Personal Information

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Self-Assessed experience rating scale

1: No experience

2: Limited Experience

3: Experienced

4: Highly Skilled

Vital Signs and Weights:

Obtaining and Recording

BP, including Orthostatic

Pulse, Radial

Temperature, Oral

Temperature, Rectal

Temperature, Axillary

Temperature, Tympanic

Respirations

Weight, Pounds and Kilograms

Recognizing Cardiac Arrest

Activating Code Team

Bringing Emergency Equipment to Room

Providing Appropriate Code Support

Scale Use:

Standing

Chair

Bed

Administering Enemas:

Tap Water

Fleets

Return Flow

Nutrition:

Estimating Intake

Setting up for Meals

Feeding Patients

Aspiration Precautions

Nourishments

Counting Calories

Fluid Restriction

NPO

Collecting Urine:

Clean Catch

24 Hour

Use of Pressure and Friction reduction devices:

Special Beds/Mattresses

Foot Cradles

Use of Shower Chair

Use of Bath/Shower Boat

Proper use of Specific Barrier, Methods:

Gloves

Gown

Mask / Goggles

Applicationof Restraints:

Belt Including Seat Belt

Wrist/Ankle

Vest

Communication

Identifying Unusual Patient Incidents that Require Reporting

Using Appropriate Abbreviations

Reinforcing RN Teaching With Patient

Selecting and Using Forms Appropriately

Using Alternate Communication Tools / Devices

Changes in Patient Condition

Patient Needs, Complaints and Concerns

Unusual Incidents

Vital Signs

Bathing / Hygiene

Turning and Repositioning

Ambulation and Activity

Diet Intake, Calorie Count

Bowel Movements

Shift Volumes and Totals

Marking and /or Measuring Amount of Urine, Gastric Fluid, NG Drainage,Emesis, Diarrhea

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Self-Assessed experience rating scale

Patient Rights:

Vital Signs and Weights:

Use of Electronic VS equipment:

Scale Use:

GI /GU:

Administering Enemas:

Vital Signs and Weights:

Nutrition:

Specimens:

Collecting Urine:

Hygiene /Skin:

Use of Pressure and Friction reduction devices:

Infection Control:

Proper use of Specific Barrier, Methods:

Safety and Activity:

Applicationof Restraints:

Care Routines: New Admissions and Transfers:

Communication

Unit Activity: