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Licensed Practical Vocational Nurse

    Instruction

    Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below)

  • 0 = No theory and/or experience
  • 1 = Limited experience/need supervision and/or support
  • 2 = Experienced/minimal support needed to perform)
  • 3 = Proficient/can perform independently
  • 4 = Expert/very experienced in the field
Personal Information

Full Name

Email

Phone number

Last 4 of Social Security Number

Date

Age Specific Competency

Neonates/Newboarns (0-30 days)

Infiant(30 days - 1 year)

Toddler (1-3 years)

Preschool Child (3-6 years)

Adolescents (12-18 years)

Young adult (18-39)

Middle adult (39-61)

Older adult (64+ years)

Able to adapt care to age of normal growth and development

Able to adapt method and language to developmental age

Able to secure environment for safety according to developmental age

Hand Cleaning Techniques

Patient Safety Goals

Patient Suicide Risk

Pain Management

Pain Level Assessment

Non-narcotic Agents

Narcotic Agents

Patient Controlled Analgesia

Leadership & Nursing Models

Long Term Care

Alzheimer Unit

Hospital

Team Nursing

Primary Care Nursing

Administrative Nursing Skills

Admission & Dischare Procedures

Computerized Charting

Checking Presence of Consent Forms

Advance Directives

HIPAA Privacy and Security; Patient Confidentiality of Information

Teaching: Patient, Family, Significant Other(s)

Infection Control: Universal Precautions

Equipment

Cardiac Monitors

Defibrillator

Glucometers

IV Pumps

Oxygen Set Up

Pulse Oxymeter

Specialty Beds

Narcotic Withdrawal System (e.g. Pyxis)

Basic Skills

Physical/Health Assessment/Plan of Care

Decubitus Care/Prevention

Wound Care

Dressing Changes

Sterile Technique

Elastic (TED) Hose/Stockings

Restraint Application: Protocol, Safeguards

Ordering-Charging Medications/Supplies

Indwelling Catheter Insertion/Removal

Straight Catherization

Nutritional Infusions (Hyperal, Lipids)

Isolation Procedures

Assisting with Lumbar Puncture

Nerve Stimulators

Nurse Care Planning

Oxygen by Bag & Mask

Oxygen by CPAP

Oxygen by Nasal Cannula

Trach Collar

Pacemaker

Continuous & Intermittent Tube Feeding

Non-Invasive Hemodynamic Monitoring (Palpation, Doppler)

Patient Positioning, Ambulation, ROM

Broviac Line Site Maintenance

Groshog Line Site Maintenance

Hickman Line Site Maintenance

PICC Line Site Maintenance

Portacath Line Site Maintenance

Quinton Line Site Maintenance

Post-mortem Care

Interpretation of Lab Results

Blood Gases

Blood Chemistry

Cardiac Enzymes & Isoenzymes

CBC with and without Differential

Coagulation Studies

Cultures

Electrolytes

Urine Dipstick

Cardiovascular

Hypertension

Post-Myocardinal Infarction Care

Congestive Heart Failure

Fem-Pop Bypass

Coronary Artery Bypass Gract (CABG)

Angina Pectoris

Peripheral Vascular Disease

Post-Open Heart Floor

Aneurysm

Post Cardiac Catheterization Care

Cerebral Vascular Accident

Cardiomyopathy

Carotid Endarterectomy

Cardiac Arrest

Endocrine

Diabetes

Glucose Monitoring

Insulin Administration

Addisons's

Pituitary Disorders

Thyroid Dysfunction

Post-Thyroidectomy Care

Gastrointestinal

Assessment of Bowl Sounds

Liver Failure

Cirrhosis

Cholecystectomy

Cholelithiases

Hepatitis

Appendicitis/Appendectomy

GI Bleeding

Gastric Lavage (Iced Saline)

Gastric Suction

Insertion of Nasogastric Tube (NGT)

NGT Resection

Colostomy

Post-GI Surgery Care

Care of Gastrostomy Tube

Care of PEG Tube

Bowel Obstruction

Paralytic lleus

Genutourinary System

Kidney Stones

TURP/TURBP

Nephrostomy Tube Care

Nephrectomy

Care of Patient Undergoing Dialysis: Peritoneal & Hemodialysis

A-V Fistula Care

A & P repair

Hysterectomy Care (Abdominal/Vaginal)

UTI, Bladder Infection

IIeal Conduit

Suprapubic Catheter

Post-Renal Transplant

Medical

Fluid & Electrolyte Imabalances

HIV/AIDS

Care of Patient Undergoing Chemotherapy

Care of Patient Undergoing Radiation Therapy

Oncological Crisis

Leukemia

Maligant Tumors

Sickle Cell Crisis

Neurological

Neurological Checks/Assessment

Glascow Coma Scale

Seizure Disorders & Precautions

Dementia

Post-Craniotomy

Post-Head Injury Care

Neuromuscular Diseases

Post-Myelogram

Meningitis

Post Basal Skull Fracture Care

Encephalitis

Skeletal System

Casts, Splinters, Tractions

Assessment for complication of Fractures

Spinal Injury

Care Post-Open/Closed Reductions, Arthrpscopic Surgery, Hip Replacement

Lumbar Laminectomy

Patient Positioning

Pulse Check/Assessment

Post-Amputation Care

Sports Injuries

Continuous Passive Moevement (CPM)

Trans Epidermal Nerve Stimulators

Knee replacement

Pinned Fractures

Halo Traction/Cervical Tongs

Pulmonary System

Assessment of Breath Sounds

Suctioning (Nares, Oropharynx)

Tracheal Suctioning

Tracheostomy Care

Chest Tube Maintenance

Chest Tube Removal

ARDS

Obstructive

Pneumothrax

Pneumonia

Tuberculosis

Pulmonary Edma

Thoracotomy

Lobecotomy

Lung resection

Incentive Spirometry

Eye, Ear, Nose & Throat

Tonsillectomy & Adenoidectomy

Nose Bleeds

Ear infection

Ear Tubes

Radical Neck, Post op-Care

Cataract Surgery

Glaucoma

Ocular Trauma

Ocular Tumor

Vertigo

Cosmetic & Reconstructive

Facelift

Blephoroplasty

Abdominoplasty

Breast Augmentation

Breast Reconstruction

Breast Reduction

Other

Patient Safety Goals

Medication Safety & Reconcilliation

Abbreviation Safety

Organ Donation

Please read and agree to the statements below by marking the checkbox.

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

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