Skill Checklists
LPN/LVN
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Activities of daily living
Admission of patient
Administration of medication
Ambulation
Application of heat and cold
Aseptic Technique
Assist with medical examination
Bathing: Sitz, tub, bed, shower
Bandaging
Binders
Body Alignment
Body Systems Review (Head to Toe data collection)
Cast care
Catheterization / Foley catheter care
Charting
Colostomy Care and irrigation
CPR
Crutch walking
Pressure Ulcer Care
Diabetes-related tests and preparation forms
Diabetic blood glucose testing
Discharge patients
Dosage computation
Draping
Dressing (sterile)
Ear drops
Elimination needs
Enemas, cleansing, retention, Harris flush
Restraints
Infection Control: Standard Universal Precautions
Infection Control: Reverse Isolation
Infection Control: TB/ Airborne Precautions
Infections Control: MRSA/ VRE Precautions
Isolation procedure for specimen collection
IVs: Monitor rate and infusion site
Medications: Oral, IM, SQ
Mouth care
Nail Care
Neurological Check
Nutritional check
Observations: Response to treatments/ meds
Observations: Signs of significant body system changes
Observations: Signs of shock
Observations: Signs of pain
Observes safety procedures
O2 administration
Pain assessment
Patient care plans (revise and update)
Patient safety standards/ precautions
Positioning patient
Postural drainage
Pre-op and post-op care
Provide comfort, safety and privacy
Pulse oximetry
Range of motion
Hand hygiene
Report observations/ changes
Skin care
Specimen collection: routine urine
Specimen collection: clean catch
Specimen collection: 12 and 24 hour specimen
Specimen collection: stool
Specimen collection: culture
Specimen collection: sputum
Specimen collection: from foley catheter
Suppositories
Suction-oral
Surgical Preps
Computerized charting
Trach care/suctioning
Telephone manners
Topical Medication Application
Traction
Transfer/ transport patients: wheelchair
Transfer/ transport patients: gurney
Transfer/ transport patients: to chair
Urine test for glucose/ acetone
Vital Signs
Weight: Bed scales and standing scales
IV therapy certified
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
