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.
OBTAINING AND RECORDING: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
BP, including Orthostatic |
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VITAL SIGNS AND WEIGHTS |
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Administering an Enema |
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Applying Ted Hose |
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Asssessing Respirations |
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Assisting with Ambulation |
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Assist with Dressing |
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Colostomy Care |
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Denture Care |
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EKG |
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Incentive Spirometer |
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Isolation Techniques |
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Making an Unoccupied Bed |
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Making an Occupied Bed |
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Massaging |
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Measuring Height |
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Measuring Intake and Output |
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Moving the Patient |
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Mouth Care |
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Perineal Care |
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Phlebotomy |
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Placing Restraints |
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Positioning the Patient |
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Postmortem Care |
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Range of Motion |
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Sterile Technique |
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Transferring the Client |
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Universal Precautions |
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Using a Mechanical Lift |
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Recognizing Cardiac Arrest |
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Activating Code Team |
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Bringing Emergency Equipment to Room |
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Providing Appropriate Code Support |
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GI/GU |
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Report Abnormal Findings |
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Bowel Function |
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Bladder Function |
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Placing and Removing Bed Pan |
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Clamping Catheter |
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Emptying Foley Bag |
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Placing Condom Catheter |
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Emptying and Replacing Ostomy Bag (Established Ostomy) |
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Assessing Pulse | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Apical |
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Radial |
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Assessing Temperature | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Axillary |
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Oral |
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Rectal |
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Tympanic |
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Medication Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Buccal |
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Oral |
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Rectal |
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Topical |
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Vaginal |
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Weighing the Client | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Chair |
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Bed |
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Sliding Scale |
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Use of Electronic VS Equipment: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Automatic BP machine (Dynamap) |
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Electronic Thermometer |
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Applying Oximeter |
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Administering Edemas: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Tap Water |
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Fleets |
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Nutrition: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Return Flow |
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Estimating Intake |
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Setting up for Meals |
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Feeding Patients |
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Aspiration Precautions |
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Nourishments |
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Counting Calories |
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Fluid Restriction |
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NPO |
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Specimens: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Collecting Stool |
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Collecting Sputum |
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Labeling Specimens and Preparing for Transport |
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Collecting Urine: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Clean catch |
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24 hour |
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Hygiene/Skin: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Risk Factors for Skin Breakdown |
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Observing Pressure Points for Redness or Breakdown |
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Bathing/Daisy Hygiene: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Bathing (Shower/Tub/Arjo) |
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Oral Care, including Patients who are NPO, Comatose |
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Pen Care |
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Foot Care for Patients with Impaired Circulation or Sensation |
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Incontinence Care |
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Shaving and Precautions |
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Reducing Pressure and Friction |
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Use of Pressure and Friction Reduction Services: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Special Beds/Mattresses |
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Heels and Elbow Protection |
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Foot Cradles |
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Use of Shower Chair |
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Use of Bath/Shower Boat |
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Infection Control: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Reverse Isolation |
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Body Substance Isolation |
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TB Precautions |
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MRSA Precautions |
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Hand washing |
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Infectious/Hazardous Waste Disposal |
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Supply/Equipment Disposal |
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Use of Disposable Thermometer |
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Use of CPR Mask/Bag |
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Proper Use of Specific Barrier, Methods: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Gloves |
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Gown |
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Mask/Goggles |
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Safety and Activity: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Determining Patient ID |
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Identifying Safety Hazards |
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Determining Need for Additional Help |
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Assessing Safety and ADL Needs |
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Recognizing Abuse: Substance, Physical, Emotional etc |
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Maintaining clean, orderly work area |
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Disposing of Sharps |
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Handling hazardous materials |
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Proper body mechanics |
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ROM Exercises |
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Transferring to bed, WC, Commode etc |
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Turning and positioning |
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Patient Safety Module |
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Reporting Broken Equipment |
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Responding to Safety Hazards |
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Use of HoyerLift (Dextra/Maxi) |
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Bed Operation |
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Use of Wheel Locks |
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Use of Alarms: Bed, Patient, Unit |
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Use of Call Light |
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Documenting Use of Restraints |
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Use of Transfer Belt |
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Use of Gait Belt for Ambulation |
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Use of Seizure Pads |
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Application of Restraints: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Belt including seat belt |
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Wrist/Ankle |
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Vest |
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AGE SPECIFIC COMPETENCIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn (birth to 30 days) |
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Infant (31 days to 1 year) |
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Toddler (ages 2-3 years) |
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Preschooler (ages 4-5 years) |
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Childhood (ages 6-12 years) |
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Adolescents (ages 13-21 years) |
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Young Adults (ages 22-39 years) |
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Adults (ages 40-64 years) |
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Older Adults (ages 65 -79 years) |
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Elderly (ages 80+ years) |
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