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
Administrative procedures
MDS Coordinator Admit/discharge patients
Familiarity with advanced directives
Observe for adverse medication reaction
Alert licensed staff of medication reaction
Position/transfer patients
Screen/direct provider calls
Screen/direct patient calls
Diagnostic testing and procedures
Apply/monitor noninvasive BP monitor
Discontinue peripheral IV
Apply nasal cannula/face mask
Assist with lumbar puncture
Instruct/obtain clean catch urine
Straight/Foley catheter female
Straight/Foley catheter male
Medication Administration
Vitamins, minerals, herbs
Respiratory system medications
Cardiovascular system medications
Gastrointestinal system medications
Urinary system medications
Reproductive system medications
Endocrine system medications
Musculoskeletal system medications
Nervous system medications
Age Specific Competencies
Newborn/neonate (birth-30 days)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Older adult (ages 65-79 years)