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.
WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Acute Care – Adult |
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Clinic – Adult |
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SNF/LTAC/Subacute |
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Hospice / Palliative Care |
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Acute/Long Term Care – Pediatrics |
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Clinic – Pediatrics |
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PRESSURE ULCERS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assessment |
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Staging |
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Prevention/ Risk Assessment Tools – Adult |
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Prevention/ Risk Assessment Tools -Pediatrics |
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Support Surface Selection |
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NEUROPATHIC ULCERS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assessment |
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Management |
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VENOUS STASIS ULCERS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assessment |
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Management |
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PERIPHERAL ARTERIAL ULCERS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assessment |
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Ankle Brachial Index |
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Management |
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OTHER WOUNDS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Fistulae – Pouching / Skin Care |
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Skin Care/ Management of Drains |
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WOUND DEBRIDEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Autolytic |
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Enzymatic |
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Mechanical |
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Sharp |
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DRESSINGS/ TREATMENTS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Hydrogels |
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Hydrocolloids |
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Silver Products |
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Foams |
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Alginates |
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Vacuum Assisted Closure |
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Growth Factors |
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Skin Substitutes |
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Hyperbaric Oxygen Therapy |
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Wound Cultures |
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Electrical Stimulation |
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Enzymatic Debriding Agents |
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Mist Therapy |
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COLOSTOMY / ILEOSTOMY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Ostomy Equipment Selection |
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Continence Skin Care Management |
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Loop with Rod Stoma |
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End Stoma |
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Mucous Fistula |
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Double Barrel Stoma |
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Irrigation |
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Ileal Lavage |
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CONTINENT ILEOSTOMY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Knock pouch |
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Pelvic Pouch |
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UROSTOMY / CONTINENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Catherization for C&S |
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Knock Pouch |
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Neobladder |
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CONTINENCE THERAPEUTIC DEVICES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Vaginal Cones |
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Penile Clamps |
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Male External Catheters |
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Internal Urethral Inserts |
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Catheters –Mgmt & Self Care Teaching |
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Magnetic Therapy |
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Urinary Incontinence Program |
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Fecal Incontinence Program |
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BURNS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Burn Management |
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PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
National Patient Safety Goals/ Core Measures |
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Patient Family Teaching |
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Age Specific/Population Based Care |
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Isolation Precautions |
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Infection Precautions |
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Pain assessment & Management |
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Interpretation & Communication of Lab Values |
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EMR |
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EPIC |
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Cerner |
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Eclipsys |
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McKesson |
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Other Computerized System |
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Computerized Physician Order Entry |
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Bar coding for Medication |
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Culture |
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OTHER / MISC. | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Pain Management Assessment of Pain Levels without intervention |
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Pain Management Response Assessment with Intervention |
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Experience: Charge Duty |
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Experience: Preceptor |
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AGE SPECIFIC CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Infant (Birth to 1 year) |
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Toddler (1-3 years) |
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Pre-school (3-6 years) |
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School Age (6-12 years) |
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Adolescent (12-18 years) |
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Young Adult (18-30 years) |
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Mature Adult (30-60 years) |
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Elderly (>60 years) |
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