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.
| Medication Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Documentation on M.A.R. |
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| Dose calculation |
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| Generic equivalents |
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| Usage of PDR |
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| Knowledge of drug actions/interactions |
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| Verification of narcotic wastage |
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| Oral medications |
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| Sublingual medications |
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| Intradermal medications |
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| Parenteral medications |
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| Subcutaneous medications |
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| Intramuscular medications |
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| Topical medications |
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| Eye drops |
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| Ear drops |
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| Swallowing precautions |
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| Inventory and storage control |
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| Infectious Control | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| AIDS/HIV interaction |
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| Hepatitis interaction |
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| Hospice |
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| MRSA |
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| VRE |
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| Fever management |
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| Interpretation of labs |
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| Decubitus/Wound care (Contaminated) |
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| Linen -Transporting, storing, & Handling |
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| Cleaned |
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| Soiled |
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| Personal clothing |
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| Proper disposal of sharpes and waste |
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| Standard precautions |
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| Pain Management | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Documentation and assessment of site, character, & frequency of pain |
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| Assessment of pain levels |
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| Documentation of response to pain medications |
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| Intraveneous Therapy | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| I.V. certified (Check '4') |
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| Administration of I.V. antibiotics |
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| Administration of I.V. fluids |
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| Administration of I.V. pain medications |
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| Administration of I.V. cardiac meds |
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| Blood draws - peripheral |
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| Blood draws - central line |
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| Blood draws - implanted catheter |
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| Care of I.V. site - peripheral |
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| Care of I.V. site - central line |
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| Care of I.V. site - implanted catheter |
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| I.V. dose calculations |
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| I.V. insertion - peripheral |
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| Use of infusion pumps |
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| Diabetic Care | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Diabetic monitoring |
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| S/S hyper/hypoglycemia |
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| Diabetic patient teaching |
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| Performing fingersticks |
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| Use of glucometers |
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| Insulin infusions |
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| Regular, long-acting insulin |
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| Mixed insulin |
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| Psychosocial Problems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment and documentation of behavioral problems (target behaviors) |
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| Assessment and documentation of s/s of depression |
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| Assessment and documentation of patient response to psychotropic medications |
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| Parameters for use of restraints in long-term care settings |
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| Assessment and documentation of effectiveness of preventive medicine medications |
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| Orthopedics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment of circulation |
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| Assessment of gait |
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| Assessment of range of motion |
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| Amputation care |
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| Post-arthroscopy care |
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| Casts and related care |
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| Osteoporosis |
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| Pinned fractures |
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| Total hip replacement |
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| Total knee replacement |
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| Rheumatic/Arthritic disease |
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| Continuous passive motion |
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| Canes |
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| Cervical collars |
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| Gait belts |
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| Prostheses |
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| Slings |
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| Transfer board |
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| Walker |
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| Wheelchair |
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| Cardiovascular Problems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Auscultation of rate/rythym |
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| Blood pressure |
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| Doppler |
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| Pulses |
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| Circulation checks |
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| CPR |
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| Post-abdominal aortic bypass |
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| Aneurysm |
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| Angina |
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| Post carotic endarterectomy |
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| Fem-pop bypass |
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| Permanent pacemaker |
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| Post acute M.I. |
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| Post cardiac surgery |
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| Thrombophlebitis |
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| DVT |
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| Congestive heart failure |
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| Administration of post-op cardiac meds |
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| Gastrointestinal Problems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Administration of tube feedings |
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| Administration of medications via tube |
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| Inflammatory bowel disease |
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| Bowel prep |
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| G.I. bleeding |
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| Gualac |
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| Nutritional status |
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| Colostomy care |
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| Post abdominal surgery |
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| NG tube placement and care |
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| Nasointestinal tube care |
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| Assessment of bowel tones |
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| Assessment of abdomen |
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| Enema administration |
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| Assessment of bowel incontinence |
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| Signs and symptoms of fecal impaction |
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| Neurological Problems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Post-Op anticonvulsant medications |
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| Assessing levels of consciousness |
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| Dementias (Re-direction/Validation) |
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| Neuromuscular disease |
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| CVA |
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| Pupil check |
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| A.I.M.S. |
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| Seizure precautions |
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| Administration of anticonvulsant |
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| Medications |
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| Aneurysm precautions |
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| Spinal cord injuries - long term |
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| Urinary Problems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment and care of AV shunt |
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| Post renal surgery |
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| Renal failure |
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| Assessment of urinary incontinence |
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| Assessment of I and O data |
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| Use of bladder scanne |
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| Signs and symptoms of UTI |
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| Indwelling catheter insertion |
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| Indwelling catheter care |
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| Straight catheter insertion |
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| Suprapubic catheter care |
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| Screening for UTI via urine dipstick |
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| Wounds, Pressure Sores, and Skin Impairments | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment and care of post-surgical wounds |
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| Assessment, prevention, and care of pressure ulcers |
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| Assessment and documentation of skin conditions/wounds |
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| Dressing changes - asceptic |
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| Dressing changes - sterile |
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| Wound irrigation |
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| Application of wound care products |
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| Use of air fluidized, low air-loss beds |
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| Use of pressure-relieving seat cushions |
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| Staple and suture removal |
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| Other Skills | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Alert charting system |
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| Use of 24-hour written and verbal reporting systems |
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| Use of '911' in LTC setting |
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| Regulatory guidelines related to the prevention of abuse and neglect of residents |
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| Regulatory guidelines related to resident rights in LTC setting |
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| Discerning code status |
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| Incident and accident reporting |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 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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