Clinical Experiences Self-Assessment NURS 3073 1/4

Student name:

Indicate the level of competence Competence level (0) Competence level (1) Competence level (2) Competence level (3) Competence level (4) Competence level (5)
for each of the skill areas listed
below. Include the approximate No clinical Limited exposure Some exposure Somewhat Comfortable Mastered
number of times the skill has experience (i.e. observed another (i.e. assisted another comfortable (i.e. preformed (i.e. skilled at
been performed, and whether (i.e. never observed health team member health team member) (i.e. preformed with independently) performance, assist
experience with the skill was or preformed) preform) assistance) others in learning
attained in NURS 3703 or in skill)
Other Nursing Courses (ONC).
Beginning of Course Midway Final
Vital signs

Bathing a dependent patient

Promoting comfort
Elimination
Ostomy care
Client mobility
Client transferring
Client lifting
Passive ROM exercises with client
Client turning & positioning
Client ambulation
Client feeding

Enteral feeding
Head to toe assessment
Point-of-care glucose monitoring
Paper charting

Electronic charting
Intake & output monitoring

Document explanation: The information in this document should inform the development of your professional learning goals, how you seek learning
experiences, and should also be reflected in your mid and final CASAs. Note that you are accountable for what you document in regards to your level of
competence with each skill. Also, please consider that being competent with a skill includes more than just the psychomotor aspect – you should also examine
your understanding of the theory related to the skill and your clinical judgement related to each skill (e.g. your ability to interpret vital signs, not just obtain
them). Please provide an updated copy to your clinical instructor each time you complete this form.
(Document created by C. Simpson, revised with permission by D.Dupont).
 Clinical Experiences Self-Assessment NURS 3073 2/4

Student name:

Specimen collection (not-including blood)

Statusing collected specimens
Client admission
Client discharge
Client transfer
Pre-op checklist
Interventional/procedural checklist
Oxygen saturation assessment
Nasal cannula management
Venti mask management
Opti-flow management

PRN medication administration

Scheduled medication administration
PO medication administration
IM medication administration
Sub Cut medication administration
SL medication administration
Inhalation medication administration
eye/ear/nose medication administration
topical medication administration
vaginal medication administration
rectal medication administration

Enteral medication administration

IV medication infusion

Document explanation: The information in this document should inform the development of your professional learning goals, how you seek learning
experiences, and should also be reflected in your mid and final CASAs. Note that you are accountable for what you document in regards to your level of
competence with each skill. Also, please consider that being competent with a skill includes more than just the psychomotor aspect – you should also examine
your understanding of the theory related to the skill and your clinical judgement related to each skill (e.g. your ability to interpret vital signs, not just obtain
them). Please provide an updated copy to your clinical instructor each time you complete this form.
(Document created by C. Simpson, revised with permission by D.Dupont).
 Clinical Experiences Self-Assessment NURS 3073 3/4

Student name:

IV secondary medication
IV push medication
Management of an IV pump
Management of an IV gravity drip
Management of a saline lock
Changing IV solutions
Monitoring a PICC line
Monitoring a central line
Isolation precautions
Wound care - aseptic technique
Wound care simple dressing changes
Suture/staple removal
Wound irrigation
Complex dressings
Urinary catheter maintenance
Urinary catheter insertion
Bladder irrigation
Management of nasogastric tube
Management of Keofeed /G tube
Management of passive drain
Management of an active drain
Management of a percutaneous drain
Client teaching: health promotion
Client teaching: illness management

Document explanation: The information in this document should inform the development of your professional learning goals, how you seek learning
experiences, and should also be reflected in your mid and final CASAs. Note that you are accountable for what you document in regards to your level of
competence with each skill. Also, please consider that being competent with a skill includes more than just the psychomotor aspect – you should also examine
your understanding of the theory related to the skill and your clinical judgement related to each skill (e.g. your ability to interpret vital signs, not just obtain
them). Please provide an updated copy to your clinical instructor each time you complete this form.
(Document created by C. Simpson, revised with permission by D.Dupont).
 Clinical Experiences Self-Assessment NURS 3073 4/4

Student name:

Client teaching: Pre- op / procedure

Client teaching: Post- op / procedure
Client teaching: hospital discharge
Interprofessional collaboration
Care of terminally ill clients
Care of actively dying clients
family support in client death/dying
Mortuary care

Document explanation: The information in this document should inform the development of your professional learning goals, how you seek learning
experiences, and should also be reflected in your mid and final CASAs. Note that you are accountable for what you document in regards to your level of
competence with each skill. Also, please consider that being competent with a skill includes more than just the psychomotor aspect – you should also examine
your understanding of the theory related to the skill and your clinical judgement related to each skill (e.g. your ability to interpret vital signs, not just obtain
them). Please provide an updated copy to your clinical instructor each time you complete this form.
(Document created by C. Simpson, revised with permission by D.Dupont).