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
BP, including Orthostatic
Assisting with Ambulation
Measuring Intake and Output
Recognizing Cardiac Arrest
Bringing Emergency Equipment to Room
Providing Appropriate Code Support
Placing and Removing Bed Pan
Emptying and Replacing Ostomy Bag (Established Ostomy)
Medication Administration
Use of Electronic VS Equipment
Automatic BP machine (Dynamap)
Labeling Specimens and Preparing for Transport
Risk Factors for Skin Breakdown
Observing Pressure Points for Redness or Breakdown
Bathing (Shower/Tub/Arjo)
Oral Care, including Patients who are NPO, Comatose
Foot Care for Patients with Impaired Circulation or Sensation
Reducing Pressure and Friction
Use of Pressure and Friction Reduction Services
Heels and Elbow Protection
Infectious/Hazardous Waste Disposal
Supply/Equipment Disposal
Use of Disposable Thermometer
Proper Use of Specific Barrier Methods
Identifying Safety Hazards
Determining Need for Additional Help
Assessing Safety and ADL Needs
Recognizing Abuse: Substance, Physical, Emotional etc
Maintaining clean, orderly work area
Handling hazardous materials
Transferring to bed, WC, Commode etc
Reporting Broken Equipment
Responding to Safety Hazards
Use of HoyerLift (Dextra/Maxi)
Use of Alarms: Bed, Patient, Unit
Documenting Use of Restraints
Use of Gait Belt for Ambulation
Application of Restraints
AGE SPECIFIC COMPETENCIES
Newborn (birth to 30 days)
Infant (31 days to 1 year)
Preschooler (ages 4-5 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)