[checklist name= "Licensed Practical (Vocational) Nurse" mailto="credentialing@teemagroup.com" templatedoc="1_Fjs1CD8LlCNf-qawnqZFAtAl8ANpkxFcbK8Bv1LcJw" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Licensed Practical (Vocational) Nurse"] 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 [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age Specific Competency"] [checklistInput type="scale"]Neonates/Newborns (0-30 days)[/checklistInput] [checklistInput type="scale"]Infant (30 days - 1 year)[/checklistInput] [checklistInput type="scale"]Toddler (1-3 years)[/checklistInput] [checklistInput type="scale"]Preschool Child (3-6 years)[/checklistInput] [checklistInput type="scale"]Adolescents (12-18 years)[/checklistInput] [checklistInput type="scale"]Young adult (18-39)[/checklistInput] [checklistInput type="scale"]Middle adult (39-61)[/checklistInput] [checklistInput type="scale"]Older adult (64+ years)[/checklistInput] [checklistInput type="scale"]Able to adapt care to age of normal growth and development[/checklistInput] [checklistInput type="scale"]Able to adapt method and language to developmental age[/checklistInput] [checklistInput type="scale"]Able to secure environment for safety according to developmental age[/checklistInput] [checklistInput type="scale"]Hand Cleaning Techniques[/checklistInput] [checklistInput type="scale"]Patient Safety Goals[/checklistInput] [checklistInput type="scale"]Patient Suicide Risk[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Pain Management"] [checklistInput type="scale"]Pain Level Assessment[/checklistInput] [checklistInput type="scale"]Non-narcotic Agents[/checklistInput] [checklistInput type="scale"]Narcotic Agents[/checklistInput] [checklistInput type="scale"]Patient Controlled Analgesia[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Leadership & Nursing Models"] [checklistInput type="scale"]Long Term Care[/checklistInput] [checklistInput type="scale"]Alzheimer Unit[/checklistInput] [checklistInput type="scale"]Hospital[/checklistInput] [checklistInput type="scale"]Team Nursing[/checklistInput] [checklistInput type="scale"]Primary Care Nursing[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Administrative Nursing Skills"] [checklistInput type="scale"]Admission & Discharge Procedures[/checklistInput] [checklistInput type="scale"]Computerized Charting[/checklistInput] [checklistInput type="scale"]Checking Presence of Consent Forms[/checklistInput] [checklistInput type="scale"]Advance Directives[/checklistInput] [checklistInput type="scale"]HIPAA Privacy and Security; Patient Confidentiality of Information[/checklistInput] [checklistInput type="scale"]Teaching: Patient, Family, Significant Other(s)[/checklistInput] [checklistInput type="scale"]Infection Control: Universal Precautions[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Equipment"] [checklistInput type="scale"]Cardiac Monitors[/checklistInput] [checklistInput type="scale"]Defibrillator[/checklistInput] [checklistInput type="scale"]Glucometers[/checklistInput] [checklistInput type="scale"]IV Pumps[/checklistInput] [checklistInput type="scale"]Oxygen Set Up[/checklistInput] [checklistInput type="scale"]Pulse Oxymeter[/checklistInput] [checklistInput type="scale"]Specialty Beds[/checklistInput] [checklistInput type="scale"]Narcotic Withdrawal System (e.g. Pyxis)[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Basic Skills"] [checklistInput type="scale"]Physical/Health Assessment/Plan of Care[/checklistInput] [checklistInput type="scale"]Decubitus Care/Prevention[/checklistInput] [checklistInput type="scale"]Wound Care[/checklistInput] [checklistInput type="scale"]Dressing Changes[/checklistInput] [checklistInput