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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