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Last 4 Of SSN
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I hereby certify that ALL information I have provided 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.
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Obtaining and Recording
BP, including Orthostatic: 0★★★★−
Vital Signs and Weights: 0★★★★−
Administering an Enema: 0★★★★−
Applying Ted Hose: 0★★★★−
Assessing Respirations: 0★★★★−
Assisting with Ambulation: 0★★★★−
Assist with Dressing: 0★★★★−
Colostomy Care: 0★★★★−
Denture Care: 0★★★★−
EKG: 0★★★★−
Incentive Spirometer: 0★★★★−
Isolation Techniques: 0★★★★−
Making an Unoccupied Bed: 0★★★★−
Making an Occupied Bed: 0★★★★−
Massaging: 0★★★★−
Measuring Height: 0★★★★−
Measuring Intake and Output: 0★★★★−
Moving the Patient: 0★★★★−
Mouth Care: 0★★★★−
Perineal Care: 0★★★★−
Phlebotomy: 0★★★★−
Placing Restraints: 0★★★★−
Positioning the Patient: 0★★★★−
Postmortem Care: 0★★★★−
Range of Motion: 0★★★★−
Sterile Technique: 0★★★★−
Transferring the Client: 0★★★★−
Universal Precautions: 0★★★★−
Using a Mechanical Lift: 0★★★★−
Recognizing Cardiac Arrest: 0★★★★−
Activating Code Team: 0★★★★−
Bringing Emergency Equipment to Room: 0★★★★−
Providing Appropriate Code Support: 0★★★★−
GI/GU Report Abnormal Findings: 0★★★★−
Bowel Function: 0★★★★−
Bladder Function: 0★★★★−
Placing and Removing Bed Pan: 0★★★★−
Clamping Catheter: 0★★★★−
Emptying Foley Bag: 0★★★★−
Placing Condom Catheter: 0★★★★−
Emptying and Replacing Ostomy Bag: 0★★★★−
Assessing Pulse
Apical: 0★★★★−
Radial: 0★★★★−
Assessing Temperature
Axillary: 0★★★★−
Oral: 0★★★★−
Rectal: 0★★★★−
Tympanic: 0★★★★−
Medication Administration
Buccal: 0★★★★−
Topical: 0★★★★−
Vaginal: 0★★★★−
Weighing the Client
Chair: 0★★★★−
Bed: 0★★★★−
Sliding Scale: 0★★★★−
Use of Electronic VS Equipment
Automatic BP Machine (Dynamap): 0★★★★−
Electronic Thermometer: 0★★★★−
Applying Oximeter: 0★★★★−
Administering Edemas
Tap Water: 0★★★★−
Fleets: 0★★★★−
Return Flow: 0★★★★−
Nutrition
Estimating Intake: 0★★★★−
Setting up for Meals: 0★★★★−
Feeding Patients: 0★★★★−
Aspiration Precautions: 0★★★★−
Nourishments: 0★★★★−
Counting Calories: 0★★★★−
Fluid Restriction: 0★★★★−
NPO: 0★★★★−
Specimens
Collecting Stool: 0★★★★−
Collecting Sputum: 0★★★★−
Labeling Specimens and Preparing for Transport: 0★★★★−
Collecting Urine
Clean Catch: 0★★★★−
24 Hour: 0★★★★−
Hygiene/Skin
Risk Factors for Skin Breakdown: 0★★★★−
Observing Pressure Points for Redness or Breakdown: 0★★★★−
Bathing/Daisy Hygiene
Bathing (Shower/Tub/Arjo): 0★★★★−
Oral Care, including Patients who are NPO, Comatose: 0★★★★−
Pen Care: 0★★★★−
Foot Care for Patients with Impaired Circulation or Sensation: 0★★★★−
Incontinence Care: 0★★★★−
Shaving and Precautions: 0★★★★−
Reducing Pressure and Friction: 0★★★★−
Use of Pressure and Friction Reduction Services
Special Beds/Mattresses: 0★★★★−
Heels and Elbow Protection: 0★★★★−
Foot Cradles: 0★★★★−
Use of Shower Chair: 0★★★★−
Use of Bath/Shower Boat: 0★★★★−
Infection Control
Reverse Isolation: 0★★★★−
Body Substance Isolation: 0★★★★−
TB Precautions: 0★★★★−
MRSA Precautions: 0★★★★−
Hand Washing: 0★★★★−
Infectious/Hazardous Waste Disposal: 0★★★★−
Supply/Equipment Disposal: 0★★★★−
Use of Disposable Thermometer: 0★★★★−
Use of CPR Mask/Bag: 0★★★★−
Proper Use of Specific Barrier Methods
Gloves: 0★★★★−
Gown: 0★★★★−
Mask/Goggles: 0★★★★−
Safety and Activity
Determining Patient ID: 0★★★★−
Identifying Safety Hazards: 0★★★★−
Determining Need for Additional Help: 0★★★★−
Assessing Safety and ADL Needs: 0★★★★−
Recognizing Abuse: Substance, Physical, Emotional etc: 0★★★★−
Maintaining Clean, Orderly Work Area: 0★★★★−
Disposing of Sharps: 0★★★★−
Handling Hazardous Materials: 0★★★★−
Proper Body Mechanics: 0★★★★−
ROM Exercises: 0★★★★−
Transferring to bed, WC, Commode etc: 0★★★★−
Turning and Positioning: 0★★★★−
Patient Safety Module: 0★★★★−
Reporting Broken Equipment: 0★★★★−
Responding to Safety Hazards: 0★★★★−
Use of HoyerLift (Dextra/Maxi): 0★★★★−
Bed Operation: 0★★★★−
Use of Wheel Locks: 0★★★★−
Use of Alarms: Bed, Patient, Unit: 0★★★★−
Use of Call Light: 0★★★★−
Documenting Use of Restraints: 0★★★★−
Use of Transfer Belt: 0★★★★−
Use of Gait Belt for Ambulation: 0★★★★−
Use of Seizure Pads: 0★★★★−
Application of Restraints
Belt including seat belt: 0★★★★−
Wrist/Ankle: 0★★★★−
Vest: 0★★★★−
Age Specific Competencies
Newborn (birth to 30 days): 0★★★★−
Infant (31 days to 1 year): 0★★★★−
Toddler (ages 2-3 years): 0★★★★−
Preschooler (ages 4-5 years): 0★★★★−
Childhood (ages 6-12 years): 0★★★★−
Adolescents (ages 13-21 years): 0★★★★−
Young Adults (ages 22-39 years): 0★★★★−
Adults (ages 40-64 years): 0★★★★−
Older Adults (ages 65-79 years): 0★★★★−
Elderly (ages 80+ years): 0★★★★−
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