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
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Cerebral Vascular Accident
Continuous Passive Motion Machine N/A
Care of Patient with Halo
Assessment of breath sounds
Care of patient w/Mechanical Vent
Activities of Daily Living
Bracing/Joint Immobilization
Casts/Check for Circulation
Upper Extremity Prosthetics
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
Ability to evaluate and assign Functional Independence Score
Function Capacity Evaluation
Pain Management/Giving Meds
Wound Debridement/Dressing Change
Age Specific Competencies
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)