Skill Checklists
Hospice
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
Admit and Initial Assessment
Supervise Unlicensed Personnel
Vital Sign Monitoring
Pulse Oximetry
Assessment of Breathing Patterns
Oropharyngeal Suctioning
Tracheostomy Suctioning
Incentive Spirometry
Admin/Monitor O2 Administration
Care of Trach Patient
Care of Diabetic Patient
Urine Dipstick
Blood Glucose Monitoring
Care of the Dialysis Patient
Care of Shunts and Fistulas
Insertion/Maintain Foley Catheter
Application/Maintain Condom Catheter
Maintain Urostomy
Maintain Suprapubic Catheter
Wound Care/Debridement
Dressing Changes
Wounds Drains (JP/Hemovac)
Positioning/Transferring
Restraints
Crutch Walking/Wheelchairs
Specialized Bed (Clinitron, etc.)
Standard Precautions
Isolation Techniques
Advance Directives
Port-A-Catheter
Temp Repair Tom/Puncture Catheters
Declot Occluded Ports or Catheters
Documentation
Computerized Documentation
Follow Protocols
Patient Teaching
Checking Dosage
Evaluate Pertinent Lab Data
Administer Oral Medications
Administer Topical Medications
Administer Ophthalmic/Otic Meds
Administer Rectal/Vaginal Meds
Administer IM/SQ Medications
Administer IVPB Medications
Administer Continuous Infusion
Needle-Less Systems
Infusion Pumps
Draw Blood for Lab Studies
Establish Peripheral IVs
Hep Lock/Saline Lock
Discontinue Peripheral IVs
Central Venous Lines (CVL)
Hickman/Broviac Catheters
Quinton Catheter
Groshong
Dressing Changes/Routine Care
Obtain Blood Specimens from Catheter
Perip. Inserted Central Catheter (PICC)
Insertion of PICC
Packed Red Blood Cells
Platelet Concentrates
Fresh Frozen Plasma
Cryoprecipitate
Reverse Isolation
AIDS Patient
Neutropenia
Thrombocytopenia
Altered Skin Integrity
Neuropathy
Altered Mental Status
Stomatitis
Assess Nutritional Status
Assess/Manage Nutritional Impairment
Interpretation of Lab Values
Oral Feedings
Enteral Tube Feeding
Tube Feeding Assessment (residual, etc)
Peripheral Parenteral Nutrition (PPN)
Central TPN
G-Tube
J-Tube
GJ-Tube
Flex. Feeding Tube Insertion (Dobhoff)
NG Tube Insertion
Enterostomy/Ostomy Care
Colostomy Irrigation and PT Teaching
Continuous Narcotic Infusion (KUB)
IV Push Narcotic Agents
Continuous Epidural Medications
Oral Medications
Transdermal Agents
PCA Pumps
Alternative Therapies
Non-Pharmacologic Strategies
Pain Management TENS Units
Cardiopulmonary Arrest
Fever/Sepsis
Seizures
Hemorrhage
Hypercalcemia
Hypo/Hyperkalemia
Hypomagnesemia
Organ Obstruction
Diabetic Ketoacidosis
Patient/Family Education
Resources for PT/Family
PT Teaching Self-Care
PT Teaching Coping Skills
Assist with Goal Setting
Quality of Life Issues
Ethical Decision Making
Death and Dying Counseling
Hospice Care
Stages of Grieving
After Treatment (Survivorship)
Family Education re: Cancer Screening
National Safety Goals
"Do Not Use" Abbreviations and Terms
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.
