RN - Geriatric/LTC Skill Assessment
Name
First Name
Last Name
Email
example@example.com
Date
-
Month
-
Day
Year
Date
TYPE OF FACILITY EXPERIENCE
*
Nursing Home/Long-Term Care Facility
Assisted Living
Continuing Care Retirement Community
Skilled Nursing Facility (SNF)
Other
SKILLED NURSING FACILITY - AGE OF PATIENTS CARED FOR
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler/Preschool (13 months to 5 years)
School Age Child/adolescent (6 years to 18 years)
Young Adults/Middle Adult (19 years to 64 years)
Older Adults/Elderly (65+ years)
GENERAL SKILLS
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Standard Precautions
Isolation Precautions
Pain Management
Care of Patient in Restraints
AUTOMATED DISPENSING SYSTEMS
Accudose
Metro
Omnicell
Promanager Rx
Pyxis
Other
ELECTRONIC DOCUMENTATION
Allscripts
Care360
Cerner
eCLinicalWorks
EPIC
MACLAB
McKesson
Meditech
PACS
Soarian
Other
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Peripheral IV Insertion, Care and Maintenance
Access/Management of Implanted Ports
Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
Patient/Family Education
Knowledge of "Do Not Use Abbreviations"
Charge/supervisor experience
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge/familiarity with HCAHPS scores
MEDICATION - KNOWLEDGE AND USE OF:
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
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
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Blood Draw-Peripheral
Mixing IVs
Regulating IVs
Blood/Blood Product Administration
IV Infusion Pumps
IV Pumps
Alaris
Alibaba
Bard
Baxter
Braun
CADD
IVAC
Zynomed
Other
CARDIAC
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Recognizing Basic & Life-Threatening Dysrhythmias
Congestive Heart Failure
Pulse Checks
Use of Doppler
Cardiac Monitors
Obtaining EKGs - 12 Lead
Use of Automatic BP Cuff (ie Dinamap)
Nitrates (Oral, Topical)
Antiarrythmics (Oral)
Antihypertensives (Oral)
RESPIRATORY
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Emphysema
COPD
Asthma Exacerbation
Tracheostomy
Pneumonia
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)
Bronchodilators (Oral, IV, Inhaler)
Steroids
NEUROLOGICAL
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Spinal Cord Injury - Acute
Spinal Cord Injury - Long Term
CVA Stroke
Neuromuscular Disease
Alzheimer Disease
Wandering
Hallucinations
Anxiousness
Agitation
Reality Orientation
Assessing Levels of Consciousness
Pupil Checks
Seizure Precautions
Stroke Precautions
Swallow Precautions
Assisting with Lumbar Puncture
Use of Hyper/Hypothermia Blanket
SENSORY DEFICITS
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Dentures
Hearing Aid Devices
Care of Patients with Hearing Loss
Prosthetic Eye
Contact Lens Care
Cataracts
Blindness
Macular Degeneration
GASTROINTESTINAL
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Nasogastric Tubes (i.e. Salem Sump, Levine)
Nasointestinal Tubes (i.e. Cantor, Miller-Abbot)
Jejunostomy, Gastrostomy, Cecostomy Tubes
Colostomy, Ileostomy
Administration of Tube Feedings via Flexible Tubes
By Gravity Infusion
By Feeding Pump
Collection of Stool Specimens
Bowel Preparation and Cleansing Procedures
Bowel Disimpaction
Bowel Retraining
Sitz Bath Treatments
Inserting and Checking Placement/Patency NG Tubes
ENDOCRINE
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Diabetes
Hyper/hypoglycemia
Blood Glucose Monitoring
Performing Fingersticks
Use of Blood Glucose Meter Device
Use of Visual Blood Glucose Strips
Insulin
Single Type
Mixed Insulins
Insulin Infusion
RENAL/GENITOURINARY
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Incontinence
Urinary Retention
UTI
Insertion of Catheter-Female
Insertion of Catheter - Male
Insertion of Suprapubic Catheter
Applications of Condom Catheter
Bladder Retraining
Urinary Diversion
Bladder Irrigation (Continuous and Intermittent)
Peritoneal Dialysis
Manual
Automatic Cycler Machine
ORTHOPEDIC
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Total Joint Replacement
Rheumatic/Arthritic Disease
Amputation
Fracture
Cast Care
CMS Checks
Traction - Skin
Traction - Skeletal
Range of Motion
Use of Assistive Devices
Applications of Splints of Extremities
Continuous Passive Motion Machine (CPM)
Transfer Techniques
Use of a Sliding Board
Gait Training/Retraining
Application of Prosthetic Devices
Application of Orthotic Devices
WOUND AND SKIN CARE
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Pressure Sores
Leg Ulcers
Burns
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
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level;
Can teach and/or supervise others
Hemovacs
Jackson-Pratt Tubes
enrose Drains
T-Tubes
Please list any additional skills not included above
Signature
Submit
Should be Empty: