffing Agency. A nurse who receives 5 points will be considered for termination. Any nurse involved in illegal activity will be terminated immediately. I have read and understand the Termination Scale Policy of Trueheart Staffing Agency in particular the Section entitled “Do Not Send policy and Process.” Signature Thank you!
