Registered Nurse Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyMedication AdministrationDocumentation on M.A.R.(Required) 1 2 3 4 Dose calculation(Required) 1 2 3 4 Generic equivalents(Required) 1 2 3 4 Usage of PDR(Required) 1 2 3 4 Knowledge of drug actions/interactions(Required) 1 2 3 4 Verification of narcotic wastage(Required) 1 2 3 4 Oral medications(Required) 1 2 3 4 Sublingual medications(Required) 1 2 3 4 Intradermal medications(Required) 1 2 3 4 Parenteral medications(Required) 1 2 3 4 Subcutaneous medications(Required) 1 2 3 4 Intramuscular medications(Required) 1 2 3 4 Topical medications(Required) 1 2 3 4 Eye drops(Required) 1 2 3 4 Ear drops(Required) 1 2 3 4 Swallowing precautions(Required) 1 2 3 4 Inventory and storage control(Required) 1 2 3 4 Infectious ControlAIDS/HIV interaction(Required) 1 2 3 4 Hepatitis interaction(Required) 1 2 3 4 Hospice(Required) 1 2 3 4 MRSA(Required) 1 2 3 4 VRE(Required) 1 2 3 4 Fever management(Required) 1 2 3 4 Interpretation of labs(Required) 1 2 3 4 Decubitus/Wound care (Contaminated)(Required) 1 2 3 4 Linen -Transporting, storing, & Handling(Required) 1 2 3 4 Cleaned(Required) 1 2 3 4 Soiled(Required) 1 2 3 4 Personal clothing(Required) 1 2 3 4 Proper disposal of sharpes and waste(Required) 1 2 3 4 Standard precautions(Required) 1 2 3 4 Pain ManagementDocumentation and assessment of site, character, & frequency of pain(Required) 1 2 3 4 Assessment of pain levels(Required) 1 2 3 4 Documentation of response to pain medications(Required) 1 2 3 4 Intraveneous TherapyI.V. certified (Check "4")(Required) 1 2 3 4 Administration of I.V. antibiotics(Required) 1 2 3 4 Administration of I.V. fluids(Required) 1 2 3 4 Administration of I.V. pain medications(Required) 1 2 3 4 Administration of I.V. cardiac meds(Required) 1 2 3 4 Blood draws - peripheral(Required) 1 2 3 4 Blood draws - central line(Required) 1 2 3 4 Blood draws - implanted catheter(Required) 1 2 3 4 Care of I.V. site - peripheral(Required) 1 2 3 4 Care of I.V. site - central line(Required) 1 2 3 4 Care of I.V. site - implanted catheter(Required) 1 2 3 4 I.V. dose calculations(Required) 1 2 3 4 I.V. insertion - peripheral(Required) 1 2 3 4 Use of infusion pumps(Required) 1 2 3 4 Diabetic CareDiabetic monitoring(Required) 1 2 3 4 S/S hyper/hypoglycemia(Required) 1 2 3 4 Diabetic patient teaching(Required) 1 2 3 4 Performing fingersticks(Required) 1 2 3 4 Use of glucometers(Required) 1 2 3 4 Insulin infusions(Required) 1 2 3 4 Regular, long-acting insulin(Required) 1 2 3 4 Mixed insulin(Required) 1 2 3 4 Psychosocial ProblemsAssessment and documentation of behavioral problems (target behaviors)(Required) 1 2 3 4 Assessment and documentation of s/s of depression(Required) 1 2 3 4 Assessment and documentation of patient response to psychotropic medications(Required) 1 2 3 4 Parameters for use of restraints in long-term care settings(Required) 1 2 3 4 Assessment and documentation of effectiveness of preventive medicine medications(Required) 1 2 3 4 OrthopedicsAssessment of circulation(Required) 1 2 3 4 Assessment of gait(Required) 1 2 3 4 Assessment of range of motion(Required) 1 2 3 4 Amputation care(Required) 1 2 3 4 Post-arthroscopy care(Required) 1 2 3 4 Casts and related care(Required) 1 2 3 4 Pinned fractures(Required) 1 2 3 4 Total hip replacement(Required) 1 2 3 4 Total knee replacement(Required) 1 2 3 4 Rheumatic/Arthritic disease(Required) 1 2 3 4 Continuous passive motion(Required) 1 2 3 4 Canes(Required) 1 2 3 4 Cervical collars(Required) 1 2 3 4 Gait belts(Required) 1 2 3 4 Prostheses(Required) 1 2 3 4 Slings(Required) 1 2 3 4 Transfer board(Required) 1 2 3 4 Walker(Required) 1 2 3 4 Wheelchair(Required) 1 2 3 4 Cardiovascular ProblemsAuscultation of rate/rythym(Required) 1 2 3 4 Blood pressure(Required) 1 2 3 4 Doppler(Required) 1 2 3 4 Pulses(Required) 1 2 3 4 Circulation checks(Required) 1 2 3 4 CPR(Required) 1 2 3 4 Post-abdominal aortic bypass(Required) 1 2 3 4 Aneurysm(Required) 1 2 3 4 Angina(Required) 1 2 3 4 Post carotic endarterectomy(Required) 1 2 3 4 Fem-pop bypass(Required) 1 2 3 4 Permanent pacemaker(Required) 1 2 3 4 Post acute M.I.