Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:
1 = No Experience (Theory or observation only during the past 12 months)
2 = Limited Experience (Performed less than 12 times within the past 12 months and may need a review)
3 = Experienced (Performed at least once per month within the past 12 months and may need minimal assistance)
4 = Highly Skilled (Performed on at least a weekly basis over the past 12 months; proficient)

MM slash DD slash YYYY

Use of cardiac monitors
Assessment of heart sounds
Care of patients with CHF
Atropine administration
Digoxin administration
Dopamine administration
Inderal administration
Lidocaine administration
Fluid Balance
Foley Catheter Insertion
GU Irrigations
Nephrostomy Tube
Blood Glucose Checks
Insulin Administration
Care of patients with Diabetes
NG tube care and feedings
Gastrostomy tube care and feedings
Colostomy Care
Assessment of Bowel Sounds
Taking Charge
Admission Procedures
Discharge Procedures
Patient Education
Patient Care Plans
Medication Calculation
Oral Administration
Eye Administration
IM Administration
SQ Administration
Rectal Administration
Starting IV’s
IV Medication Administration
Central Line Care
Assessment of Neurological Status
Seizure Precautions
Care of a patient with a CVA
Care of a patient with Alzheimer’s
Care of patients with Spinal Cord Injury
Decadron Administration
Dilantin Administration
Phenobarbital Administration
Valium Administration
Assessment of skin
Wound Care and Treatments
Use of special pressure relief devices
Care of pts with a total hip replacement
Care of pts with a total knee replacement
Crutch Walking
Pulse Oximetry
Oxygen Administration via nasal cannuia
Oxygen Administration via face mask
Principles of chest percussion
Care of patients with ventilator
Care of patients with COPD
Care of patients with ARDS
Care of patient with a Tracheotomy
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)