HIS Checklist


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.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  Medication Administration         Rating Stars (Click) 1 2 3 4
  Documentation on M.A.R.  
  Dose calculation  
  Generic equivalents  
  Usage of PDR  
  Knowledge of drug actions/interactions  
  Verification of narcotic wastage  
  Oral medications  
  Sublingual medications  
  Intradermal medications  
  Parenteral medications  
  Subcutaneous medications  
  Intramuscular medications  
  Topical medications  
  Eye drops  
  Ear drops  
  Swallowing precautions  
  Inventory and storage control  
  Infectious Control         Rating Stars (Click) 1 2 3 4
  AIDS/HIV interaction  
  Hepatitis interaction  
  Hospice  
  MRSA  
  VRE  
  Fever management  
  Interpretation of labs  
  Decubitus/Wound care (Contaminated)  
  Linen -Transporting  
  storing  
  & Handling  
  Cleaned  
  Soiled  
  Personal clothing  
  Proper disposal of sharpes and waste  
  Standard precautions  
  Pain Management         Rating Stars (Click) 1 2 3 4
  Documentation and assessment of site  
  character  
  & frequency of pain  
  Assessment of pain levels  
  Documentation of response to pain medications  
  Intraveneous Therapy         Rating Stars (Click) 1 2 3 4
  I.V. certified (Check \'4\')  
  Administration of I.V. antibiotics  
  Administration of I.V. fluids  
  Administration of I.V. pain medications  
  Administration of I.V. cardiac meds  
  Blood draws - peripheral  
  Blood draws - central line  
  Blood draws - implanted catheter  
  Care of I.V. site - peripheral  
  Care of I.V. site - central line  
  Care of I.V. site - implanted catheter  
  I.V. dose calculations  
  I.V. insertion - peripheral  
  Use of infusion pumps  
  Diabetic Care         Rating Stars (Click) 1 2 3 4
  Diabetic monitoring  
  S/S hyper/hypoglycemia  
  Diabetic patient teaching  
  Performing fingersticks  
  Use of glucometers  
  Insulin infusions  
  Regular  
  long-acting insulin  
  Mixed insulin  
  Psychosocial Problems         Rating Stars (Click) 1 2 3 4
  Assessment and documentation of behavioral problems (target behaviors)  
  Assessment and documentation of s/s of depression  
  Assessment and documentation of patient response to psychotropic medications  
  Parameters for use of restraints in long-term care settings  
  Assessment and documentation of effectiveness of preventive medicine medications  
  Orthopedics         Rating Stars (Click) 1 2 3 4
  Assessment of circulation  
  Assessment of gait  
  Assessment of range of motion  
  Amputation care  
  Post-arthroscopy care  
  Casts and related care  
  Osteoporosis  
  Pinned fractures  
  Total hip replacement  
  Total knee replacement  
  Rheumatic/Arthritic disease  
  Continuous passive motion  
  Canes  
  Cervical collars  
  Gait belts  
  Prostheses  
  Slings  
  Transfer board  
  Walker  
  Wheelchair  
  Cardiovascular Problems         Rating Stars (Click) 1 2 3 4
  Auscultation of rate/rythym  
  Blood pressure  
  Doppler  
  Pulses  
  Circulation checks  
  CPR  
  Post-abdominal aortic bypass  
  Aneurysm  
  Angina  
  Post carotic endarterectomy  
  Fem-pop bypass  
  Permanent pacemaker  
  Post acute M.I.  
  Post cardiac surgery  
  Thrombophlebitis  
  DVT  
  Congestive heart failure  
  Administration of post-op cardiac meds  
  Gastrointestinal Problems         Rating Stars (Click) 1 2 3 4
  Administration of tube feedings  
  Administration of medications via tube  
  Inflammatory bowel disease  
  Bowel prep  
  G.I. bleeding  
  Gualac  
  Nutritional status  
  Colostomy care  
  Post abdominal surgery  
  NG tube placement and care  
  Nasointestinal tube care  
  Assessment of bowel tones  
  Assessment of abdomen  
  Enema administration  
  Assessment of bowel incontinence  
  Signs and symptoms of fecal impaction  
  Neurological Problems         Rating Stars (Click) 1 2 3 4
  Post-Op anticonvulsant medications  
  Assessing levels of consciousness  
  Dementias (Re-direction/Validation)  
  Neuromuscular disease  
  CVA  
  Pupil check  
  A.I.M.S.  
  Seizure precautions  
  Administration of anticonvulsant  
  Medications  
  Aneurysm precautions  
  Spinal cord injuries - long term  
  Urinary Problems         Rating Stars (Click) 1 2 3 4
  Assessment and care of AV shunt  
  Post renal surgery  
  Renal failure  
  Assessment of urinary incontinence  
  Assessment of I and O data  
  Use of bladder scanne  
  Signs and symptoms of UTI  
  Indwelling catheter insertion  
  Indwelling catheter care  
  Straight catheter insertion  
  Suprapubic catheter care  
  Screening for UTI via urine dipstick  
  Wounds, Pressure Sores, and Skin Impairments         Rating Stars (Click) 1 2 3 4
  Assessment and care of post-surgical wounds  
  Assessment  
  prevention  
  and care of pressure ulcers  
  Assessment and documentation of skin conditions/wounds  
  Dressing changes - asceptic  
  Dressing changes - sterile  
  Wound irrigation  
  Application of wound care products  
  Use of air fluidized  
  low air-loss beds  
  Use of pressure-relieving seat cushions  
  Staple and suture removal  
  Other Skills         Rating Stars (Click) 1 2 3 4
  Alert charting system  
  Use of 24-hour written and verbal reporting systems  
  Use of \'911\' in LTC setting  
  Regulatory guidelines related to the prevention of abuse and neglect of residents  
  Regulatory guidelines related to resident rights in LTC setting  
  Discerning code status  
  Incident and accident reporting  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  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)