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
Activities of daily living
Administration of medication
Application of heat and cold
Assist with medical examination
Bathing: Sitz, tub, bed, shower
Body Systems Review (Head to Toe data collection)
Catheterization / Foley catheter care
Colostomy Care and irrigation
Diabetic tests and preparation forms
Diabetic blood glucose testing
Enemas, cleansing, retention, Harris flush
Infection Control: Standard Universal Precautions
Infection Control: Reverse Isolation
Infection Control: TB/ Airborne Precautions
Infections Control: MRSA/ VRE Precautions
Isolation procedure for specimen collection
IVs: Monitor rate and infusion site
Medications: Oral, IM, SQ
Observations: Response to treatments/ meds
Observations: Signs of significant body system changes
Observations: Signs of shock
Observations: Signs of pain
Observes safety procedures
Patient care plans (revise and update)
Patient safety standards/ precautions
Provide comfort, safety and privacy
Report observations/ changes
Specimen collection: routine urine
Specimen collection: clean catch
Specimen collection: 12 & 24 hour specimen
Specimen collection: stool
Specimen collection: culture
Specimen collection: sputum
Specimen collection: from foley catheter
Topical Medication Application
Transfer/ transport patients: wheelchair
Transfer/ transport patients: gurney
Transfer/ transport patients: to chair
Urine test for glucose/ acetone
Weight: Bed scales and standing scales
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)