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Long Term Care Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided to FILL IN THE BLANK on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| 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 |
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| Rating Stars (Click) | CARDIAC | 1 | 2 | 3 | 4 | ||
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Use of cardiac monitors | ||||||
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Assessment of heart sounds | ||||||
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Cardiac Arrest | ||||||
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CPR | ||||||
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Care of patients with CHF | ||||||
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Atropine administration | ||||||
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Digoxin administration | ||||||
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Dopamine administration | ||||||
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Inderal administration | ||||||
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Lidocaine administration | ||||||
| Rating Stars (Click) | GENITOURINARY | 1 | 2 | 3 | 4 | ||
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Fluid Balance | ||||||
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Foley Catheter Insertion | ||||||
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Ileostomy | ||||||
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GU Irrigations | ||||||
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Nephrostomy Tube | ||||||
| Rating Stars (Click) | ENDOCRINE | 1 | 2 | 3 | 4 | ||
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Blood Glucose Checks | ||||||
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Insulin Administration | ||||||
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Care of patients with Diabetes | ||||||
| Rating Stars (Click) | GASTROINTESTINAL | 1 | 2 | 3 | 4 | ||
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NG tube care and feedings | ||||||
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Gastrostomy tube care and feedings | ||||||
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Colostomy Care | ||||||
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Assessment of Bowel Sounds | ||||||
| Rating Stars (Click) | LEADERSHIP/PATIENT CARE | 1 | 2 | 3 | 4 | ||
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Taking Charge | ||||||
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Admission Procedures | ||||||
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Discharge Procedures | ||||||
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Patient Education | ||||||
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Patient Care Plans | ||||||
| Rating Stars (Click) | MEDICATIONS/IV THERAPY | 1 | 2 | 3 | 4 | ||
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Medication Calculation | ||||||
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Reconstitution | ||||||
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Oral Administration | ||||||
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Eye Administration | ||||||
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IM Administration | ||||||
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SQ Administration | ||||||
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Rectal Administration | ||||||
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Starting IV’s | ||||||
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IV Medication Administration | ||||||
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Central Line Care | ||||||
| Rating Stars (Click) | NEUROLOGY | 1 | 2 | 3 | 4 | ||
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Assessment of Neurological Status | ||||||
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Seizure Precautions | ||||||
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Care of a patient with a CVA | ||||||
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Care of a patient with Alzheimer’s | ||||||
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Care of patients with Spinal Cord Injury | ||||||
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Decadron Administration | ||||||
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Dilantin Administration | ||||||
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Phenobarbital Administration | ||||||
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Valium Administration | ||||||
| Rating Stars (Click) | ORTHO/SKIN | 1 | 2 | 3 | 4 | ||
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Assessment of skin | ||||||
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Wound Care and Treatments | ||||||
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Use of special pressure relief devices | ||||||
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Care of pts with a total hip replacement | ||||||
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Care of pts with a total knee replacement | ||||||
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Crutch Walking | ||||||
| Rating Stars (Click) | RESPIRATORY | 1 | 2 | 3 | 4 | ||
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Pulse Oximetry | ||||||
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Oxygen Administration via nasal cannuia | ||||||
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Oxygen Administration via face mask | ||||||
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Principles of chest percussion | ||||||
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Care of patients with ventilator | ||||||
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Care of patients with COPD | ||||||
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Care of patients with ARDS | ||||||
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Care of patient with a Tracheotomy | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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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) | ||||||