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
Communication
Observation, reporting and documentation of patient status and the care of services provided
Reading and recording temperature, pulse and respiration
Universal Precautions
Basic elements of body functions and changes in condition that must be reported
Maintaining a clean, safe and health environment
Ability to recognize emergency situations
Ability to recognize physical and emotional needs and work with the client and respect the pt’s privacy and property
Bed Bath
Sponge Bath
Shampoo (sink, tub or bed)
Nail Care
Skin Care
Oral Hygiene
Toileting and elimination
Safe transfer techniques
Safe Ambulation
Normal positioning with proper body alignment
Ability to recognize adequate nutrition and intake
Other
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