type="scale"]Sterile Technique[/checklistInput] [checklistInput type="scale"]Elastic (TED) Hose/Stockings[/checklistInput] [checklistInput type="scale"]Restraint Application: Protocol, Safeguards[/checklistInput] [checklistInput type="scale"]Ordering-Charging Medications/Supplies[/checklistInput] [checklistInput type="scale"]Indwelling Catheter Insertion/Removal[/checklistInput] [checklistInput type="scale"]Straight Catheterization[/checklistInput] [checklistInput type="scale"]Nutritional Infusions (Hyperal, Lipids)[/checklistInput] [checklistInput type="scale"]Isolation Procedures[/checklistInput] [checklistInput type="scale"]Assisting with Lumbar Puncture[/checklistInput] [checklistInput type="scale"]Nerve Stimulators[/checklistInput] [checklistInput type="scale"]Nurse Care Planning[/checklistInput] [checklistInput type="scale"]Oxygen by Bag & Mask[/checklistInput] [checklistInput type="scale"]Oxygen by CPAP[/checklistInput] [checklistInput type="scale"]Oxygen by Nasal Cannula[/checklistInput] [checklistInput type="scale"]Trach Collar[/checklistInput] [checklistInput type="scale"]Pacemaker[/checklistInput] [checklistInput type="scale"]Continuous & Intermittent Tube Feeding[/checklistInput] [checklistInput type="scale"]Non-Invasive Hemodynamic Monitoring (Palpation, Doppler)[/checklistInput] [checklistInput type="scale"]Patient Positioning, Ambulation, ROM[/checklistInput] [checklistInput type="scale"]Broviac Line Site Maintenance[/checklistInput] [checklistInput type="scale"]Groshog Line Site Maintenance[/checklistInput] [checklistInput type="scale"]Hickman Line Site Maintenance[/checklistInput] [checklistInput type="scale"]PICC Line Site Maintenance[/checklistInput] [checklistInput type="scale"]Portacath Line Site Maintenance[/checklistInput] [checklistInput type="scale"]Quinton Line Site Maintenance[/checklistInput] [checklistInput type="scale"]Post-mortem Care[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Interpretation of Lab Results"] [checklistInput type="scale"]Blood Gases[/checklistInput] [checklistInput type="scale"]Blood Chemistry[/checklistInput] [checklistInput type="scale"]Cardiac Enzymes & Isoenzymes[/checklistInput] [checklistInput type="scale"]CBC with and without Differential[/checklistInput] [checklistInput type="scale"]Coagulation Studies[/checklistInput] [checklistInput type="scale"]Cultures[/checklistInput] [checklistInput type="scale"]Electrolytes[/checklistInput] [checklistInput type="scale"]Urine Dipstick[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Cardiovascular"] [checklistInput type="scale"]Hypertension[/checklistInput] [checklistInput type="scale"]Post-Myocardial Infarction Care[/checklistInput] [checklistInput type="scale"]Congestive Heart Failure[/checklistInput] [checklistInput type="scale"]Fem-Pop Bypass[/checklistInput] [checklistInput type="scale"]Coronary Artery Bypass Graft (CABG)[/checklistInput] [checklistInput type="scale"]Angina Pectoris[/checklistInput] [checklistInput type="scale"]Peripheral Vascular Disease[/checklistInput] [checklistInput type="scale"]Post-Open Heart Floor[/checklistInput] [checklistInput type="scale"]Aneurysm[/checklistInput] [checklistInput type="scale"]Post Cardiac Catheterization Care[/checklistInput] [checklistInput type="scale"]Cerebral Vascular Accident[/checklistInput] [checklistInput type="scale"]Cardiomyopathy[/checklistInput] [checklistInput type="scale"]Carotid Endarterectomy[/checklistInput] [checklistInput type="scale"]Cardiac Arrest[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Endocrine"] [checklistInput type="scale"]Diabetes[/checklistInput] [checklistInput type="scale"]Glucose Monitoring[/checklistInput] [checklistInput