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LPN/RN

    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

Are you a LPN or RN?

Total years of LPN/RN experience

Date

Nursing Skills

Documentation/Notes

Vital Signs – BP, TPR, Height, Weight

Intake & Output monitoring

Activities of Daily Living (ADLs)

Admission of Client

Medications: Oral, IM, SQ, PR, Topical

Body Systems Review (Head to Toe Assessment)

Bathing assistance

Oral Hygiene; Denture Care

Nail and Skin Care

Backrubs/back care

Use of Bedpan/Urinal

Bowel Regimen

Client Care Plans (Revise & Update)

Client Safety Standards/Precautions

Infection Control Precautions

Handwashing

Compresses: warm/cold

CPR

Applying/Removing TEDS stockings

Prosthetic/Assistive Devices

Restraints – Apply/Monitor

Reporting changes in client’s condition

Intravenous therapy

Colostomy Care & Irrigation

Wound Care

Discharge of Client

Pain Assessment

Traction

Supervision of LNA, PCSP

Repositioning/Transferring

Assessing Educational Needs

Teaching Client, Staff, Family, Caregivers

Coordinating Care with Team

Communicating with Physician/Provider

Documenting Orders Appropriately

Drug Calculations

Handling Emergent Situations

Reporting concerns to team/supervisor

Use of Walker/Canes

Use of Hoyer Lift

Crutch walking

Use of manual wheelchair

Use of electric wheelchair

Special Diet Restrictions (Diabetic, Low Salt, Fluid Restriction, etc.)

Making occupied bed

Basic Medical Asepsis

Oxygen (cannula, mask, etc)

Pulse Oximetry

Range of Motion Exercises

Assist with Ambulation

Dressing changes

Advance Directives

Postmortem Care

Cast Care

GT/NG tubes

Ostomy Care

Catheterization – straight/foley

Incentive Spirometry

Specimen Collection

Phlebotomy

Urine Dipstick

Fingerstick Blood Glucose Monitoring

Suctioning

Tracheostomy Care

Transfer/Transport Clients

Care of Client with

Alzheimer’s/Dementia

Stroke

Asthma/COPD/Respiratory Illness

Head Injuries

Amputation

Diabetes

Pacemaker

Spinal Cord Injury

Wounds/Drains

Tracheostomy

CHF/Cardiac Disease

Renal Disease

Hip/Knee Replacements

AIDS/Immunosuppression

Cancer

Burns

Recent Surgery

Mental Illness

Multiple Trauma

Terminal Illness

Age-Appropriate Care of

Newborn (birth – 30 days)

Infant (31 days – 1 year)

Toddler (1 – 3 years)

Preschooler (3 – 5 years)

School Age (5 – 12 years)

Adolescents (12 – 18 years)

Young Adults (18-39 years)

Middle Adults (39 – 64 years)

Older Adults (64+ years)

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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