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Long Term Care 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

CARDIAC Rating Stars (Click) 1 2 3 4  
Use of cardiac monitors 
 
Assessment of heart sounds 
 
Cardiac Arrest 
 
CPR 
 
Care of patients with CHF 
 
Atropine administration 
 
Digoxin administration 
 
Dopamine administration 
 
Inderal administration 
 
Lidocaine administration 
 
GENITOURINARY Rating Stars (Click) 1 2 3 4  
Fluid Balance 
 
Foley Catheter Insertion 
 
Ileostomy 
 
GU Irrigations 
 
Nephrostomy Tube 
 
ENDOCRINE Rating Stars (Click) 1 2 3 4  
Blood Glucose Checks 
 
Insulin Administration 
 
Care of patients with Diabetes 
 
GASTROINTESTINAL Rating Stars (Click) 1 2 3 4  
NG tube care and feedings 
 
Gastrostomy tube care and feedings 
 
Colostomy Care 
 
Assessment of Bowel Sounds 
 
LEADERSHIP/PATIENT CARE Rating Stars (Click) 1 2 3 4  
Taking Charge† 
 
Admission Procedures 
 
Discharge Procedures 
 
Patient Education 
 
Patient Care Plans 
 
MEDICATIONS/IV THERAPY Rating Stars (Click) 1 2 3 4  
Medication Calculation 
 
Reconstitution 
 
Oral Administration 
 
Eye Administration 
 
IM Administration 
 
SQ Administration 
 
Rectal Administration 
 
Starting IVís 
 
IV Medication Administration 
 
Central Line Care 
 
NEUROLOGY Rating Stars (Click) 1 2 3 4  
Assessment of Neurological Status 
 
Seizure Precautions 
 
Care of a patient with a CVA 
 
Care of a patient with Alzheimerís 
 
Care of patients with Spinal Cord Injury 
 
Decadron Administration 
 
Dilantin Administration 
 
Phenobarbital Administration 
 
Valium Administration 
 
ORTHO/SKIN Rating Stars (Click) 1 2 3 4  
Assessment of skin 
 
Wound Care and Treatments 
 
Use of special pressure relief devices 
 
Care of pts with a total hip replacement 
 
Care of pts with a total knee replacement 
 
Crutch Walking 
 
RESPIRATORY Rating Stars (Click) 1 2 3 4  
Pulse Oximetry 
 
Oxygen Administration via nasal cannuia 
 
Oxygen Administration via face mask 
 
Principles of chest percussion 
 
Care of patients with ventilator 
 
Care of patients with COPD 
 
Care of patients with ARDS 
 
Care of patient with a Tracheotomy 
 
Age Specific Competencies Rating Stars (Click) 1 2 3 4  
Infant (Birth - 1 year) 
 
Preschooler (ages 2-5 years) 
 
Childhood (ages 6-12 years) 
 
Adolescents (ages 13-21 years) 
 
Young Adults (ages 22-39 years) 
 
Adults (ages 40-64 years) 
 
Older Adults (ages 65-79 years) 
 
Elderly (ages 80+ years)