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
General Acute Care
Home Health
Nursing Home
Pediatric Rehab
Acute Rehab Hospital
Rehab Unit in Hospital
Cerebral Vascular Accident
Coma Patients
Head Trauma
Spinal cord injury
Parkinson’s Disease
Traumatic Brain Injury
Neuromuscular Disease
Post Craniotomy
Bowl/Bladder Programs
Arthritis Programs
Back Syndrome
Cervical Traction
Continuous Passive Motion Machine N/A
Gait Training
Hand Injury
Hip Fractures
Care of Patient with Halo
Hot/Cold Packs
Neck Injuries
TMJ Dysfunction
Total Hip Replacement
Total Knee Replacement
Assessment of breath sounds
Chest Physiotherapy
Nasal cannula
Face Mask
Portable O2 tank
Nasotracheal Suctioning
Tracheal Suctioning
Care of patient w/Mechanical Vent
COPD
Cerebral Palsy
Activities of Daily Living
Learning Disabilities
Orthotics
Spina Bifida
Autism
AK Prosthetics
Amputees
Bracing/Joint Immobilization
Resting Splints
Casts/Check for Circulation
Upper Extremity Prosthetics
Thickened Liquids
Minimal
Thick
Extra Thick
Pudding Thick
NG Tubes
Peg Tubes
4pt
Shoulder Strap
Hand Mitts
Wrist
Ankle
Pelvic Strap
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
Ability to evaluate and assign Functional Independence Score
AIDS Patients
Burn Management
Cardiac Rehabilitation
Function Capacity Evaluation
Geriatrics
Manual Therapy
Massage Therapy
Muscle Stimulation
Pain Management/Giving Meds
Physical Capacity
Pulmonary Rehab
Sterilization Technique
TENS
Wound Debridement/Dressing Change
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
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