type="scale"]Insulin Administration[/checklistInput] [checklistInput type="scale"]Addison's[/checklistInput] [checklistInput type="scale"]Pituitary Disorders[/checklistInput] [checklistInput type="scale"]Thyroid Dysfunction[/checklistInput] [checklistInput type="scale"]Post-Thyroidectomy Care[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Gastrointestinal"] [checklistInput type="scale"]Assessment of Bowel Sounds[/checklistInput] [checklistInput type="scale"]Liver Failure[/checklistInput] [checklistInput type="scale"]Cirrhosis[/checklistInput] [checklistInput type="scale"]Cholecystectomy[/checklistInput] [checklistInput type="scale"]Cholelithiases[/checklistInput] [checklistInput type="scale"]Hepatitis[/checklistInput] [checklistInput type="scale"]Appendicitis/Appendectomy[/checklistInput] [checklistInput type="scale"]GI Bleeding[/checklistInput] [checklistInput type="scale"]Gastric Lavage (Iced Saline)[/checklistInput] [checklistInput type="scale"]Gastric Suction[/checklistInput] [checklistInput type="scale"]Insertion of Nasogastric Tube (NGT)[/checklistInput] [checklistInput type="scale"]NGT Resection[/checklistInput] [checklistInput type="scale"]Colostomy[/checklistInput] [checklistInput type="scale"]Post-GI Surgery Care[/checklistInput] [checklistInput type="scale"]Care of Gastrostomy Tube[/checklistInput] [checklistInput type="scale"]Care of PEG Tube[/checklistInput] [checklistInput type="scale"]Bowel Obstruction[/checklistInput] [checklistInput type="scale"]Paralytic ileus[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Genitourinary System"] [checklistInput type="scale"]Kidney Stones[/checklistInput] [checklistInput type="scale"]TURP/TURBP[/checklistInput] [checklistInput type="scale"]Nephrostomy Tube Care[/checklistInput] [checklistInput type="scale"]Nephrectomy[/checklistInput] [checklistInput type="scale"]Care of Patient Undergoing Dialysis: Peritoneal & Hemodialysis[/checklistInput] [checklistInput type="scale"]A-V Fistula Care[/checklistInput] [checklistInput type="scale"]A & P repair[/checklistInput] [checklistInput type="scale"]Hysterectomy Care (Abdominal/Vaginal)[/checklistInput] [checklistInput type="scale"]UTI, Bladder Infection[/checklistInput] [checklistInput type="scale"]ILeal Conduit[/checklistInput] [checklistInput type="scale"]Suprapubic Catheter[/checklistInput] [checklistInput type="scale"]Post-Renal Transplant[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Medical"] [checklistInput type="scale"]Fluid & Electrolyte Imbalances[/checklistInput] [checklistInput type="scale"]HIV/AIDS[/checklistInput] [checklistInput type="scale"]Care of Patient Undergoing Chemotherapy[/checklistInput] [checklistInput type="scale"]Care of Patient Undergoing Radiation Therapy[/checklistInput] [checklistInput type="scale"]Oncological Crisis[/checklistInput] [checklistInput type="scale"]Leukemia[/checklistInput] [checklistInput type="scale"]Malignant Tumors[/checklistInput] [checklistInput type="scale"]Sickle Cell Crisis[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Neurological"] [checklistInput type="scale"]Neurological Checks/Assessment[/checklistInput] [checklistInput type="scale"]Glascow Coma Scale[/checklistInput] [checklistInput type="scale"]Seizure Disorders & Precautions[/checklistInput] [checklistInput type="scale"]Dementia[/checklistInput] [checklistInput type="scale"]Post-Craniotomy[/checklistInput] [checklistInput type="scale"]Post-Head Injury Care[/checklistInput] [checklistInput type="scale"]Neuromuscular Diseases[/checklistInput] [checklistInput type="scale"]Post-Myelogram[/checklistInput] [checklistInput type="scale"]Meningitis[/checklistInput] [checklistInput type="scale"]Post Basal Skull