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CNA 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

Patient Rights Rating Stars (Click) 1 2 3 4  
Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 
 
Involves the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives. 
 
Complies with nursing staff responsibility included in the hospital policy related to Organ Donation. 
 
Meets patient and families needs regarding communication, including interpreter services 
 
Provides accurate information to patient and families in a timely manner. 
 
Vital Signs and Weights Rating Stars (Click) 1 2 3 4  
Obtaining and Recording 
 
BP, including Orthostatic 
 
Pulse, Radia 
 
Temperature, Oral 
 
Temperature, Rectal 
 
Temperature, Axillary 
 
Temperature, Tympanic 
 
Respirations 
 
Weight, Pounds and Kilograms 
 
Recognizing Cardiac Arrest 
 
Activating Code Team 
 
Bringing Emergency Equipment to Room 
 
Providing Appropriate Code Support 
 
Use of Electronic VS equipment: Rating Stars (Click) 1 2 3 4  
Automatic BP machine (Dynamap) 
 
Electronic Thermometer 
 
Applying Oximeter 
 
Scale Use: Rating Stars (Click) 1 2 3 4  
Standing 
 
Chair 
 
Bed 
 
GI /GU Rating Stars (Click) 1 2 3 4  
Report Abnormal Findings 
 
Bowel Function 
 
Bladder Function 
 
Administering Enemas: Rating Stars (Click) 1 2 3 4  
Tap Water 
 
Fleets 
 
Return Flow 
 
Vital Signs and Weights Rating Stars (Click) 1 2 3 4  
Placing and Removing Bed Pan 
 
Clamping Catheter 
 
Emptying Foley Bag 
 
Placing Condom Catheter 
 
Emptying and Replacing Ostomy Bag (Established Ostomy) 
 
Nutrition Rating Stars (Click) 1 2 3 4  
Estimating Intake 
 
Setting up for Meals 
 
Feeding Patients 
 
Aspiration Precautions 
 
Nourishments 
 
Counting Calories 
 
Fluid Restriction 
 
NPO 
 
Specimens Rating Stars (Click) 1 2 3 4  
Collecting Stool 
 
Collecting Sputum 
 
Labeling Specimens and Preparing for Transport 
 
Collecting Urine: Rating Stars (Click) 1 2 3 4  
Clean Catch 
 
24 Hour 
 
Hygiene /Skin Rating Stars (Click) 1 2 3 4  
Risk Factorsfor Skin Breakdown 
 
Observing Pressure Points for Redness or Breakdown 
 
Bathing /Daisy Hygiene: Rating Stars (Click) 1 2 3 4  
Bathing (Shower /Tub /Arjo) 
 
Oral Care, Including Patients who are NPO,Comatose, Patients with 
 
Pen Care 
 
Foot Care for Patients with Impaired Circulation or Sensation 
 
Incontinence Care 
 
Shaving and Precautions 
 
Reducing Pressure and Friction 
 
Use of Pressure and Friction Reduction Devices: Rating Stars (Click) 1 2 3 4  
Special Beds/Mattresses 
 
Heels and Elbow Protection 
 
Foot Cradles 
 
Use of Shower Chair 
 
Use of Bath/Shower Boat 
 
Infection Control Rating Stars (Click) 1 2 3 4  
Reverse Isolation 
 
Body Substance isolation 
 
TB Precautions 
 
MRSA Precautions 
 
Hand Washing 
 
Infectious/Hazardous Waste Disposal 
 
Supply/Equipment Disposal 
 
Use of Disposable Therrnomete 
 
Use of CPR Mask/Bag 
 
Proper use of Specific Barrier, Methods: Rating Stars (Click) 1 2 3 4  
Gloves 
 
Gown 
 
Mask / Goggles 
 
Safety and Activity Rating Stars (Click) 1 2 3 4  
Determining Patient ID 
 
Identifying Safety Hazards 
 
Determining Need for Additional Help 
 
Assessing Safety and ADL Needs 
 
Assessing Safety and ADL Needs 
 
Recognizing Abuse: Substance, Physical, Emotional, etc 
 
MaintainingClean, Orderly Work Area 
 
Disposing of Sharps 
 
Handling Hazardous Materials 
 
Proper Body Mechanics 
 
ROM Exercises 
 
Transferring to Bed,WC, Commode, etc 
 
Turning and Positioning 
 
Patient Safety Module 
 
Reporting Broken Equipment 
 
Responding to Safety Hazards 
 
Use of HoyerLift (Dextra /Maxi) 
 
Bed Operation 
 
Use of Wheel Locks 
 
Use of Alarms: Bed, Patient, Unit 
 
Use of CaIl Light 
 
Documenting Use of Restraints 
 
Use of Transfer Belt 
 
Use of Gait Belt for Ambulation 
 
Use of Seizure Pads 
 
Application of Restraints: Rating Stars (Click) 1 2 3 4  
Belt Including Seat Belt 
 
Wrist/Ankle 
 
Vest 
 
New Admissions and Transfers: Rating Stars (Click) 1 2 3 4  
Inventory andDispositionof Belongings, Useof Checklist 
 
Room Orientation, Call Bell 
 
Post-op Patients: Rating Stars (Click) 1 2 3 4  
Transferring into Bed 
 
Call Bell 
 
Assist with Turns 
 
ROM Exercises 
 
Maintaining 02 Therapy: Rating Stars (Click) 1 2 3 4  
Replacing Mask or Nasal Caunula if Needed 
 
Notifying Nurse of Problems 
 
Basic Comfort Measures 
 
Preparation For and Transfer to SNF: Rating Stars (Click) 1 2 3 4  
Early Bath 
 
Preparing Belongings 
 
Preparingfor and Explaining Routinesto Patient 
 
Post Mortem Care 
 
Use ofIncentive Spirometer 
 
Removing /Replacing: Rating Stars (Click) 1 2 3 4  
Antiembolic Stockings 
 
Sequential Stockings 
 
Communication Rating Stars (Click) 1 2 3 4  
Using Appropriate Abbreviations 
 
Identifying UnusuaI Patient Incidents that Require Reporting 
 
Reinforcing RN Teaching With Patient 
 
Selecting and Using Forms Appropriately 
 
Using Alternate Communication Tools /Devices 
 
Communicating to RN: Rating Stars (Click) 1 2 3 4  
Changes in Patient Condition 
 
Patient Needs, Complaints and Concerns 
 
Unusual Incidents 
 
Recording and Reporting: Rating Stars (Click) 1 2 3 4  
Vital Signs 
 
Bathing /Hygiene 
 
Turning and Repositioning 
 
Ambulation and Activity 
 
Diet intake, Calorie Count 
 
Bowel Movements 
 
1 & 0: Rating Stars (Click) 1 2 3 4  
Shift Volumes and Totals 
 
Marking and /or Measuring Amount of Urine, Gastric Fluid, NG Drainage, Emesis, Diarrhea 
 
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) 
 
Older Adults (ages 65-79 years) 
 
Adults (ages 40-64 years) 
 
Elderly (ages 80+ years) 
 
Unit Activity Rating Stars (Click) 1 2 3 4  
Identifying Unusual Incidents on the Unit that Require Reporting 
 
Locating and Using Appropriate Reference Materials: Hospital, Patient Care and 
 
Charging for Patient Care Items 
 
Completing Risk Management Reports as Needed 
 
Obtaining Needed Supplies and Equipment 
 
Reporting and Following up on Faulty Equipment and Supplies 
 
Using Telephone System