[checklist name= "LPN/RN" mailto="credentialing@teemagroup.com" templatedoc="1FrgzkHG6Bu8o0ykMn2Saqa_DUdMr43oetEdFUWjvsSo" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="LPN/RN"] 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="Nursing Skills"] [checklistInput type="scale"]Documentation/Notes[/checklistInput] [checklistInput type="scale"]Vital Signs - BP, TPR, Height, Weight[/checklistInput] [checklistInput type="scale"]Intake & Output monitoring[/checklistInput] [checklistInput type="scale"]Activities of Daily Living (ADLs)[/checklistInput] [checklistInput type="scale"]Admission of Client[/checklistInput] [checklistInput type="scale"]Medications: Oral, IM, SQ, PR, Topical[/checklistInput] [checklistInput type="scale"]Body Systems Review (Head to Toe Assessment)[/checklistInput] [checklistInput type="scale"]Bathing assistance[/checklistInput] [checklistInput type="scale"]Oral Hygiene; Denture Care[/checklistInput] [checklistInput type="scale"]Nail and Skin Care[/checklistInput] [checklistInput type="scale"]Backrubs/back care[/checklistInput] [checklistInput type="scale"]Use of Bedpan/Urinal[/checklistInput] [checklistInput type="scale"]Bowel Regimen[/checklistInput] [checklistInput type="scale"]Client Care Plans (Revise & Update)[/checklistInput] [checklistInput type="scale"]Client Safety Standards/Precautions[/checklistInput] [checklistInput type="scale"]Infection Control Precautions[/checklistInput] [checklistInput type="scale"]Handwashing[/checklistInput] [checklistInput type="scale"]Compresses: warm/cold[/checklistInput] [checklistInput type="scale"]CPR[/checklistInput] [checklistInput type="scale"]Applying/Removing TEDS stockings[/checklistInput] [checklistInput type="scale"]Prosthetic/Assistive Devices[/checklistInput] [checklistInput type="scale"]Restraints - Apply/Monitor[/checklistInput] [checklistInput type="scale"]Reporting changes in client’s condition[/checklistInput] [checklistInput type="scale"]Intravenous therapy[/checklistInput] [checklistInput type="scale"]Colostomy Care & Irrigation[/checklistInput] [checklistInput type="scale"]Wound Care[/checklistInput] [checklistInput type="scale"]Discharge of Client[/checklistInput] [checklistInput type="scale"]Pain Assessment[/checklistInput] [checklistInput type="scale"]Traction[/checklistInput] [checklistInput type="scale"]Supervision of LNA, PCSP[/checklistInput] [checklistInput type="scale"]Repositioning/Transferring[/checklistInput] [checklistInput type="scale"]Assessing Educational Needs[/checklistInput] [checklistInput type="scale"]Teaching Client, Staff, Family, Caregivers[/checklistInput] [checklistInput type="scale"]Coordinating Care with Team[/checklistInput] [checklistInput type="scale"]Communicating with Physician/Provider[/checklistInput] [checklistInput type="scale"]Documenting Orders Appropriately[/checklistInput] [checklistInput type="scale"]Drug Calculations[/checklistInput] [checklistInput type="scale"]Handling Emergent Situations[/checklistInput] [checklistInput type="scale"]Reporting concerns to team/supervisor[/checklistInput] [checklistInput type="scale"]Use of Walker/Canes[/checklistInput] [checklistInput type="scale"]Use of Hoyer Lift[/checklistInput] [checklistInput type="scale"]Crutch walking[/checklistInput] [checklistInput type="scale"]Use of manual wheelchair[/checklistInput] [checklistInput type="scale"]Use of electric wheelchair[/checklistInput] [checklistInput type="scale"]Special Diet Restrictions (Diabetic, Low Salt, Fluid Restriction, etc.)[/checklistInput] [checklistInput type="scale"]Making occupied bed[/checklistInput] [checklistInput type="scale"]Basic Medical Asepsis[/checklistInput] [checklistInput type="scale"]Oxygen (cannula, mask, etc)[/checklistInput] [checklistInput type="scale"]Pulse Oximetry[/checklistInput] [checklistInput type="scale"]Range of Motion Exercises[/checklistInput] [checklistInput type="scale"]Assist with Ambulation[/checklistInput] [checklistInput type="scale"]Dressing changes[/checklistInput] [checklistInput type="scale"]Advance Directives[/checklistInput] [checklistInput type="scale"]Postmortem Care[/checklistInput] [checklistInput type="scale"]Cast Care[/checklistInput] [checklistInput type="scale"]GT/NG tubes[/checklistInput] [checklistInput type="scale"]Ostomy Care[/checklistInput] [checklistInput type="scale"]Catheterization - straight/foley[/checklistInput] [checklistInput type="scale"]Incentive Spirometry[/checklistInput] [checklistInput type="scale"]Specimen Collection[/checklistInput] [checklistInput type="scale"]Phlebotomy[/checklistInput] [checklistInput type="scale"]Urine Dipstick[/checklistInput] [checklistInput type="scale"]Fingerstick Blood Glucose Monitoring[/checklistInput] [checklistInput type="scale"]Suctioning[/checklistInput] [checklistInput type="scale"]Tracheostomy Care[/checklistInput] [checklistInput type="scale"]Transfer/Transport Clients[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Care of Patients With"] [checklistInput type="scale"]Alzheimer’s/Dementia[/checklistInput] [checklistInput type="scale"]Stroke[/checklistInput] [checklistInput type="scale"]Asthma/COPD/Respiratory Illness[/checklistInput] [checklistInput type="scale"]Head Injuries[/checklistInput] [checklistInput type="scale"]Amputation[/checklistInput] [checklistInput type="scale"]Diabetes[/checklistInput] [checklistInput type="scale"]Pacemaker[/checklistInput] [checklistInput type="scale"]Spinal Cord Injury[/checklistInput] [checklistInput type="scale"]Wounds/Drains[/checklistInput] [checklistInput type="scale"]Tracheostomy[/checklistInput] [checklistInput type="scale"]CHF/Cardiac Disease[/checklistInput] [checklistInput type="scale"]Renal Disease[/checklistInput] [checklistInput type="scale"]Hip/Knee Replacements[/checklistInput] [checklistInput type="scale"]AIDS/Immunosuppression[/checklistInput] [checklistInput type="scale"]Cancer[/checklistInput] [checklistInput type="scale"]Burns[/checklistInput] [checklistInput type="scale"]Recent Surgery[/checklistInput] [checklistInput type="scale"]Mental Illness[/checklistInput] [checklistInput type="scale"]Multiple Trauma[/checklistInput] [checklistInput type="scale"]Terminal Illness[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age-Appropriate Care of"] [checklistInput type="scale"]Newborn (birth - 30 days)[/checklistInput] [checklistInput type="scale"]Infant (31 days - 1 year)[/checklistInput] [checklistInput type="scale"]Toddler (1 - 3 years)[/checklistInput] [checklistInput type="scale"]Preschooler (3 - 5 years)[/checklistInput] [checklistInput type="scale"]School Age (5 - 12 years)[/checklistInput] [checklistInput type="scale"]Adolescents (12 - 18 years)[/checklistInput] [checklistInput type="scale"]Young Adults (18 - 39 years)[/checklistInput] [checklistInput type="scale"]Middle Adults (39 - 64 years)[/checklistInput] [checklistInput type="scale"]Older Adults (64+ years)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]