Professional Documents
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CHECKLIST
6. Hand Washing
NAME: 7. Infectious / Hazardous Waste
ID #: Disposal
DATE: 8. Supply / Equipment Disposal
9. Use of Disposable
This Skills Checklist is for use by nurses Thermometer
with more than one year experience in 10. Use of CPR Mask / Bag
their discipline and specialty. Please be 11. AIDS
accurate with your assessment.
DIRECTIONS: Please indicate your level of
experience by placing a check (√) in the
DESCRIPTION 1 2 3 4 box. Experience level:
PATIENT RIGHTS 1 NO EXPERIENCE
1. Communicates and obtains 2 MINIMAL EXPERIENCE-requires
information while respecting supervision/assistance
the rights, privacy, and 3 MODERATELY EXPERIENCED-requires
confidentiality of information in initial review, then performs
accordance with the Health independently
Insurance Portability and
4 VERY EXPERIENCED- proficient
Accountability Act of 1996
(HIPPA)
2. Involves the patient and DESCRIPTION 1 2 3 4
family and 12. Hepatitis B
respects their role in VITAL SIGNS AND WEIGHTS
determining the nature of care 1. Recognizing Cardiac Arrest
to be provided, including 2. Activating Code Team
Advance Directives. 3. Initiating CPR
3. Complies with nursing staff 4. Bringing Emergency
responsibility included in the Equipment to
hospital policy related to Organ Room
Donation. 5. Providing Appropriate Code
4. Meets patient’s and families’ Support
needs 6. Use of Electronic VS
regarding communication, Equipment
including interpreter services. a. Automatic BP Machine
5. Provides accurate information (Dynamap)
to b. Electronic Thermometer
patient and families in a timely c. Applying Oximeter
manner. SAFETY AND ACTIVITY
INFECTION CONTROL 1. Determining Patient ID
1. Proper Use of Specific Barrier Methods: 2. Identifying Safety Hazards
a. Gloves 3. Determining Need for
b. Gown Additional Help
c. Mask / Goggles 4. Assessing Safety and ADL
2. Protective / Reverse Isolation Needs and Restraints
3. Body Substance Isolation 5. Maintaining Orderly Work
4. TB Precautions Area
5. MRSA Precautions 6. Disposing of Sharps
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IV THERAPY KNOWLEDGE & SKILLS
CHECKLIST
7. Handling Hazardous Materials
8. Proper Body Mechanics
9. Reporting Broken Equipment
10. Responding to Safety Hazards
11. Use of Wheel Locks
12. Use of Call Light
13. Application of Restraints
SPECIMENS
1. Venipuncture
2. Arterial Draw
3. Line Draw
4. Culture Specimens
5. Labeling Specimens and
Preparing for
Transport
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IV THERAPY KNOWLEDGE & SKILLS
CHECKLIST
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IV THERAPY KNOWLEDGE & SKILLS
CHECKLIST
Please check the boxes below for each NEUROLOGY years
age group for which you have expertise in PULMONARY years
providing age-appropriate nursing care. SURGICAL years
MEDICAL years
A. Newborn/Neonatal (birth – 30 days) CARDIAC CARE years
B. Infant (30 days – 1 year) TELEMETRY years
C. Toddler (1 – 3 years)
D. Preschool (3 – 5 years) I HAVE CURRENT CERTIFICATIONS FOR:
E. School Age Children (5 – 12 years)
F. Adolescent (12 – 18 years) TYPE COURSE
G. Young Adults (18 – 39 years) DATE (MM/DD/YY)
H. Middle Adults (40 – 64 years) ARRHYTHMIA
I. Older Adults (64 + years) CRITICAL CARE
ACLS
EXPERIENCE WITH AGE GROUPS: BLS
1. Able to assess age appropriate TNCC
behavior, motor skills and physiological NRP
norms. PALS
NALS
A B C D E F G H I Other
Other
Other
2. Able to adapt care according to normal Other
growth and development.
The information I have provided in this
A B C D E F G H I knowledge and skills checklist it true and
accurate to the best of my knowledge.
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IV THERAPY KNOWLEDGE & SKILLS
CHECKLIST
Email: records@nns-ic.com
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