PCT Skills Checklist

PCT

Name*

Telephone*

Who is your recruiter?*

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.

Proficiency : -	1 = Never Performed	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always

Age Specific Proficiency Frequency

Infant (Birth to 1year)

1

2

3

4

1

2

3

4

Toddler (1-3 years)

1

2

3

4

1

2

3

4

Pre-school (3-6 years)

1

2

3

4

1

2

3

4

School Age (6-12 years)

1

2

3

4

1

2

3

4

Adolescent (12-18 years)

1

2

3

4

1

2

3

4

Young Adult (18-30 years)

1

2

3

4

1

2

3

4

Mature Adult (30-60 years)

1

2

3

4

1

2

3

4

Elderly(>60 years)

1

2

3

4

1

2

3

4

Suicide Precautions

1

2

3

4

1

2

3

4

Transfer of patient using safe transfer technique

1

2

3

4

1

2

3

4

Ambulation of patient with assistive device such as gait belt or walker

1

2

3

4

1

2

3

4

Use of prosthetic/orthotic device

1

2

3

4

1

2

3

4

Fall Precautions

1

2

3

4

1

2

3

4

Wrist restraint

1

2

3

4

1

2

3

4

Mitt restraints

1

2

3

4

1

2

3

4

Vest restraint

1

2

3

4

1

2

3

4

Bed alarms

1

2

3

4

1

2

3

4

Chair alarms

1

2

3

4

1

2

3

4

Acute Care/Hospital

1

2

3

4

1

2

3

4

Surgical Unit

1

2

3

4

1

2

3

4

Private Duty

1

2

3

4

1

2

3

4

Labor & Delivery

1

2

3

4

1

2

3

4

Orthopedic

1

2

3

4

1

2

3

4

Cardiac Unit

1

2

3

4

1

2

3

4

Clinic

1

2

3

4

1

2

3

4

Urology

1

2

3

4

1

2

3

4

Hospice

1

2

3

4

1

2

3

4

Central Supply

1

2

3

4

1

2

3

4

1:1 Patient

1

2

3

4

1

2

3

4

Nursery

1

2

3

4

1

2

3

4

Behavioral Health

1

2

3

4

1

2

3

4

Crisis Intervention

1

2

3

4

1

2

3

4

OB/GYN

1

2

3

4

1

2

3

4

Neuro Unit

1

2

3

4

1

2

3

4

Alzheimers

1

2

3

4

1

2

3

4

Home Care

1

2

3

4

1

2

3

4

Med-Surg

1

2

3

4

1

2

3

4

Geriatric

1

2

3

4

1

2

3

4

Nursing Home/Skilled Nursing Facility

1

2

3

4

1

2

3

4

Utilize common medical acronyms and abbreviations

1

2

3

4

1

2

3

4

Report and Document Incidents

1

2

3

4

1

2

3

4

Utilize common medical terminology such as pulse, oxygen, stat with correct spelling

1

2

3

4

1

2

3

4

Read and document time correctly, and correctly calculate time intervals

1

2

3

4

1

2

3

4

Record vital signs

1

2

3

4

1

2

3

4

Record and calculate Intake & Output measurements

1

2

3

4

1

2

3

4

Use of English and Metric conversions to calculate measurements

1

2

3

4

1

2

3

4

Document work-related activities and actions, including writing text

1

2

3

4

1

2

3

4

Document using Graphic Notes

1

2

3

4

1

2

3

4

Document using Checklist format

1

2

3

4

1

2

3

4

Document using Narrative format

1

2

3

4

1

2

3

4

Utilize Computerized documentation

1

2

3

4

1

2

3

4

Care and cleaning of medical equipment

1

2

3

4

1

2

3

4

Scales

1

2

3

4

1

2

3

4

Bed Position

1

2

3

4

1

2

3

4

Bed alarm

1

2

3

4

1

2

3

4

Therapeutic beds

1

2

3

4

1

2

3

4

Therapeutic mattresses

1

2

3

4

1

2

3

4

Hoyer

1

2

3

4

1

2

3

4

HoverJack

1

2

3

4

1

2

3

4

HoverMatt

1

2

3

4

1

2

3

4

Use of pneumatic tube system

1

2

3

4

1

2

3

4

Wound vacuums

1

2

3

4

1

2

3

4

Bladder scanner

1

2

3

4

1

2

3

4

Bed Scale

1

2

3

4

1

2

3

4

Walker/Crutches

1

2

3

4

1

2

3

4

Traction

1

2

3

4

1

2

3

4

Sequential compression devices

1

2

3

4

1

2

3

4

Blood Glucose Monitor

1

2

3

4

1

2

3

4

Suction equipment set-up

1

2

3

4

1

2

3

4

Care of oxygen equipment

1

2

3

4

1

2

3

4

Utilize hospital communication/ information systems, such as telephones and patient call systems

