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.
| Work Settings | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| General Acute Care |
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| Home Health |
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| Nursing Home |
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| Outpatient Clinic |
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| Pediatric Rehab |
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| Acute Rehab Hospital |
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| Rehab Unit in Hospital |
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| Neuro | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cerebral Vascular Accident |
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| Coma Patients |
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| Head Trauma |
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| Spinal Cord Injury |
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| Parkinson’s Disease |
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| Traumatic Brain Injury |
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| Neuromuscular Disease |
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| Post Craniotomy |
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| Bowl/Bladder Programs |
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| Ortho | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Arthritis Programs |
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| Back Syndrome |
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| Cervical Traction |
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| Continuous Passive Motion Machine N/A |
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| Gait Training |
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| Hand Injury |
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| Hip Fractures |
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| Care of Patient with Halo |
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| Hot/Cold Packs |
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| Mobilization Techniques |
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| Neck Injuries |
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| TMJ Dysfunction |
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| Total Hip Replacement |
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| Total Knee Replacement |
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| Pulmonary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment of breath sounds |
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| Chest Physiotherapy |
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| Oximetry |
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| Nasal cannula |
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| Face Mask |
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| Portable O2 tank |
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| Nasotracheal Suctioning |
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| Tracheal Suctioning |
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| Care of patient w/Mechanical Vent |
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| COPD |
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| Pediatrics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cerebral Palsy |
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| Activities of Daily Living |
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| Learning Disabilities |
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| Orthotics |
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| Spina Bifida |
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| Autism |
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| AK Prosthetics |
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| Amputees |
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| BK Prosthetics |
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| Bracing/Joint Immobilization |
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| Resting Splints |
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| Casts/Check for Circulation |
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| Upper Extremity Prosthetics |
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| Nutritional Requirements | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Thickened Liquids |
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| Minimal |
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| Thick |
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| Extra Thick |
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| Pudding Thick |
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| NG Tubes |
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| Peg Tubes |
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| Restraints | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 4pt |
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| Shoulder Strap |
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| Hand Mitts |
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| Wrist |
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| Ankle |
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| Pelvic Strap |
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| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Epic |
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| Cerner |
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| Eclipsys |
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| McKesson |
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| Meditech |
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| Other Computerized System |
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| Computerized Physician Order Entry |
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| Bar Coding for Medication Administration |
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| Other | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Ability to evaluate and assign Functional Independence Score |
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| AIDS Patients |
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| Burn Management |
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| Cardiac Rehabilitation |
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| Function Capacity Evaluation |
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| Geriatrics |
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| Manual Therapy |
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| Massage Therapy |
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| Muscle Stimulation |
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| Pain Management/Giving Meds |
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| Physical Capacity |
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| Pulmonary Rehab |
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| Sterilization Technique |
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| TENS |
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| Wound Debridement/Dressing Change |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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) |
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