Skills Checklist – LTC RN

Skills Checklist – LTC RN

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• GENERAL SKILLS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Standard Precautions
  Isolation Precautions
  Pediatric Respiratory/ Cardiac Arrest
  Adult Respiratory/ Cardiac Arrest
  Crash Carts
  Defibrillators
  Care of Patients in Restraints
  Pain Management
  Care Planning & Discharge Planning
  Patient/ Family Education
  Patient Head to Toe Assessment
  Automated Med Dispensing System
  Electronic Documentation

• GENERAL SKILLS – TYPES OF AUTOMATED MED DISPENSING SYSTEMS:(if applicable)
• GENERAL SKILLS – TYPES OF ELECTRONIC DOCUMENTATION:(if applicable)
• MEDICATION-KNOWLEDGE AND USE OF*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pouring from Stock Medications
  Narcotic Administration
  IV Push/ Drip Medications
  Antibiotics
  Oral
  Topical
  Otic
  Rectal
  Vaginal
  Ophthalmic
  Continuous Subcutaneous Infusion Pumps
  Total Parenteral Nutrition (TPN)
  Peripheral Parenteral Nutrition
  Patient Controlled Analgesia (PCA)

• PHLEBOTOMY/ IV THERAPY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Blood Draw- Peripheral
  Blood Draw- Central Line/ Port
  Insertion, Care and Maintenance of Peripheral IV
  Care and Maintenance of Central Lines
  Care and Maintenance of Implanted Port- A- Cath
  Mixing IVs
  Regulating IVs
  IV Infusion Pumps
  Blood/ Blood Product Administration

• CARDIAC*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Recognizing Basic & Life- Threatening Dysrhythmia
  Congestive Heart Failure
  Pulse Checks
  Use of Doppler Cardiac Monitors
  Taking EKGs- 12 Lead
  Use of Automatic BP Cuff (ie Dinamap)

• CARDIAC – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Heart Failure
  CHF
  MI
  Arrhythmias
  Hypertension
  Hypotension
  CAD

• CARDIAC – Knowledge and Use of:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Anticoagulants
  Nitrates (Oral, Topical)
  Antiarrhythmics (Oral)
  Antihypertensives (Oral)

• RESPIRATORY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  COPD
  Asthma Exacerbation
  Tracheostomy
  Pneumonia
  Emphysema
  Pre/ Post Thoracic Surgery
  Chest Tubes
  Collection of Sputum Specimen
  O2 Cannulas/ Masks
  Non- rebreather Mask
  Nebulizer Set- up/ Use
  Incentive Spirometry
  Chest PT
  Suctioning (Oral/ Nasotracheal)
  Suctioning (Tracheostomy Tube)
  Ventilator Patient (Mouth Care, Suctioning, Ambu bag)

• RESPIRATORY – Knowledge and Use of:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bronchodilators (Oral, IV, Inhaler)
  Steroids

• NEURO*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Spinal Cord Injury- Acute
  Spinal Cord Injury- Long Term
  CVA/Stroke
  Neuromuscular Disease
  Alzheimer’s Disease
  Wandering
  Hallucinations
  Anxiety
  Reality Orientation
  Assessing Levels of Consciousness
  Pupil Checks
  Seizure Precautions
  Stroke Precautions
  Swallow Precautions
  Assisting with Lumbar Puncture
  Use of Hyper/ Hypothermia Blanket

• NEURO – Knowledge and Use of:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Anticonvulsant
  Sedative

• SENSORY DEFICITS-CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Dentures
  Hearing Aids
  Hearing Loss
  Prosthetic eye
  Contact Lens Care
  Blindness
  Macular Degeneration

• GASTROINTESTINAL- CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Nasogastric tubes (i.e. Salem Sump, Levine)
  Nasointestinal Tubes (i.e. Cantor, Miller- Abbott)
  Jejunostomy, Gastrostomy, Cecostomy Tubes
  Colostomy, Ileostomy
  Bronchoscopy Lung/ Wedge Resection

• GI GENERAL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Collection of Stool Specimens
  Bowel Preparation and Cleansing Procedures
  Administration of Tube Feedings via Flexible Tubes
  Bowel Disimpaction
  Bowel Retraining
  Sitz Bath Treatments
  Insertion and Checking Placement/ Patency NG Tubes

• ENDOCRINE- CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Diabetes
  Hyper/ hypoglycemia

• ENDOCRINE GENERAL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Blood Glucose Monitoring
  Performing Fingersticks
  Use of Blood Glucose Meter Device
  Use of Visual Blood Glucose Strips

• ENDOCRINE GENERAL – Knowledge and Use of:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Single Type Insulin
  Mixed Insulins
  Insulin Infusion

• RENAL/ GU- CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Incontinence
  Urinary Retention
  UTI
  Insertion of Foley Catheter- Female
  Insertion of Foley Catheter- Male
  Straight Catheterization- Male
  Straight Catheterization- Female
  Insertion of Suprapubic Catheter
  Application of Condom Catheter
  Bladder Retraining
  Urinary Diversion
  Bladder Irrigation (Continuous and Intermittent)

• RENAL/ GU- Peritoneal Dialysis*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Manual
  Automatic Cycler Machine

• ORTHOPEDIC- CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Total Joint Replacement
  Rheumatic/ Arthritic Disease
  Amputation
  Fracture

• ORTHOPEDIC GENERAL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Cast Care
  CMS Checks
  Traction- Skin
  Traction- Skeletal
  Range of Motion
  Use of Assistive Devices
  Application of Splints of Extremities
  Continuous Passive Motion Machine (CPM)
  Transfer Techniques
  Use of Sliding Board
  Gait Training/ Retraining
  Application of Prosthetic Devices
  Application of Orthotic Devices

• WOUND/ SKIN- CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pressure Sores
  Leg Ulcers
  Burns

• WOUND/ SKIN GENERAL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acute Dressing Changes
  Wound Care
  Irrigations
  Identifying Common Skin Problems
  Recognizing Normal Skin Changes
  Use of Special Pressure Relief Devices
  Pressure Relief Mattress/ Seat Cushion

• ADDITIONAL SKILLS- CARE OF PATIENTS WITH:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Hemovacs*
  Jackson-Pratt Tubes*
  Penrose Drains*
  T-Tubes*
  Wound Vac

• Age Group Experience*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Newborn (birth – 30 days)
  Infant (30 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)

• Do you speak any languages other than English?*
  • No

  If yes, enter languages above, separated by commas.

• Confirmation*
  • 
    I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
• Signature
• Date
  
  Date Format: MM slash DD slash YYYY