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.
Patient Rights | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) |
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Involves the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives. |
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Complies with nursing staff responsibility included in the hospital policy related to Organ Donation. |
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Meets patient and families needs regarding communication, including interpreter services |
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Provides accurate information to patient and families in a timely manner. |
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Vital Signs and Weights | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Obtaining and Recording |
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BP, including Orthostatic |
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Pulse, Radia |
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Temperature, Oral |
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Temperature, Rectal |
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Temperature, Axillary |
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Temperature, Tympanic |
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Respirations |
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Weight, Pounds and Kilograms |
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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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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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Scale Use: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Standing |
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Chair |
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Bed |
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GI /GU | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Report Abnormal Findings |
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Bowel Function |
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Bladder Function |
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Administering Enemas: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Tap Water |
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Fleets |
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Return Flow |
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Vital Signs and Weights | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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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Nutrition | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 Factorsfor 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, Patients with |
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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 Devices: | 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 Therrnomete |
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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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Assessing Safety and ADL Needs |
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Recognizing Abuse: Substance, Physical, Emotional, etc |
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MaintainingClean, 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 CaIl 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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New Admissions and Transfers: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Inventory andDispositionof Belongings, Useof Checklist |
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Room Orientation, Call Bell |
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Post-op Patients: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Transferring into Bed |
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Call Bell |
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Assist with Turns |
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ROM Exercises |
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Maintaining 02 Therapy: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Replacing Mask or Nasal Caunula if Needed |
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Notifying Nurse of Problems |
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Basic Comfort Measures |
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Preparation For and Transfer to SNF: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Early Bath |
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Preparing Belongings |
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Preparingfor and Explaining Routinesto Patient |
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Post Mortem Care |
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Use ofIncentive Spirometer |
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Removing /Replacing: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Antiembolic Stockings |
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Sequential Stockings |
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Communication | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Using Appropriate Abbreviations |
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Identifying UnusuaI Patient Incidents that Require Reporting |
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Reinforcing RN Teaching With Patient |
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Selecting and Using Forms Appropriately |
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Using Alternate Communication Tools /Devices |
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Communicating to RN: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Changes in Patient Condition |
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Patient Needs, Complaints and Concerns |
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Unusual Incidents |
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Recording and Reporting: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Vital Signs |
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Bathing /Hygiene |
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Turning and Repositioning |
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Ambulation and Activity |
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Diet intake, Calorie Count |
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Bowel Movements |
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1 & 0: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Shift Volumes and Totals |
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Marking and /or Measuring Amount of Urine, Gastric Fluid, NG Drainage, Emesis, Diarrhea |
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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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Older Adults (ages 65-79 years) |
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Adults (ages 40-64 years) |
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Elderly (ages 80+ years) |
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Unit Activity | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Identifying Unusual Incidents on the Unit that Require Reporting |
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Locating and Using Appropriate Reference Materials: Hospital, Patient Care and |
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Charging for Patient Care Items |
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Completing Risk Management Reports as Needed |
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Obtaining Needed Supplies and Equipment |
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Reporting and Following up on Faulty Equipment and Supplies |
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Using Telephone System |
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