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.
General Duties | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Awareness of HCAHPS |
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Administrative procedures |
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MDS Coordinator Admit/discharge patients |
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Blood glucose monitoring |
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Coordinate scheduling |
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Documentation |
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Dressing changes |
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Familiarity with advanced directives |
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HIPPA regulations |
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Isolation techniques |
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Observe for adverse medication reaction |
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Alert licensed staff of medication reaction |
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Patient education |
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Position/transfer patients |
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Prepare reports |
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Pulse oximetry |
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Lab draw |
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Screen/direct provider calls |
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Screen/direct patient calls |
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Urine dipstick |
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Universal precautions |
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Vital signs |
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Wound care |
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Patient's health history |
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Patient's physical exam |
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Patient procedures |
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Diagnostic testing and procedures |
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Discharge instructions |
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Therapeutic procedures |
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Cardiac | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assist with emergency |
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Perform 12 lead EKG |
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Use of cardiac monitor |
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Vascular | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Apply/monitor noninvasive BP monitor |
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Intake and output |
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Discontinue peripheral IV |
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Manual BP |
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Phlebotomy draws |
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Pulmonary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Apply nasal cannula/face mask |
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Incentive spirometry |
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O2 saturation monitor |
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Neurology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assist with lumbar puncture |
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Neurological evaluation |
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Seizure precautions |
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Orthopedic | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cast care |
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Crutch walking |
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Traction |
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Gastrointestinal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assist with feeding |
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Nutritional evaluation |
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Instruct/obtain clean catch urine |
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Straight/Foley catheter female |
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Straight/Foley catheter male |
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Medication Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Vitamins, minerals, herbs |
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Antibiotics |
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Antifungal |
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Antiviral |
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Psychotropic |
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Ophthalmic medications |
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Aural medications |
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Respiratory system medications |
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Cardiovascular system medications |
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Gastrointestinal system medications |
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Urinary system medications |
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Reproductive system medications |
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Endocrine system medications |
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Musculoskeletal system medications |
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Nervous system medications |
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Intramuscular (IM) |
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Subcutaneous (SQ |
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Intradermal |
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Z-track |
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Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn/neonate (birth-30 days) |
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Infant (31 days-1 year) |
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Toddler (ages 2-3 years) |
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Preschool (ages 4-5 years) |
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School age (ages 6-12 years) |
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Adolescent (ages 13-21 years) |
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Young adult (ages 22-39 years) |
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Adult (ages 40-64 years) |
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Older adult (ages 65-79 years) |
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Elderly (ages 80+ years) |
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