Skills Checklist:
RN - Long Term Care

Skills Checklist – RN - Long Term Care

Recognizing Basic & Life- Threatening Dysrhythmia*

Congestive Heart Failure*

Use of Doppler Cardiac Monitors*

Taking EKGs- Lead*

Use of Automatic BP Cuff (ie Dinamap)*

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

AGE of Patients Cared For:(Required)

	0	1	2	3	4	5
Newborn/Neonatal (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)*
Elderly Adults (over 79+ years)*

GENERAL SKILLS(Required)

	0	1	2	3	4	5
Standard Precautions*
Isolation Precautions*
Pediatric Respiratory/Cardiac Arrest*
Adult Respiratory/Cardiac Arrest*
Crash Carts*
Defibrillators*
Care of Patients in Restraints*
Pain Management*
Automated Med Dispensing System*
Care Planning & Discharge Planning*
Patient/Family Education*
Electronic Documentation*
Patient Head to Toe Assessment*

MEDICATION- KNOWLEDGE AND USE OF(Required)

	0	1	2	3	4	5
Pouring from Stock Medications*
Narcotic Administration*
IV Push/Drip Medications*
Antibiotics*
Oral*
Topical*
Otic*
Rectal*
Vaginal*
Ophthalmic*
Continuous Subcutaneous Infusion Pumps*
Total Parental Nutrition (TPN)*
Peripheral Parental Nutrition*
Patient Controlled Analgesia (PCA)*

PHLEBOTOMY/IV THERAPY(Required)

	0	1	2	3	4	5
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(Required)

CARDIAC- CARE OF PATIENT WITH:(Required)

CARDIAC- KNOWLEDGE AND USE OF(Required)

RESPIRATORY(Required)

	0	1	2	3	4	5
COPD*
Asthma Exacerbation*
Tracheostomy*
Pneumonia*
Emphysema*
Pre/ Post Thoracic Surgery*
Chest Tubes*
Collection of Sputum Specimen*
O 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:(Required)

NEURO:(Required)

	0	1	2	3	4	5
Spinal Cord Injury- Acute*
Spinal Cord Injury- Long Term*
CVA/Stroke*
Neuromuscular Disease*
Alzheimer's Disease*
Wandering*
Hallucinations*
Anxiety*
Agitation*
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(Required)

SENSORY DEFICITS - CARE OF PATIENT WITH(Required)

GASTROINTESTINAL- CARE OF PATIENT WITH:(Required)

GI GENERAL- CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
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 PATIENT WITH:(Required)

ENDOCRINE GENERAL- CARE OF PATIENT WITH:(Required)

ENDOCRINE -KNOWLEDGE AND USE OF(Required)

RENAL/ GU- CARE OF PATIENTS WITH:(Required)

	0	1	2	3	4	5
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- CARE OF PATIENTS WITH:(Required)

ONCOLOGY - CARE OF PATIENT WITH:(Required)

ORTHOPEDIC- CARE OF PATIENT WITH:(Required)

ORTHOPEDIC GENERAL- CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
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:(Required)

WOUND/ SKIN GENERAL- CARE OF PATIENTS WITH:(Required)

ADDITIONAL SKILLS- CARE OF PATIENTS WITH:(Required)

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	0	1	2	3	4	5
Heart Failure*
CHF*
MI*
Arrhythmias*
Hypertension*
Hypotension*
CAD*

	0	1	2	3	4	5
Dentures*
Hearing Aids*
Hearing Loss*
Prosthetic eye*
Contact Lens Care*
Blindness*
Macular Degeneration*

	0	1	2	3	4	5
Bone Marrow Transplant*
Inpatient Chemotherapy*
Leukemia*
Radiation Implant*
Lymphoma*
Depressed Immune System*
Radiation Therapy*
Fresh Oncology Surgery*

	0	1	2	3	4	5
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*

	0	1	2	3	4	5
Bronchodilators (Oral, IV, Inhaler)*
Steroids*

	0	1	2	3	4	5
Anticonvulsant*
Sedative*

	0	1	2	3	4	5
Diabetes*
Hyper/ hypoglycemia*