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.
| General Duties | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Awareness of HCAHPS |
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| Administrative procedures |
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| MDS Coordinator Admit/discharge patients |
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| Blood glucose monitoring |
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| Coordinate scheduling |
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| Documentation |
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| Dressing changes |
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| Familiarity with advanced directives |
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| HIPPA regulations |
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| Isolation techniques |
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| Observe for adverse medication reaction |
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| Alert licensed staff of medication reaction |
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| Patient education |
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| Position/transfer patients |
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| Prepare reports |
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| Pulse oximetry |
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| Lab draw |
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| Screen/direct provider calls |
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| Screen/direct patient calls |
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| Urine dipstick |
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| Universal precautions |
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| Vital signs |
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| Wound care |
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| Patient's health history |
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| Patient's physical exam |
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| Patient procedures |
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| Diagnostic testing and procedures |
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| Discharge instructions |
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| Therapeutic procedures |
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| Cardiac | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assist with emergency |
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| Perform 12 lead EKG |
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| Use of cardiac monitor |
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| Vascular | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Apply/monitor noninvasive BP monitor |
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| Intake and output |
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| Discontinue peripheral IV |
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| Manual BP |
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| Phlebotomy draws |
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| Pulmonary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Apply nasal cannula/face mask |
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| Incentive spirometry |
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| O2 saturation monitor |
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| Neurology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assist with lumbar puncture |
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| Neurological evaluation |
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| Seizure precautions |
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| Orthopedic | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cast care |
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| Crutch walking |
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| Traction |
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| Gastrointestinal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assist with feeding |
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| Nutritional evaluation |
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| Instruct/obtain clean catch urine |
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| Straight/Foley catheter female |
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| Straight/Foley catheter male |
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| Medication Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Vitamins, minerals, herbs |
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| Antibiotics |
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| Antifungal |
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| Antiviral |
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| Psychotropic |
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| Ophthalmic medications |
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| Aural medications |
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| Respiratory system medications |
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| Cardiovascular system medications |
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| Gastrointestinal system medications |
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| Urinary system medications |
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| Reproductive system medications |
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| Endocrine system medications |
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| Musculoskeletal system medications |
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| Nervous system medications |
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| Intramuscular (IM) |
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| Subcutaneous (SQ |
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| Intradermal |
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| Z-track |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Newborn/neonate (birth-30 days) |
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| Infant (31 days-1 year) |
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| Toddler (ages 2-3 years) |
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| Preschool (ages 4-5 years) |
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| School age (ages 6-12 years) |
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| Adolescent (ages 13-21 years) |
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| Young adult (ages 22-39 years) |
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| Adult (ages 40-64 years) |
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| Older adult (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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