Skill Checklists
Home Health RN
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
ACS/Post MI
Heart Failure
Post Cardiac Surgery
Cardiac Auscultation (Rate/Rhythm)
Peripheral Pulse/Circulation Checks
Asthma
COPD
Pneumonia
Lung Cancer
Pulmonary Emboli
Auscultate Lung Sounds
Oxygen Administration
Oxygen Safety
Oro/Nasotracheal Suctioning
CPAP/BiPAP
Ventilator Management (Specify):
CVA
Alzheimer's Disease/Dementia
Parkinson's
Degenerative Neurologic Disorders (ALS, MS, etc.)
Brain Tumor
Brain Injury
Para/Quadriplegia
Seizure Disorder
Level of Consciousness/Neuro Changes
Joint Replacement
DVT Prophylaxis/Recognition
Incision Checks
Staple Removal
Fractures
Cast/Brace
Amputation
Arthritis
Assistive Equipment/Lift Devices
In Home PT/INR (Specify):
Nutritional Assessment
Colostomy/Ileostomy Management
Fecal Incontinence/Diarrhea
Bowel Obstruction
GI Bleed
Post GI Surgery
Hepatitis Liver Failure
NG Tubes
Feeding Tubes
Drainage Devices
Feeding Pumps (Specify):
Hemodialysis
AV Fistula/Shunt
Peritoneal Dialysis
Post Bladder Surgery
Post Prostate Surgery
Urostomy
Urinary Incontinence
Bladder Catheter Insertion/Maintenance
Suprapubic Catheter Insertion/Maintenance
Diabetes
Hyper/Hypoglycemia/td>
Diabetic Skin Assessment
Cushing's / Addison's Disease
Thyroid Disease
Insulin Pumps
Glucometers
Braden Scale
Pressure Ulcer Prevention
Pressure Ulcer Staging
Pressure Ulcer Management
Burns
Wound Care
Wound Cultures
Wound Vac
Risk for Infection
Symptom Management
Side Effects of Treatment
Terminal Disease
MRSA
VRE
C. Difficile
HIV
Tuberculosis
Isolation Precautions
Peripheral Venipuncture for Labs
Start Ivs
Peripheral Ivs
PICC/CVP Lines
Venous Access Ports
Infusion Pump Setup and Management
Specify Infusion Pump Type:
Cognitive Disorders
Mood Disorders
Schizophrenia/Psychotic Disorders
Medication Compliance
Pregnancy-Related Complications
Fetal Heart Tones
Contractions
Post Partum Mother/Baby Visit
Newborn Care
Phototherapy
Breastfeeding Support
Growth and Development
Respiratory Distress Syndrome
Bronchopulmonary Dysplasia
Cystic Fibrosis
Muscular Dystrophy
Spina Bifida
Spinal Surgery
Sickle Cell Disease
Trach Care/Suctioning
Ventilator Management
Ventilator Type (Specify):
Verbal/Nonverbal Pain Scales
Response to Pain Management Interventions
PCA Pump
Epidural Cath/Site Monitoring/Pump
Non-Pharmacologic Pain Measures
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)
BLS
5
CNRN
ACLS
CCRN
Other:
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.
