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.
| SKILL: Communication | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Organize written and oral communication in a logical manner |
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| Question other health care professionals to collect pertinent patient information |
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| Communicate appropriately with the level of understanding of one's audience |
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| Use good listening skills in all aspects of job |
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| Interested in improving self and asks questions |
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| Other by site: |
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| Other by site: |
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| SKILL: Patient Interaction / Staff Relations | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Greets patient and introduces self |
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| Puts others at ease |
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| Interview patient or caregiver to collect pertinent patient information |
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| Use different strategies for communicating with non-English speakers or patients who are impaired i.e. deaf, cognitively impaired, etc |
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| Exhibit empathy and compassion |
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| Cooperation / Diplomacy and Tact with Staff |
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| Emotional Maturity to Function Under Stress |
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| Appropriate Conversation with Staff/Patients |
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| Use of Correct Terminology |
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| Sensitivity to Patient Comfort |
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| Other by site: |
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| SKILL: Personal Characteristics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Problem solve in the workplace to better a situation i.e. coworker conflict, workflow mechanics, etc. |
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| Adaptable to change; industrious |
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| Ability to learn and retain information |
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| Sufficent speed in completing tasks |
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| Ability to adapt to new procedures |
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| Displays initiative |
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| Demonstrate ethical behavior with emphasis on confidentiality, realization of professional liability, and importance of following protocol |
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| Maintain emotional stability to withstand the stresses, uncertainties, and changing circumstances that characterize patient/client care responsibilities |
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| Accept direction and guidance from a supervisor or faculty member |
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| Understands that each facility has some procedures that may differ from others and easily adapts to yours |
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| Arrives for shift on time / punctual |
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| Undertaking of appropriate & additional duties |
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| Maintains impeccable personal hygiene & professional personal appearance |
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| Anticipates Doctor’s / Co-worker needs |
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| Neatness in accomplishing work |
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| Other by site: |
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| SKILL: Essential Job Functions | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Collect pertinent patient information for use by the pharmacist from the chart or patient profile with efficiency and accuracy |
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| Be able to locate specific information from a medical record, profile, or electronic medical device |
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| Understand what is needed by the pharmacist to efficiently and accurately manage pharmacy services |
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| Demonstrate proficiency with word processing and database software |
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| Be able to use the internet, e-mail and computerized medication information databases |
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| Follow an established procedure for purchasing and pharmaceuticals, devices and supplies |
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| Understand, observe, and comply with State/Federal laws at practice site |
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| Be able to compound a sterile and non-sterile product |
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| Prepare an IV admixture |
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| Observe or prepare a T.P.N. order |
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| Suggest alternative avenues for procuring a product which is unavailable |
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| Understand alternative avenues for pricing and products available |
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| Know proper storage conditions for pharmaceutical items |
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| Know how to return expired, damaged or recalled pharmaceuticals |
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| Understand how to deter theft and/or medication diversion |
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| Inventory and maintain records for controlled substances |
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| Screen medication orders/prescriptions for completeness |
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| Create new patient profile |
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| Enter information accurately into computer to obtain label and MAR |
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| Accurately prepare medication order/prescription |
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| Know how to dispose of hazardous materials/waste |
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| Know how to prepare and label repackaged products |
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| Process reimbursement claim forms |
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| Sterilize a laminar or horizontal air flow hood |
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| Efficiently deliver the correct medication to the correct patient/representative |
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| Know the Pertinent policies and procedures for distribution of medications/controlled substances |
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| Know the facets of patient consultation a technician can/can’t perform |
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| Know how to handle 3rd party rejection claims |
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| Understand how to prevent and report medication errors |
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| Be able to work a cash register |
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| Reconstitute a granular antibiotic into suspension form |
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| Know how to prepare, store and distribute investigational drug products |
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| Know how to obtain technician licensure and certification |
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| Determine patient eligibility and co-pay |
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| Calibrate a device |
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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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