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
Auscultation/Irregular Heart Sounds
Lab Tests (Cardiac Enzymes, Troponin, BNP)
Arrhythmia Interpretation
12-Lead Basic Interpretation
ALS (Epinephrine, Atropine, Anti-Arrhythmics)
Abnormal Breath Sounds (Wheezing, Stridor, Crackles)
Abnormal Breathing Pattern (Rapid, Labored, Slow)
Oxygen Therapy (Nasal Cannula, Face Mask)
Manual Resuscitation Bag (MRB, Ambu Bag)
Metered-Dose Inhaler (MDI)
Asthma/Reactive Airway Disease
Signs & Symptoms of Stroke
Assist with Lumbar Puncture
Imitrex (Sumatriptan Succinate)
Color, Warmth, Movement, Sensation
Assist with Reduction of Dislocation
G-Tube (Reinsertion/Replacement)
Shunt/Fistula (Thrill/Bruit)
BUN/Creatinine/Electrolytes
Placement & Management of Bladder Catheters
Bedside Blood Glucose Monitoring
Hypoglycemia/Insulin Shock
Ear Irrigation/Removal Foreign Body
Eye Injury/Foreign Body/Detached Retina
Assist with Removal of Nasal Foreign Body
Interpret Culture Results
Reverse Isolation/Hepa Filter
Use of Personal Protective Equipment
Immunosuppression/Neutropenia
Wound Repair (Staples/Sutures, etc.)
Assessment of Pain Level/Use of Pain Scale
Assessment of Response to Pain Management Interventions
Monitoring of Patients after Pain Medication
Managing Threatening/Violent Behavior
Antipsychotics/Antidepressants
Doppler/Fetal Heart Tones
Pelvic Inflammatory Disease
Pregnancy-Induced Hypertension
Child Abuse Recognition/Reporting
Obtaining Consent to Treat
Use of Dynamap/Doppler Leg Cuffs for B/P
Assist with Fracture Stabilization
Draw Labs (Venous/Butterfly)
Ear Care-Assist with Cleaning/Wash, Insert Ear Drops
IM/SQ Medications in Pediatric Patients
Obtain Urine Culture (Cath/Bag)
Papoose Board/Therapeutic Hold
Start IV in Pediatric Patient
Asthma/Reactive Airway Disease
Bronchodilators/Nebulizers
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)
National Patient Safety Goals
Hazardous Materials Exposure
Victims of Acts of Violence