Skills Checklist

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = No Experience
1 = Some Experience
2 = Intermittent Experience
3 = Experienced
4 = Very Experienced

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Age of Patients Cared For:

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Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64 years to 79 years)
Elderly Adults (over 79+ years)

GENERAL SKILLS

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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

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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

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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:

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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)

Care of Patient With:

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Heart Failure
CHF
MI
Arrhythmias
Hypertension
Hypotension
CAD

Knowledge and Use of:

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Anticoagulants
Nitrates (Oral, Topical)
Antiarrhythmics (Oral)
Antihypertensives (Oral)

RESPIRATORY

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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)

Knowledge and Use of:

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Bronchodilators (Oral, IV, Inhaler)
Steroids

NEURO:

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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

Knowledge and Use of:

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Anticonvulsant
Sedative

SENSORY DEFICITS-CARE OF PATIENTS WITH:

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Dentures
Hearing Aids
Hearing Loss
Prosthetic eye
Contact Lens Care
Blindness
Macular Degeneration

GASTROINTESTINAL- CARE OF PATIENTS WITH:

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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

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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:

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Diabetes
Hyper/ hypoglycemia

ENDOCRINE GENERAL

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Blood Glucose Monitoring
Performing Fingersticks
Use of Blood Glucose Meter Device
Use of Visual Blood Glucose Strips

Knowledge and Use of:

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Single Type Insulin
Mixed Insulins
Insulin Infusion

RENAL/ GU- CARE OF PATIENTS WITH:

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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)

Peritoneal Dialysis

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Manual
Automatic Cycler Machine

ORTHOPEDIC- CARE OF PATIENTS WITH:

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Total Joint Replacement
Rheumatic/ Arthritic Disease
Amputation
Fracture

ORTHOPEDIC GENERAL

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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:

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Pressure Sores
Leg Ulcers
Burns

WOUND/ SKIN GENERAL

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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:

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Hemovacs
Jackson-Pratt Tubes
Penrose Drains
T-Tubes
Wound Vac

Position Category

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Total Years of Experience

First Name

Last Name

Social Security #

Date of Birth

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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Skills Checklist - LTC RN