Common use of PATIENT CARE FACTORS CONTRIBUTING TO THE OCCURRENCE Clause in Contracts

PATIENT CARE FACTORS CONTRIBUTING TO THE OCCURRENCE. Please check off the factor(s) you believe contributed to the workload issue and provide details: ☐ Rounds ☐ Consultation with MD/Delay   ☐ Change in patient acuity   ☐ Telemedicine   ☐ Normal number of beds on unit   Beds closed   Beds opened during tour   ☐ Patient census at time of occurrence   ☐ # of Admissions   # of Discharges   # of Transfers   ☐ # of assigned patients   ☐ Lack of/or equipment/malfunctioning equipment. Please specify:  ☐ Visitors/Family Members. Please specify:  ☐ Number of patients on infectious precautions   ☐ Over Capacity Protocol. Please specify:  ☐ Resources/Supplies   ☐ Interdepartmental Challenges   ☐ System Issues   ☐ Exceptional Patient Factors (i.e., significant time and attention required to meet patient expectations). Please specify:  ☐ Other (e.g., Non-nursing duties, student supervision, mentorship, etc.). Please specify: 

PATIENT CARE FACTORS CONTRIBUTING TO THE OCCURRENCE. Please check off the factor(s) you believe contributed to the workload issue and provide details: ☐ Rounds ☐ Consultation with MD/Delay   ☐ Change in patient acuity   ☐ Telemedicine   ☐ Normal number of beds on unit   Beds closed   Beds opened during tour   ☐ Patient census at time of occurrence   ☐ # of Admissions   # of Discharges   # of Transfers   ☐ # of assigned patients   ☐ Lack of/or equipment/malfunctioning equipment. Please specify:  specify: ☐ Visitors/Family Members. Please specify:  specify: ☐ Number of patients on infectious precautions   ☐ Over Capacity Protocol. Please specify:  specify: ☐ Resources/Supplies   ☐ Interdepartmental Challenges   ☐ System Issues   ☐ Exceptional Patient Factors (i.e., i.e. significant time and attention required to meet patient expectations). Please specify:  specify: ☐ Other (e.g., e.g. Non-nursing duties, student supervision, mentorship, etc.). Please specify: specify:

PATIENT CARE FACTORS CONTRIBUTING TO THE OCCURRENCE. Please check off the factor(s) you believe contributed to the workload issue and provide details: ☐ Rounds ☐ Consultation with MD/Delay   ☐ Change in patient acuity   ☐ Telemedicine   ☐ Normal number of beds on unit   Beds closed   Beds opened during tour   ☐ Patient census at time of occurrence   ☐ # of Admissions   # of Discharges   # of Transfers   ☐ # of assigned patients   ☐ Lack of/or equipment/malfunctioning equipment. Please specify:  specify: ☐ Visitors/Family Members. Please specify:  specify: ☐ Number of patients on infectious precautions   ☐ Over Capacity Protocol. Please specify:  specify: ☐ Resources/Supplies   ☐ Interdepartmental Challenges   ☐ System Issues   ☐ Exceptional Patient Factors (i.e., significant time and attention required to meet patient expectations). Please specify:  specify: ☐ Other (e.g., Non-nursing duties, student supervision, mentorship, etc.). Please specify: specify: