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
ADMIT / ORIENT VOLUNTARY CLIENTS
ADMIT / ORIENT INVOLUNTARY CLIENTS
INITIAL COMPREHENSIVE ASSESSMENT
INITIAL FOCUSED ASSESSMENT
INITIAL SCREENING ASSESSMENT
INITIATE CARE PLAN
REASSESSMENT / UPDATE CARE PLAN
MULTI-DISCIPLINARY PLANNING
SUPERVISE UNLICENSED PERSONNEL
VITAL SIGN MONITORING
FULL RESTRAINTS
WRIST RESTRAINTS
AMBULATORY CUFFS
ADMIN / MONITOR TUBE FEEDINGS
INSERT / CARE OF FOLEY CATHETER
ASSIST WITH LUMBAR PUNCTURE
ISOLATION TECHNIQUES
ADVANCE DIRECTIVES
PATIENT TEACHING
CASE MANAGER
DISCHARGE PLANNING
DISCHARGE CLIENTS
CULTURAL DIVERSITY
ETHNIC AWARENESS
FORENSIC NURSE
Schizophrenia
Paranoid Psychotic Disorder
Catatonic Psychotic Disorder
Hallucinations
Bipolar Disorder
Depression
Suicidal Ideation/Attempts
Delusional Disorders
Anxiety Disorders
Panic Attacks
Phobias
Obsessive/Compulsive Disorder
Dissociative Identity Disorder
Sexual Disorders
Sexual Abuse/Assault
Survivor of Abuse/Violence
Post Traumatic Stress Disorder
Somatoform Disorders (Pain etc.)
Mental Retardation
ADHD
Developmental / Autistc Disorders
Delirium
Dementia
Alzheimer's (Dementia)
Amnestic Disorders
Cluster A-Paranoid/Schizoid
Cluster B-Antisocial/Borderline
Cluster C-Anxious/Fearful
Anorexia Nervosa
Obesity
Bulimia Nervosa
Alcohol-Related
Drug-Related
BLURRED VISION
CONSTIPATION
DROWSINESS
DRY MOUTH
GASTROINTESTINAL EFFECTS
HYPO / HYPERGLYCEMIA
HYPOTENSION / ORTHOSTATIC
INSOMNIA
CHANGES IN LIBIDO
TACHYCARDIA
URINARY RETENTION
WEIGHT GAIN
PARKINSONISM SYMPTOMS
AKATHISIA (MOTOR RESTLESSNESS)
ACUTE DYSTONIC REACTIONS
TARDIVE DYSKINESIA
NEUROLEPTIC MALIGNANT SYNDROME
NEWBORN (BIRTH-30 DAYS)
INFANT (30 DAYS - 1 YEAR)
TODDLER (1 - 3 YEARS)
PRESCHOOLER (3 - 5 YEARS)
SCHOOL AGE (5 - 12 YEARS)
ADOLESCENTS (12 - 18 YEARS)
YOUNG ADULTS (18 - 39 YEARS)
MIDDLE ADULTS (39 - 64 YEARS)
OLDER ADULTS (64+ YEARS)
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