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Skilled Nursing CheckList

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

General Skills Rating Stars (Click) 1 2 3 4  
Advanced directives 
 
Awareness of HCAHPS 
 
Patient/family teaching 
 
Discharge planning 
 
UR/medicare review 
 
Lift/transfer devices 
 
Specialty beds 
 
Restrictive devices (restraints) 
 
End of life care/palliative care 
 
Automated Medication Dispensing System, Pyxis, Omnicell, or other 
 
National Patient Safety Goals 
 
Accurate patient identification 
 
Effective communication 
 
Awareness of patient rights 
 
Interpretation & communication of lab values 
 
Medication administration 
 
Labeling (medications & specimens) 
 
Medication reconciliation 
 
Anticoagulation therapy 
 
Pain assessment & management 
 
Infection control 
 
Universal precautions 
 
Isolation 
 
Minimize risk for falls 
 
Prevention of pressure ulcers 
 
Cardiac Rating Stars (Click) 1 2 3 4  
Assessment of heart sounds 
 
Identification of arrhythmias (rate/rhythm) 
 
Pacemakers/AIDís 
 
Cardiac arrest/CPR 
 
Hypertension 
 
Pre/post MI 
 
CHF 
 
Post cardiac surgery 
 
Fluid & electrolyte imbalances 
 
Anticoagulants 
 
Antiarrhythmics 
 
Beta blockers 
 
Nitroglycerin 
 
Diuretics 
 
Respiratory Rating Stars (Click) 1 2 3 4  
Assessment/auscultation of lung sounds 
 
Establishing an airway 
 
Chest PT 
 
Incentive spirometry 
 
Supplemental oxygen (cannula, facemask) 
 
Tracheostomy care 
 
Suctioning (tracheostomy & nasotracheal) 
 
Nebulizer use 
 
Pneumonia 
 
Asthma 
 
COPD 
 
Emphysema 
 
Bronchodilators 
 
Expectorants 
 
Corticosteroids 
 
Neurology Rating Stars (Click) 1 2 3 4  
Assessment of neuro signs 
 
Seizure precautions 
 
TBI (Traumatic Brain Injury: history of) 
 
Seizure activity 
 
Spinal cord injury 
 
Stroke (CVA) 
 
Multiple sclerosis 
 
Alzheimerís disease 
 
Parkinsonís disease 
 
ALS (Amyotrophic Lateral Sclerosis) 
 
Antiseizure medications 
 
Antiemetics 
 
Laxatives 
 
Enemas 
 
Bowel prep 
 
Gastrointestinal Rating Stars (Click) 1 2 3 4  
NG tube (insertion/removal) 
 
Long term feeding tubes (dobhoff/keofeed) 
 
Gastrostomy tube 
 
Tube feedings 
 
Monitoring input/output 
 
Colostomy/ileostomy 
 
GI bleed 
 
Feeding devices/adaptive equipment 
 
Dietary restrictions 
 
GT/PEG feedings 
 
Antiemetics 
 
Laxatives 
 
Enemas 
 
Bowel prep 
 
Gastrointestinal Rating Stars (Click) 1 2 3 4  
Foley catheter insertion/removal 
 
GU irrigations 
 
Nephrostomy tube 
 
Suprapubic catheter 
 
Ileo conduit 
 
Use of bladder scan equipment 
 
Shunts and fistulas 
 
Straight catheterizations 
 
Incontinence/bladder training 
 
Chronic renal failure/dialysis 
 
Peritoneal dialysis 
 
Orthopedic Rating Stars (Click) 1 2 3 4  
Total joint replacement 
 
Arthroscopic surgery 
 
Cast care 
 
Pulse/CMS checks 
 
Suture/staple removal 
 
Prosthesis application 
 
Standard extremity braces 
 
Amputation 
 
Stump wrapping 
 
Laminectomy 
 
Assistive devices 
 
CPM machines 
 
IV Therapy Rating Stars (Click) 1 2 3 4  
Start & maintain Ivs 
 
Blood draw: venous 
 
Central line care (PICC) 
 
Blood draw: central line PICC 
 
Care & management of ports 
 
Infusion pumps 
 
Administration of blood/blood products 
 
Skin Rating Stars (Click) 1 2 3 4  
Wound care/surgical 
 
Wound care/medical 
 
Dressing changes 
 
Skin assessment 
 
Wound vac 
 
Age Specific Competencies Rating Stars (Click) 1 2 3 4  
Newborn/neonate (birth-30 days) 
 
Infant (31 days-1 year) 
 
Toddler (2-3 years) 
 
Preschool (ages 4-5 years) 
 
School age (ages 6-12 years) 
 
Adolescents (ages 13-21 years) 
 
Young adult (ages 22-39 years) 
 
Adults (ages 40-64 years) 
 
Older adult (ages 65-79 years) 
 
Elderly (ages 80+ years)