(Required) 1 2 3 4 Post cardiac surgery(Required) 1 2 3 4 Thrombophlebitis(Required) 1 2 3 4 DVT(Required) 1 2 3 4 Congestive heart failure(Required) 1 2 3 4 Administration of post-op cardiac meds(Required) 1 2 3 4 Gastrointestinal ProblemsAdministration of tube feedings(Required) 1 2 3 4 Administration of medications via tube(Required) 1 2 3 4 Inflammatory bowel disease(Required) 1 2 3 4 Bowel prep(Required) 1 2 3 4 G.I. bleeding(Required) 1 2 3 4 Gualac(Required) 1 2 3 4 Nutritional status(Required) 1 2 3 4 Colostomy care(Required) 1 2 3 4 Post abdominal surgery(Required) 1 2 3 4 NG tube placement and care(Required) 1 2 3 4 Nasointestinal tube care(Required) 1 2 3 4 Assessment of bowel tones(Required) 1 2 3 4 Assessment of abdomen(Required) 1 2 3 4 Enema administration(Required) 1 2 3 4 Assessment of bowel incontinence(Required) 1 2 3 4 Signs and symptoms of fecal impaction(Required) 1 2 3 4 Neurological ProblemsPost-Op anticonvulsant medications(Required) 1 2 3 4 Assessing levels of consciousness(Required) 1 2 3 4 Dementias (Re-direction/Validation)(Required) 1 2 3 4 Neuromuscular disease(Required) 1 2 3 4 CVA(Required) 1 2 3 4 Pupil check(Required) 1 2 3 4 A.I.M.S.(Required) 1 2 3 4 Seizure precautions(Required) 1 2 3 4 Administration of anticonvulsant(Required) 1 2 3 4 Medications(Required) 1 2 3 4 Aneurysm precautions(Required) 1 2 3 4 Spinal cord injuries - long term(Required) 1 2 3 4 Urinary ProblemsAssessment and care of AV shunt(Required) 1 2 3 4 Post renal surgery(Required) 1 2 3 4 Renal failure(Required) 1 2 3 4 Assessment of urinary incontinence(Required) 1 2 3 4 Assessment of I and O data(Required) 1 2 3 4 Use of bladder scanne(Required) 1 2 3 4 Signs and symptoms of UTI(Required) 1 2 3 4 Indwelling catheter insertion(Required) 1 2 3 4 Indwelling catheter care(Required) 1 2 3 4 Straight catheter insertion(Required) 1 2 3 4 Suprapubic catheter care(Required) 1 2 3 4 Screening for UTI via urine dipstick(Required) 1 2 3 4 Wounds, Pressure Sores, and Skin ImpairmentsAssessment and care of post-surgical wounds(Required) 1 2 3 4 Assessment, prevention, and care of pressure ulcers(Required) 1 2 3 4 Assessment and documentation of skin conditions/wounds(Required) 1 2 3 4 Dressing changes - asceptic(Required) 1 2 3 4 Dressing changes - sterile(Required) 1 2 3 4 Wound irrigation(Required) 1 2 3 4 Application of wound care products(Required) 1 2 3 4 Use of air fluidized, low air-loss beds(Required) 1 2 3 4 Use of pressure-relieving seat cushions(Required) 1 2 3 4 Staple and suture removal(Required) 1 2 3 4 Other SkillsAlert charting system(Required) 1 2 3 4 Use of 24-hour written and verbal reporting systems(Required) 1 2 3 4 Use of "911" in LTC setting(Required) 1 2 3 4 Regulatory guidelines related to the prevention of abuse and neglect of residents(Required) 1 2 3 4 Regulatory guidelines related to resident rights in LTC setting(Required) 1 2 3 4 Discerning code status(Required) 1 2 3 4 Incident and accident reporting(Required) 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year)(Required) 1 2 3 4 Preschooler (ages 2-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 13-21 years)(Required) 1 2 3 4 Young Adults (ages 22-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. 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In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