1

2

3

4

1

2

3

4

Utilize computer or electronic device at a basic level, including using a keyboard

1

2

3

4

1

2

3

4

Complete Bed Bath

1

2

3

4

1

2

3

4

Partial Bed Bath

1

2

3

4

1

2

3

4

Tub Bath with assist

1

2

3

4

1

2

3

4

Sitz

1

2

3

4

1

2

3

4

Whirlpool bath

1

2

3

4

1

2

3

4

Shower

1

2

3

4

1

2

3

4

Proper feeding techniques (with/without assistive devices)

1

2

3

4

1

2

3

4

Correct positioning of patient during and after feeding

1

2

3

4

1

2

3

4

Special Dietary requirements

1

2

3

4

1

2

3

4

Preparation of food such as opening containers and packages

1

2

3

4

1

2

3

4

Assist patient with menu selection

1

2

3

4

1

2

3

4

Aspiration Precautions

1

2

3

4

1

2

3

4

Secure patient valuables

1

2

3

4

1

2

3

4

Adjust bed settings/controls

1

2

3

4

1

2

3

4

Equipment Set-up

1

2

3

4

1

2

3

4

Provide notification to nurse of patient arrival

1

2

3

4

1

2

3

4

Provide patient orientation to room

1

2

3

4

1

2

3

4

Provide assistance with hospital gown

1

2

3

4

1

2

3

4

Provide appropriate and timely information to team members regarding patient care

1

2

3

4

1

2

3

4

Provide introduction of self to patient and explanation of all actions before they are taken

1

2

3

4

1

2

3

4

Communicate clearly and effectively with others using phone/patient call system or in person

1

2

3

4

1

2

3

4

Communicate and immediately report any change in patient condition to nursing supervisor

1

2

3

4

1

2

3

4

Oral Temperature

1

2

3

4

1

2

3

4

Axillary Temperature

1

2

3

4

1

2

3

4

Rectal Temperature

1

2

3

4

1

2

3

4

Tympanic Temperature

1

2

3

4

1

2

3

4

Pulse

1

2

3

4

1

2

3

4

Respirations

1

2

3

4

1

2

3

4

Blood Pressure (Manual)

1

2

3

4

1

2

3

4

Blood Pressure Monitor

1

2

3

4

1

2

3

4

Unoccupied

1

2

3

4

1

2

3

4

Occupied

1

2

3

4

1

2

3

4

Post Op Surgical

1

2

3

4

1

2

3

4

Brushing Teeth

1

2

3

4

1

2

3

4

Dental care

1

2

3

4

1

2

3

4

Partials

1

2

3

4

1

2

3

4

Mouth Care (swab, lip ointment)

1

2

3

4

1

2

3

4

Clean patient and patient environment

1

2

3

4

1

2

3

4

Assist patient with bedpan

1

2

3

4

1

2

3

4

Assist patient with urinal

1

2

3

4

1

2

3

4

Assist patient with bedside commode

1

2

3

4

1

2

3

4

Maintenance and care of foley catheter

1

2

3

4

1

2

3

4

Empty foley catheter

1

2

3

4

1

2

3

4

Provide ostomy care and assistance

1

2

3

4

1

2

3

4

Empty Colostomy

1

2

3

4

1

2

3

4

Post-mortem care in accordance with cultural and religious considerations

1

2

3

4

1

2

3

4

Care for Suicidal Patient

1

2

3

4

1

2

3

4

Care for Combative Patient

1

2

3

4

1

2

3

4

Care for Confused Patient

1

2

3

4

1

2

3

4

Care for the dying patient

1

2

3

4

1

2

3

4

Care for patient with DNR order

1

2

3

4

1

2

3

4

Understanding of pain scales

1

2

3

4

1

2

3

4

Maintain patient dignity and privacy at all times

1

2

3

4

1

2

3

4

Prioritize and pace work activities based upon productivity needs

1

2

3

4

1

2

3

4

Patient Identification using Two Patient Identifiers

1

2

3

4

1

2

3

4

Incorporate federal regulatory laws into care (i.e. Patient Bills of Rights, HIPAA, Joint Commission National Patient Safety Goals, SDS)

