This checklist was electronically signed on (Today’s date)
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.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Utilize Common Medical acronyms and Abbrevations
Read and Document Time Correctly , and Correctly Calculate time Intervals
Report and Documents Incidents
Utilize Common Medical Terminology such as pulse , Oxygen start with Correct Spelling
Record Vital Signs
Record and Calculate intake & Output Measurement
Use of English and Metric Conversions to Calculate measurements
Document work Related activities and actions , including Writing Text
Documents using Graphic Notes
Document using Checklist Format
Document using Narrative Format
Utilize Computerized Documentation
Suicide Precautions
Transfer of Patient using safe transfer technique
Ambulation of Patient with assistive device as gait belt or walker
Use of prostehetic/ orthothi device
Fail Precaultions
Chair Alarms
Bed Alarms
Vest restraint
Mitt restraints
Wrist restraint
Prep patient prior to surgery
Simpel dressing change, if Applicable
Vaginal Douche
Bowel / Bladder Training
Application of K-Pads/ Modules
Applications of TED/ Support Stockings
Perform administration of enemas such as soaps suds/ Fleets
Replace telemetry leads and change batteries as needed
Perform fingerstick for blood glucose
Set/ Application of hot/cold catheter
Remove of external foley catheter
Removal of indewelling foley catheter
Propely Label all Specimens
Perform identification of patient before any procedure using two patient identifier
Assist nursing staff during patient, department and facility emergencies
Drains associated with post -operative care of patient (Jackson - Pratt, Hemo- Cac, Wounds Vacs, etc)
CPR
Post Mortem care wuth cultural/spirtual considerations
Preparation and use of EKG Equipment
Removal of peripheral IV needle and saline lock
AED
Blood (Fingerstick)
Emesis
Stool
Urine (toley)
Urine (Clean Catch)
Measuring Height & Weight
Assists with Patient Transport
Incorporate federal regulatory laws into care (ie Patients Bills of Rights, HIPAA Joint Commission National Patient Safety Goals. SDS)
Patient indentifcation using Two Patient Identifiers
Maintain patient dignity and privacy at all times
Understanding of pain scales
Priortize and pace work activities based upon productivity needs
Care for patient with DNR order
Care for the dying patient
Care for Confused Patient
Care for Combative Patient
Care for Suicidal Patient
Post-mortem care in accordance with cultural and religious considerations
Provide assistance with hospital gown
Provide patient orientation to room
Provide Equipment Set-up
Adjust bed setting/ controls
Secure patient valuables
Positioning / Turning
Shaving patient (safety/electri razor)
Skin Care (preventing pressure areas)
Nail Care (Clean /File)
Shampoo (in sink, tub, or bed)
Perineal Care
Shaving a patient
Tracheostomy Care
Colostomy care
Catheter Care
Back Care/ Massage
Range of Motion
Application Hot/ Cold Packs
Cast Care
Application of Ace Bandage
Assist patient with personal belongings
Assist with transport for patient such as wheelchair / stretcher
Communicate and immediately report any change in patient condition to nursing supervisor
Communicate clearly and effectively with other using phone/ patient call system or in persons
Provide introduction of self to patient and explaination of all actions before they are taken
Provide appropriate and timely information to team members regarding patient care
Blood Pressure Monitor
Blood Pressure (Manual)
Respirations
Pulse
Tympanic Temparature
Recital Temperature
Axillary Temperature
Oral Temperature
Shower
Whirlpool Bath
Sitz
Tub Bath with Assist
Partial Bed Bath
Complete Bed Bath
Post Op Surgical
Occupied
Unoccupied
Mouth Care (Swab, Lip Ointment)
Partials
Dental Care
Brushing Teeth
Aspiration Precautions
Assist patient with menu selection
Preparation of food such as opening containers and packages
Special Dietary requirements
Correct positioning of patient during and after feeding
Proper feeding techniques (with/without assistive devices)
Empty Colostomy
Provide ostomy care and assistance
Empty foley catheter
Maitenance and care of foley catheter
Assist patient with bedside commode
Assist patient with urinal
Assist patient with bedpan
Clean patient and patient enviornment
Utilize Computer or electronic device at a basic level including using a keyboard
Utilize hospital communication/ information system , such as telephones and patients call systems
Care of Oxygen equipment
Suction equipment set up
Blood Glucose monitor
Sequential compression devices
Traction
Walker / Cructhes
Bed Scale
Bladder Scanner
Wound vacuums
Use of Pneumatic tube systems
Care and cleaning of medical equipment
Therpeutic mattresses
Therapeutic beds
Bed Alarm
Bed Position
Scales
HoverMatt
HoverJack
Hoyer
Nursing Home/ Skilled Nursing Facility
Geriatic
Med-Surg
Home Care
Alzeimers
Neuro Unit
OB/GYN
Crisis Intervention
Behavioural Health
Nursery
1 : 1 Patient
Central Supply
Hospice
Urology
Clinic
Cardiac Unit
Orthopedic
Labor & Delivery
Private Duty
Surgical Unit
Acute Care/ Hospital
Personal Protective Equipment
Droplet Precautions
Contact Precautions
Airborne Precautions
Standard/ Universal Precautions
Hand Hygiene
Elderly (>60 years)
Mature Adult (30-60 years)
Young Adult (18-30 years)
Adolescent (12-18 years)
School Age (6-12 years)
Pre School (3-6 years)
Toddler (1-3)
Infant (Birth to 1 year)
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