Administrative Registered Nurse Skills Checklist

Hospice Skills Checklist

Fill Out and Submit your Skills Checklist

(Hospice)

Your name

Your Email

Last 4 Of SSN

Date

E-Signature

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.

Proficiency Scale:

1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

WORK SETTINGS

Home Hospice:

★★★★

Inpatient Hospice:

★★★★

Pediatric Hospice:

★★★★

Home Health/Hospice Setting:

★★★★

ASSESSMENT

Intake Assessment:

★★★★

Assessment Interview:

★★★★

Physical Exam:

★★★★

Coping Status:

★★★★

Environmental Status:

★★★★

PLAN OF CARE

Set Goals with Pt/Family:

★★★★

Collaborate with Other Team Members:

★★★★

Ensure Continuity of Care:

★★★★

SYMPTOM MANAGEMENT

Urgent Assessment of Symptoms:

★★★★

Reduce Symptoms to Level Acceptable to Pt.:

★★★★

Report Symptoms/Management to Provider:

★★★★

Treat Underlying Cause:

★★★★

Severity Scale:

★★★★

Management of Nausea:

★★★★

Management of Constipation:

★★★★

Management of Fatigue:

★★★★

Anorexia/Cachexia:

★★★★

Restlessness:

★★★★

Educate Family on Symptom Management:

★★★★

PAIN MANAGEMENT

Identify Source of Pain:

★★★★

Pain Severity:

★★★★

PAINAD Scale for Non Verbal Patient:

★★★★

Reduce Pain to Level Acceptable to Patient:

★★★★

WHO 3 Step Ladder:

★★★★

Non-Pharmacologic Management of Pain:

★★★★

Pharmacologic Management of Pain:

★★★★

Effects of Pharmacologic Treatment:

★★★★

Nociceptive/Neuropathic/Mixed Pain:

★★★★

Management of Nociceptive Pain:

★★★★

Management of Neuropathic Pain:

★★★★

Educate Family on Pain Management:

★★★★

WOUND CARE

Positioning Techniques:

★★★★

Bed/Support Surface Selection:

★★★★

Pressure Ulcer Staging/Management:

★★★★

Response to Treatment:

★★★★

Evaluate Factors that Impede Healing:

★★★★

Educate Family on Positioning/Shearing:

★★★★

PEDIATRICS

Developmentally Appropriate Assessment:

★★★★

Parental/Sibling Support:

★★★★

Pediatric Support Team Collaboration:

★★★★

MEDICATION ADMIN

Equianalgesic Conversion Formula:

★★★★

Titration of opioids:

★★★★

IV Pump Management:

★★★★

Evaluate Effectiveness of Medications:

★★★★

Family Management of Medications:

★★★★

Disposal of Medications:

★★★★

AFTER DEATH

Facility Family/Cultural Rituals/Rites:

★★★★

Patient Care after Death:

★★★★

Coordinate Mortuary Services:

★★★★

Bereavement Services:

★★★★

COMPLIANCE

Scope and Frequency of Services:

★★★★

Medicare/State Regulations for Hospice:

★★★★

Document Progression of Decline:

★★★★

DME Authorization & Documentation of Need/Order:

★★★★

OASIS-C:

★★★★

PROFESSIONAL KNOWLEDGE AND SKILLS

Identify Source of Suffering:

★★★★

Palliative Care Philosophy:

★★★★

Patient/Family Directs Goals of Care:

★★★★

Maximize Quality of Life:

★★★★

Cultural Diversity:

★★★★

Supervision of Ancillary Staff:

★★★★

National Patient Safety Goals/Core Measures:

★★★★

Fall Risk Assessment/Prevention:

★★★★

Infection Prevention:

★★★★

Isolation Precautions:

★★★★

Interpretation and Communication of Lab Values:

★★★★

EMR

Epic:

★★★★

Cerner:

★★★★

Eclipsys:

★★★★

Allscripts:

★★★★

McKesson:

★★★★

Meditech:

★★★★

Other Computerized System:

★★★★

Computerized Physician Order Entry:

★★★★

Bar Coding for Medication Administration:

★★★★

EMR Conversion:

Certifications

BLS

Expiry Date:

CHPN

Expiry Date:

ACHPN

Expiry Date:

Other (specify):

Expiry Date:

Other (specify):

Expiry Date:

Hospice Skills Checklist

Fill Out and Submit your Skills Checklist

(Hospice)

Proficiency Scale:

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