1

2

3

4

1

2

3

4

Assists with Patient Transport

1

2

3

4

1

2

3

4

Measuring Height and Weight

1

2

3

4

1

2

3

4

Assist with transport for patient such as a wheelchair/stretcher

1

2

3

4

1

2

3

4

Assist patient with personal belongings

1

2

3

4

1

2

3

4

Range of Motion

1

2

3

4

1

2

3

4

Back Care/Massage

1

2

3

4

1

2

3

4

Catheter Care

1

2

3

4

1

2

3

4

Colostomy Care

1

2

3

4

1

2

3

4

Tracheostomy Care

1

2

3

4

1

2

3

4

Shaving a patient

1

2

3

4

1

2

3

4

Perineal care

1

2

3

4

1

2

3

4

Shampoo (in sink, tub, or bed)

1

2

3

4

1

2

3

4

Nail care (clean/file)

1

2

3

4

1

2

3

4

Skin care (preventing pressure areas)

1

2

3

4

1

2

3

4

Shaving patient (safety/electric razor)

1

2

3

4

1

2

3

4

Positioning/Turning

1

2

3

4

1

2

3

4

Application of Ace Bandage

1

2

3

4

1

2

3

4

Cast Care

1

2

3

4

1

2

3

4

Application Hot/Cold Packs

1

2

3

4

1

2

3

4

Hand hygiene

1

2

3

4

1

2

3

4

Standard/Universal Precautions

1

2

3

4

1

2

3

4

Airborne Precautions

1

2

3

4

1

2

3

4

Contact Precautions

1

2

3

4

1

2

3

4

Droplet Precautions

1

2

3

4

1

2

3

4

Personal Protective Equipment

1

2

3

4

1

2

3

4

Urine (clean catch)

1

2

3

4

1

2

3

4

Urine(foley)

1

2

3

4

1

2

3

4

Stool

1

2

3

4

1

2

3

4

Emesis

1

2

3

4

1

2

3

4

Blood(fingerstick)

1

2

3

4

1

2

3

4

Drains associated with post-operative care of patient (Jackson-Pratt, Hemo-Vac, Wound Vacs, etc.)

1

2

3

4

1

2

3

4

Assist nursing staff during patient, departmental, and facility emergencies

1

2

3

4

1

2

3

4

Perform identification of patient before any procedure using two patient identifiers

1

2

3

4

1

2

3

4

Properly label all specimens

1

2

3

4

1

2

3

4

Removal of indwelling foley catheter

1

2

3

4

1

2

3

4

Removal of external foley catheter

1

2

3

4

1

2

3

4

Set/application of hot/cold packs as directed

1

2

3

4

1

2

3

4

Perform fingerstick for blood glucose

1

2

3

4

1

2

3

4

Replace telemetry leads and change batteries as needed

1

2

3

4

1

2

3

4

Perform administration of enemas such as soap suds/Fleets

1

2

3

4

1

2

3

4

Application of TED/Support Stockings

1

2

3

4

1

2

3

4

Application of K- Pads/Modules

1

2

3

4

1

2

3

4

Bowel/bladder training

1

2

3

4

1

2

3

4

Vaginal douche

1

2

3

4

1

2

3

4

Simple dressing change, if applicable

1

2

3

4

1

2

3

4

Prep patient prior to surgery

1

2

3

4

1

2

3

4

AED

1

2

3

4

1

2

3

4

Removal of peripheral IV needle and saline lock

1

2

3

4

1

2

3

4

Preparation and use of EKG equipment

1

2

3

4

1

2

3

4

Post Mortem Care with cultural/spiritual considerations

1

2

3

4

1

2

3

4

CPR

1

2

3

4

1

2

3

4

Years Experience in Clinical Specialty :

Most recent facility worked at :

*

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.