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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