Long Term CareSkills Checklist

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 below to describe your experience/expertise in each area listed below.

PROCEDURES / SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
A. CARDIAC
Use of cardiac monitors

Assessment of heart sounds

Cardiac Arrest

CPR

Care of patients with CHF

Atropine administration

Digoxin administration

Dopamine administration

Inderal administration

Lidocaine administration

B. GENITOURINARY

Fluid Balance

Foley Catheter Insertion

Ileostomy

GU Irrigations

Nephrostomy Tube

C. ENDOCRINE

Blood Glucose Checks

Insulin Administration

Care of patients with Diabetes

D. GASTROINTESTINAL

NG tube care and feedings

Gastrostomy tube care and feedings

Colostomy Care

Assessment of Bowel Sounds

E. LEADERSHIP/PATIENT CARE

Taking Charge

Admission Procedures

Discharge Procedures

Patient Education

Patient Care Plans

F. MEDICATIONS/IV THERAPY

Medication Calculation

Reconstitution

Oral Administration

Eye Administration

IM Administration

SQ Administration

Rectal Administration

Starting IV's

IV Medication Administration

Central Line Care

G. NEUROLOGY

Assessment of Neurological Status

Seizure Precautions

Care of a patient with a CVA

Care of a patient with Alzheimer's

Care of patients with Spinal Cord Injury

Decadron Administration

Dilantin Administration

Phenobarbital Administration

Valium Administration

H. ORTHO/SKIN

Assessment of skin

Wound Care and Treatments

Use of special pressure relief devices

Care of pts with a total hip replacement

Care of pts with a total knee replacement

Crutch Walking

I. RESPIRATORY

Pulse Oximetry

Oxygen Administration via nasal cannuia

Oxygen Administration via face mask

Principles of chest percussion

Care of patients with ventilator

Care of patients with COPD

Care of patientd with ARDS

Care of patient with a Tracheotomy

Do you speak any languages other than
English?

Yes

If yes, which language(s)?

Check the box under EACH age group that you have experience with and are comfortable with for each skill below.

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different communication needs for the age group & changes communication methods and terminology accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different safety risks for the age group and alters the environment accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the normal growth and development for the age group and adapts care accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.