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