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
Restrictive devices (restraints)
End of life care/palliative care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
National Patient Safety Goals
Accurate patient identification
Awareness of patient rights
Interpretation & communication of lab values
Medication administration
Labeling (medications & specimens)
Medication reconciliation
Pain assessment & management
Prevention of pressure ulcers
Assessment of heart sounds
Identification of arrhythmias (rate/rhythm)
Fluid & electrolyte imbalances
Assessment/auscultation of lung sounds
Supplemental oxygen (cannula, facemask)
Suctioning (tracheostomy & nasotracheal)
Assessment of neuro signs
TBI (Traumatic Brain Injury: history of)
ALS (Amyotrophic Lateral Sclerosis)
NG tube (insertion/removal)
Long term feeding tubes (dobhoff/keofeed)
Feeding devices/adaptive equipment
Foley catheter insertion/removal
Use of bladder scan equipment
Straight catheterizations
Incontinence/bladder training
Chronic renal failure/dialysis
Standard extremity braces
Blood draw: central line PICC
Care & management of ports
Administration of blood/blood products
Age Specific Competencies
Newborn/neonate (birth-30 days)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescents (ages 13-21 years)
Young adult (ages 22-39 years)
Adults (ages 40-64 years)
Older adult (ages 65-79 years)