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 | ||
| General acute care |
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| Adult/adult ICU |
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| Pediatrics/PICU |
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| Children’s hospital |
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| Hand therapy |
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| Home health care |
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| Outpatient neuro |
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| Outpatient ortho |
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| Psychiatric hospital |
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| Rehabilitation hospital/inpatient rehabilitation unit |
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| Skilled care facility |
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| School setting |
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| Early intervention |
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| Subacute |
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| Orthopedics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Hand injury |
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| Total joint replacement/upper extremities |
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| Lower back/spinal surgeries |
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| Arthritis programs |
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| Soft tissue injuries |
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| Knee injuries & total knee replacement |
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| Hip fractures & total hip replacement |
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| Mobilization techniques |
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| Prosthetics/amputations |
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| Neurologic | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Alzheimers/dementia |
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| Degenerative diseases of the CNS |
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| Multiple sclerosis |
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| Parkinson’s disease |
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| Spinal cord injury |
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| Adaptive equipment |
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| Neurodevelopmental testing (NDT) |
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| Wheelchair evaluation |
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| Stroke acute |
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| Stroke rehabilitation |
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| Functional splinting |
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| Traumatic brain injury |
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| Pediatric Assessments | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Neurodevelopmental testing |
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| Developmental screening |
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| Sensory-motor testing |
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| Visual perceptual testing |
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| Feeding/swallowing/oral motor |
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| Seating & positioning assessment (i.e. w/c) |
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| Other Assessments | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Physical capacity evaluation |
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| Home assessments/home accessibility |
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| Activities of daily living |
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| Driving evaluation |
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| Cognitive/perception |
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| Treatment Approaches | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| ADL |
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| Cognitive retraining |
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| Community re-entry |
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| Energy conservation/work simplification techniques |
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| Functional transfer training |
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| Home safety |
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| Lymphedema management |
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| Orthotics/Prosthetics training |
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| Treatment Approaches - cont. | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Patient, family & staff training |
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| PNF |
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| SI |
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| Therapeutic exercises/activities |
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| Work hardening |
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| Splinting |
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| Neurodevelopmental testing (NDT) |
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| Incontinence management |
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| Modalities | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Anodyne |
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| Biofeedback |
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| Electrical stimulation |
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| Fluidotherapy |
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| Oral motor facilities |
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| Paraffin bath |
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| TENS |
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| Therapeutic pool |
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| Ultrasound |
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| Prosthetics/Orthotics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| UE prosthetics |
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| Static splints |
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| Dynamic splints |
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| Serial casting |
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| Other | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Burn management |
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| Cardiac rehabilitation |
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| Cognitive retraining |
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| Computer skills |
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| FIM scoring |
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| Geriatrics |
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| Group dynamics |
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| IEP skills |
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| Other - cont. | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Inservice education |
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| Job task analysis |
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| Therapeutic media |
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| Knowledge of payment sources |
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| Medicare |
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| Medicaid |
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| MDS |
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| General Skills | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Patient/family teaching |
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| Patients in isolation |
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| Patients in restraints |
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| Initial evaluation |
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| Lift/transfer devices |
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| Specialty beds |
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| End of life care/palliative care |
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| Cerner |
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| EPIC |
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| McKesson |
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| Meditech |
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| Accurate patient identification |
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| Effective communication |
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| Pain assessment & management |
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| Infection control |
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| Universal precautions |
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| Care of patients in isolation |
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| Minimize risk of falls |
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| Prevention of pressure ulcers |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (birth to 1 year) |
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| Toddler (ages 1-3 years) |
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| Preschooler (ages 3-5 years) |
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| Childhood (ages 6-12 years) |
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| Age Specific Competencies - cont. | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Adolescents (ages 12-21 years) |
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| Young Adults (ages 21-39 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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| Additional training: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Additional equipment: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||