NURSING SKILLS CHECKLIST

Use the following scales when rating the frequency and confidence in performing each skill:

1. I have performed the skill at least 10 times in the past year.

2. I have performed the skill at least 5 times in the past year.
3. I have performed the skills less than 5 times in the past year.
4. I have not performed the skill in the past year.

A. I feel comfortable in performing the skill unassisted.

B. I need practice and would prefer another nurse assist me with the skill.
C. I would prefer to watch another nurse perform the skill then have him/her
watch me perform the skill until I am comfortable.

CLINICAL SKILL:

Vital Signs (Child):

_4, A______ Temp
__4, A_____ Pulse
__4 A_____ Respiration
___4 A____ Blood Pressure
___4 A____ O2 Sat Monitoring

Vital Signs (Adult):

___3 A____ Temp
__1, A_____ Pulse
__1, A_____ Respiration
__1, A_____ Blood Pressure
___4, A____ O2 Sat Monitoring

Medication Administration (Child):

_4, A______ PO
_4, A_____ IM
_4, A______ SQ
_4, A______ IVP
_4, A______ IVPB
__4, A_____ Rectal
__4, A_____ Eye
__4, A_____ Ear
__4, A____ Topical
 Medication Administration (Adult):
__4,A_____ PO
___4, A____ IM
__4, A_____ SQ
___4, A____ IVPB
____4, A ___ IVPB
___4, A ____ Rectal
__4, A _____ Vaginal
4, A Eye
_4, A ______ Ear
_4, A ______ Topical

_______ Blood Transfusion

__4,b_____ Infant
__4,b_____ Child
__4,b_____ Adult

IV Initiation:
_4,b______ Infant
__4,b_____ Child
_4,a______ Adult

N/G Insertion:
_4,b______ Infant
_4,b______ Child
_4,a______ Adult

Tube feedings:
___4,a____ N/G
___4,a____ Peg

Foley Catheterization (STERILE technique)

_4,b_______ Male
__4,b______ Female
__4,b______ Child
__4,b______ Adult

Wound/Skin Care/Drains:
___4,a____ Sterile dressing changes
___4,b____ Colostomy Care
___4,b___ Wound vac
____4,b___ JP drain
__4,b_____ Pen-rose drain
__4,b_____ Hemovac

Respiratory
____4,b___ BIPAP
____4,a___ Simple face mask oxygen
___4,a____ Non rebreather
___4,b____ Care/management of chest tubes
____4,b___ Tracheostomy Care
____4,b___ Tracheostomy suctioning
____4,b___ Endotracheal suctioning
___4,b____ Nasal suctioning

Cardiac/Neuro
__4,b_____ EKG Interpretation of Basic Arrhythmias
__4,b _____ Monitoring post cardiac sheath removal
__4,b _____ Management of heparin drip
_4,b ______ Ventriculostomy
_4,b ______ External Ventricular Device
_4,b ______ ICP monitoring
_4,b ______ CVP monitoring
_4,b ______ IABP Machine
_4,b ______ Titration of high risk medications (i.e. inotropes, sedation, insulin)

Invasive Lines
__4,b _____ Care of Central Lines
__4,b _____ Care of PICC lines
__4,b _____ Access of Port-a-Cath

Equipment/Technology: (please list brand used if possible)

__4,b _____ PCA pumps
__4,b _____ Infusion pumps
__4,b _____ Ventilator management
__4,b _____ Use of electronic medical records (EMR systems)
__4,b _____ Use of electronic medication administration system

Assistance/familiarity with procedures:

__4,b ______ Insertion of central lines/arterial lines
__4,b ______ Insertion of chest tubes
__4,b ______ Full arrest codes-adult
__4,b ______ Full arrest codes- pediatric
_4,b _______ Code Stroke
___4,b _____ Code STEMI
___4,b _____ Isolation procedures/Infection control