IPAMS Recruitment RN Checklist-001

RN Skills Self Assessment Revised March 08, 2016

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Name:______________________________________________________________________________________
# of Years of Experience in: Med/Surg________; Telemetry________; OR_______; ICU________;
CCU________; ED________; OB________; Peds________; Other_________________________________
TOTAL YEARS OF NURSING EXPERIENCE: __________________________

Circle the Appropriate Number that corresponds to Coding Key

Coding Key
3 Frequent Experience, Perform Well
2 Intermediate Experience, Minimal Review Needed
1 Familiar, but More Review Needed
0 Theory Only, No Practice, Major Review Needed

Nursing Skills
Respiratory 3 2 1 0
1. Hi-flow Nebulizer
2. Incentive Spirometry
3. Oxygen via Nasal Cannulus
4. Oxygen via Mask
5. Oxygen via Ambu
6. Tracheostomy Care
7. Oral Suctioning
8. Tracheal Suctioning
9. Nasopharyngeal Suctioning
10. Incentive Spirometry
11. C-Pap
12. Bi-Pap
13. Assessment of Breath Sounds
14. Identify Abnormalities: Rales, Rhonchi
15. Interpretation of ABGs
16. Pulse Oximeter
17. Respiratory Assessment
18. Establishing an Airway
19. Assessing for Signs and Symptoms of Pulmonary
Embolism
20. Care of a Patient on a Ventilator - Type of Equipment Used:
21. Weaning a Patient from a Ventilator
22. Care of a Patient with COPD
23. Care of a Patient with Asthma
24. Care of a Patient with Pneumonia
Cardiovascular 3 2 1 0
1. Interpretation of Arrhythmias
2. Defibrillation
3. Cardiac Monitors - Type of Equipment Used:
4. C.P.R.
5. Principles of 12 Lead EKG
6. Acute MI
7. Peripheral Pulse Assessment
8. Apical Pulse Assessment
9. Blood Pressure Assessment
10. Assessment of Heart Sounds

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 RN Skills Self Assessment
Coding Key
3 Frequent Experience, Perform Well
2 Intermediate Experience, Minimal Review Needed
1 Familiar, but More Review Needed
0 Theory Only, No Practice, Major Review Needed

Nursing Skills – Cardiovascular (continued)

11. Care of a Patient with CHF
12. Care of a Patient with an Internal Automated Defibrillator
13. Care of a Patient Post CABG
14. Care of a Patient with Chest Pain/Angina
15. Starting IVs
16. Care of a Patient with IVs
17. Care of a Patient with a Central Vascular Line (Hickman,
Broviac…)
18. Care of a Patient receiving TPN/Hyperalimentation
19. Infusion Pumps - Type of Equipment Used:
20. Drawing Blood Specimens
21. Knowledge of Normal Serum Blood Values
22. Blood Glucose Monitoring - Type of Equipment:
23. Administration of Blood & Blood Products
Gastrointestinal 3 2 1 0
1. Gastrointestinal System Assessment
2. Feeding Pump - Type of Equipment Used:
3. Stool for Guiac
4. Bowel Program
5. Care of the Patient with a Colostomy
6. Insertion of a Gastrostomy Tube
7. Care of the Patient with a Gastrostomy Tube
8. Insertions of a Nasogastric Tube
9. Care of the Patient with an Nasogastric Tube
Genitourinary 3 2 1 0
1. Foley Catheter Insertion
2. Care of the Patient with a Foley Catheter
3. Timed Toileting
4. Intermittent Straight Catheterization
5. Bladder Scan
6. Peritoneal Dialysis - Type of Equipment:
7. Hemodialysis - Type of Equipment:
8. Care of the Patient with a Nephrostomy Tube
9. Care of the Incontinent Patient
10. Bladder Irrigation
Integumentary/ Skin and Wound Care Management 3 2 1 0
1. Sterile Dressing Change
2. Wound Irrigation
3. Transparent/Bio-Occlusive Dressing
4. Duaderm
5. Care of the Patient with a Skin Graft/Flap
6. Suture Removal
7. Staple Removal
8. Care of the Patient with Burns

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 RN Skills Self Assessment

Coding Key
3 Frequent Experience, Perform Well
2 Intermediate Experience, Minimal Review Needed
1 Familiar, but More Review Needed
0 Theory Only, No Practice, Major Review Needed

Nursing Skills (continued)

Musculoskeletal 3 2 1 0
1. TENS Unit
2. Heat Application
3. Cold Application
4. Abductor Pillow
5. Care of the Patient in Skeletal Traction/External Fixator
6. Care of the Patient with a Halo
7. Care of the Patient with a Total Knee Replacement
8. Care of the Patient in a Cast
9. Care of the Patient with a Total Hip Replacement
10. Care of the Patient with an Amputation
11. Care of the Patient with a Spinal Cord Injury
Neurologic 3 2 1 0
1. Glascow Coma Scale
2. Ranchos Los Amigos Scale
3. Assessment of LOC
4. Care of a Patient with a Traumatic Brain Injury
5. Care of a Patient with a CVA
6. Care of a Patient with MS
7. Care of a Patient with Seizures
8. Care of a Patient with Guillian Barre
Care of the Special Need Patient 3 2 1 0
1. Care of the Diabetic Patient
2. Care of the Oncology Patient
3. Care of the Dementia Patient
4. Care of the Safety Unaware Patient
5. Care of the Isolation Patient
Medications 3 2 1 0
1. Medication Calculation
2. Reconstitution
3. Oral Administration
4. Ophthalmic Administration
5. IM Administration
6. SQ Administration
7. Rectal Administration
8. Topical Administration
9. Ear Administration
10. Antihypertension Medications
11. Antiarrhythmic Medications
12. Chemotherapy
13. Insulin

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 RN Skills Self Assessment

Coding Key
3 Frequent Experience, Perform Well
2 Intermediate Experience, Minimal Review Needed
1 Familiar, but More Review Needed
0 Theory Only, No Practice, Major Review Needed

Nursing Skills (continued)

Leadership Skills 3 2 1 0
1. Charge Experience
2. Nursing Management Experience
3. Communication with Physicians
Other Skills, Not Listed 3 2 1 0
1.
2.
3.
4.
5.

Signature_________________________________________________Date: ________________________

Are you currently employed: ( ) Yes ( ) No

If yes, please indicate the name of the company: ___________________________________________________
Current position: ______________________________________________________________________________

National College Entrance Examination (NCEE) Rating (if applicable):

___________________________________

National Nursing Board Exam Rating: __________________

License Valid Until: __________________________

CGFNS: ( ) Passed ( ) Failed ( ) Not taken

CGFNS # _____________________________________
Times Taken ______________________________________

TOEFL/TWE Scores: _____________________/_____________________

Date Taken _______________________
TSE Score: ___________________________________________
Date Taken: ______________________
IELTS Scores: _____________________/ ______________________
Date Taken: ______________________

NCLEX: ( ) Passed ( ) Failed ( ) Not Taken

US State & License # ____________________/________________________
Times Taken:_____________________