Fracture Care[/checklistInput] [checklistInput type="scale"]Encephalitis[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Skeletal System"] [checklistInput type="scale"]Casts, Splinters, Tractions[/checklistInput] [checklistInput type="scale"]Assessment for complication of Fractures[/checklistInput] [checklistInput type="scale"]Spinal Injury[/checklistInput] [checklistInput type="scale"]Care Post-Open/Closed Reductions, Arthroscopic Surgery, Hip Replacement[/checklistInput] [checklistInput type="scale"]Lumbar Laminectomy[/checklistInput] [checklistInput type="scale"]Patient Positioning[/checklistInput] [checklistInput type="scale"]Pulse Check/Assessment[/checklistInput] [checklistInput type="scale"]Post-Amputation Care[/checklistInput] [checklistInput type="scale"]Sports Injuries[/checklistInput] [checklistInput type="scale"]Continuous Passive Movement (CPM)[/checklistInput] [checklistInput type="scale"]Trans Epidermal Nerve Stimulators[/checklistInput] [checklistInput type="scale"]Knee replacement[/checklistInput] [checklistInput type="scale"]Pinned Fractures[/checklistInput] [checklistInput type="scale"]Halo Traction/Cervical Tongs[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Pulmonary System"] [checklistInput type="scale"]Assessment of Breath Sounds[/checklistInput] [checklistInput type="scale"]Suctioning (Nares, Oropharynx)[/checklistInput] [checklistInput type="scale"]Tracheal Suctioning[/checklistInput] [checklistInput type="scale"]Tracheostomy Care[/checklistInput] [checklistInput type="scale"]Chest Tube Maintenance[/checklistInput] [checklistInput type="scale"]Chest Tube Removal[/checklistInput] [checklistInput type="scale"]ARDS[/checklistInput] [checklistInput type="scale"]Obstructive[/checklistInput] [checklistInput type="scale"]Pneumothorax[/checklistInput] [checklistInput type="scale"]Pneumonia[/checklistInput] [checklistInput type="scale"]Tuberculosis[/checklistInput] [checklistInput type="scale"]Pulmonary Edema[/checklistInput] [checklistInput type="scale"]Thoracotomy[/checklistInput] [checklistInput type="scale"]Lobectomy[/checklistInput] [checklistInput type="scale"]Lung resection[/checklistInput] [checklistInput type="scale"]Incentive Spirometry[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Eye, Ear, Nose & Throat"] [checklistInput type="scale"]Tonsillectomy & Adenoidectomy[/checklistInput] [checklistInput type="scale"]Nose Bleeds[/checklistInput] [checklistInput type="scale"]Ear infection[/checklistInput] [checklistInput type="scale"]Ear Tubes[/checklistInput] [checklistInput type="scale"]Radical Neck, Post op-Care[/checklistInput] [checklistInput type="scale"]Cataract Surgery[/checklistInput] [checklistInput type="scale"]Glaucoma[/checklistInput] [checklistInput type="scale"]Ocular Trauma[/checklistInput] [checklistInput type="scale"]Ocular Tumor[/checklistInput] [checklistInput type="scale"]Vertigo[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Cosmetic & Reconstructive"] [checklistInput type="scale"]Facelift[/checklistInput] [checklistInput type="scale"]Blepharoplasty[/checklistInput] [checklistInput type="scale"]Abdominoplasty[/checklistInput] [checklistInput type="scale"]Breast Augmentation[/checklistInput] [checklistInput type="scale"]Breast Reconstruction[/checklistInput] [checklistInput type="scale"]Breast Reduction[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Other"] [checklistInput type="scale"]Patient Safety Goals[/checklistInput] [checklistInput type="scale"]Medication Safety & Reconciliation[/checklistInput] [checklistInput type="scale"]Abbreviation Safety[/checklistInput] [checklistInput type="scale"]Organ Donation[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]