Agency Nurse First Shift Buddy Sign-Off

Buddy RN sign-off form completed after an agency nurse's first shift to confirm readiness for independent assignment and identify any follow-up support needed.

Shift and Assignment Details

• Shift Date
• Unit or Department
• Shift Type
• Agency Nurse Identifier
  Use an employee, agency, or assignment identifier. Do not enter SSN or other unnecessary PII.
• Buddy RN Name

Readiness Assessment

• Understands unit layout, workflow, and escalation path
• Demonstrated required clinical skills for the assignment
• Documentation was complete and accurate
• Communicated effectively and escalated concerns appropriately
• Followed unit policy, safety, and infection control requirements

Observed Strengths and Support Needs

• Observed strengths
• Additional support or coaching needed
• Any safety concerns observed?
• Safety concern details

Final Buddy RN Sign-Off

• Recommendation for independent assignment
• Follow-up actions required
• Buddy RN Signature
• I confirm this sign-off reflects my direct observation during the first shift and uses only the minimum necessary information.