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.
CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
ACS/Post MI |
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Heart Failure |
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Post Cardiac Surgery |
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Cardiac Auscultation (Rate/Rhythm) |
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Peripheral Pulse/Circulation Checks |
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PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Asthma |
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COPD |
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Pneumonia |
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Lung Cancer |
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Pulmonary Emboli |
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Auscultate Lung Sounds |
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Oxygen Administration |
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Oxygen Safety |
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Oro/Nasotracheal Suctioning |
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CPAP/BiPAP |
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Ventilator Management (Specify): |
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NEUROLOGICAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
CVA |
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Alzheimer's Disease/Dementia |
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Parkinson's |
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Degenerative Neurologic Disorders (ALS, MS, etc.) |
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Brain Tumor |
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Brain Injury |
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Para/Quadriplegia |
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Seizure Disorder |
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Level of Consciousness/Neuro Changes |
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ORTHOPEDICS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Joint Replacement |
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DVT Prophylaxis/Recognition |
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Incision Checks |
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Staple Removal |
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Fractures |
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Cast/Brace |
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Amputation |
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Arthritis |
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Assistive Equipment/Lift Devices |
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In Home PT/INR (Specify): |
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GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Nutritional Assessment |
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Colostomy/Ileostomy Management |
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Fecal Incontinence/Diarrhea |
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Bowel Obstruction |
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GI Bleed |
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Post GI Surgery |
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Hepatitis Liver Failure |
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NG Tubes |
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Feeding Tubes |
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Feeding Pumps (Specify): |
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Drainage Devices |
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RENAL/GENITOURINARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Hemodialysis |
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AV Fistula/Shunt |
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Peritoneal Dialysis |
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Post Bladder Surgery |
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Post Prostate Surgery |
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Urostomy |
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Urinary Incontinence |
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Bladder Catheter Insertion/Maintenance |
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Suprapubic Catheter Insertion/Maintenance |
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ENDOCRINE/METABOLIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Diabetes |
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Hyper/Hypoglycemia |
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Diabetic Skin Assessment |
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Cushing's / Addison's Disease |
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Thyroid Disease |
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Insulin Pumps |
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Glucometers |
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WOUND/SKIN CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Braden Scale |
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Pressure Ulcer Prevention |
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Pressure Ulcer Staging |
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Pressure Ulcer Management |
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Burns |
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Wound Care |
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Wound Cultures |
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Wound Vac |
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ONCOLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Risk for Infection |
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Symptom Management |
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Side Effects of Treatment |
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Terminal Disease |
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INFECTIOUS DISEASE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
MRSA |
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VRE |
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C. Difficile |
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HIV |
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Tuberculosis |
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Isolation Precautions |
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PHLEBOTOMY/IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Peripheral Venipuncture for Labs |
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Start Ivs |
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Peripheral Ivs |
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PICC/CVP Lines |
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Venous Access Ports |
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Infusion Pump Set up and Management |
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Specify Infusion Pump Type: |
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PSYCHIATRIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cognitive Disorders |
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Mood Disorders |
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Schizophrenia/Psychotic Disorders |
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Medication Compliance |
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WOMENS HEALTH/MATERNAL-INFANT CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Pregnancy Related Complications |
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Fetal Heart Tones |
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Contractions |
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Post Partum Mother/Baby Visit |
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Newborn Care |
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Phototherapy |
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Breast Feeding Support |
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PEDIATRICS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Growth and Development |
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Respiratory Distress Syndrome |
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Bronchopulmonary Dysplasia |
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Cystic Fibrosis |
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Muscular Dystrophy |
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Spina Bifida |
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Spinal Surgery |
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Sickle Cell Disease |
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Trach Care/Suctioning |
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Ventilator Management |
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Ventilator Type (Specify): |
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PAIN MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Verbal/Nonverbal Pain Scales |
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Response to Pain Management Interventions |
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PCA Pump |
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Epidural Cath/Site Monitoring/Pump |
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Non-Pharmacologic Pain Measures |
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PALLIATIVE AND END OF LIFE CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Palliative Symptom Management |
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Pain Management/Response |
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Family Support/Teaching |
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After Death Protocols |
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MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Alzheimer's Medications |
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Antiarrhythmics |
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Antibiotics/Antivirals |
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Anti-Depressants |
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Anti-Hypertensives |
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Anti-Psychotics |
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Anti-Seizure Medications |
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Benzodiazepines |
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Calculation of Pediatric Dosages |
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Coumadin |
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Diuretics |
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Enoxaparin |
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Inhaled Medications |
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Nebulizer Medications |
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Insulin |
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Opioid and Non-Opioid Analgesics |
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Oral Chemotherapy |
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Oral Hypoglycemics |
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Oral & Topics Nitrates |
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Rivaroxaban |
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Sedative/Hypnotics |
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Steroids |
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HOME HEALTH | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Intake/Admissions |
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Case Manager |
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Case Load - Pts/Day(specify) |
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Supervise LVNs/HHAs |
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Medicare/Medicaid |
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Long/Short Term Disability |
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Private Insurance |
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Telephonic Assessments |
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Management of Complaints |
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APS Reports |
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OASIS |
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Diagnosis Coding |
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Document Plan of Care |
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Clinical Assessment Documentation |
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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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Safety Assessment |
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Fall Assessment and Prevention |
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Patient/Family Teaching |
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Age Specific/Population Based Care |
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EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Allscripts |
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Cerner |
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Epic |
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HomeCare Home Base |
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McKesson |
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Meditech |
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Other Computerized Documentation System |
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EMR Conversion |
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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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