Long Term Care Skills Checklist

Fill Out and Submit your Skills Checklist

(Long Term Care)

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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.

Proficiency Scale:

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

CARDIAC

Use of cardiac monitors:

★★★★

Assessment of heart sounds:

★★★★

Cardiac Arrest:

★★★★

CPR:

★★★★

Care of patients with CHF:

★★★★

Atropine administration:

★★★★

Digoxin administration:

★★★★

Dopamine administration:

★★★★

Inderal administration:

★★★★

Lidocaine administration:

★★★★

GENITOURINARY

Fluid Balance:

★★★★

Foley Catheter Insertion:

★★★★

Ileostomy:

★★★★

GU Irrigations:

★★★★

Nephrostomy Tube:

★★★★

ENDOCRINE

Blood Glucose Checks:

★★★★

Insulin Administration:

★★★★

Care of patients with Diabetes:

★★★★

GASTROINTESTINAL

NG tube care and feedings:

★★★★

Gastrostomy tube care and feedings:

★★★★

Colostomy Care:

★★★★

Assessment of Bowel Sounds:

★★★★

LEADERSHIP/PATIENT CARE

Taking Charge:

★★★★

Admission Procedures:

★★★★

Discharge Procedures:

★★★★

Patient Education:

★★★★

Patient Care Plans:

★★★★

MEDICATIONS/IV THERAPY

Medication Calculation:

★★★★

Reconstitution:

★★★★

Oral Administration:

★★★★

Eye Administration:

★★★★

IM Administration:

★★★★

SQ Administration:

★★★★

Rectal Administration:

★★★★

Starting IV’s:

★★★★

IV Medication Administration:

★★★★

Central Line Care:

★★★★

NEUROLOGY

Assessment of Neurological Status:

★★★★

Seizure Precautions:

★★★★

Care of a patient with a CVA:

★★★★

Care of a patient with Alzheimer’s:

★★★★

Care of patients with Spinal Cord Injury:

★★★★

Decadron Administration:

★★★★

Dilantin Administration:

★★★★

Phenobarbital Administration:

★★★★

Valium Administration:

★★★★

ORTHO/SKIN

Assessment of skin:

★★★★

Wound Care and Treatments:

★★★★

Use of special pressure relief devices:

★★★★

Care of pts with a total hip replacement:

★★★★

Care of pts with a total knee replacement:

★★★★

Crutch Walking:

★★★★

RESPIRATORY

Pulse Oximetry:

★★★★

Oxygen Administration via nasal cannula:

★★★★

Oxygen Administration via face mask:

★★★★

Principles of chest percussion:

★★★★

Care of patients with ventilator:

★★★★

Care of patients with COPD:

★★★★

Care of patients with ARDS:

★★★★

Care of patient with a Tracheotomy:

★★★★

Age Specific Competencies

Infant (Birth - 1 year):

★★★★

Preschooler (ages 2-5 years):

★★★★

Childhood (ages 6-12 years):

★★★★

Adolescents (ages 13-21 years):

★★★★

Young Adults (ages 22-39 years):

★★★★

Adults (ages 40-64 years):

★★★★

Older Adults (ages 65-79 years):

★★★★

Elderly (ages 80+ years):

★★★★