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 
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 
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 
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)