LPN 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

  Skills         Rating Stars (Click) 1 2 3 4
  Activities of daily living  
  Admission of patient  
  Administration of medication  
  Ambulation  
  Application of heat and cold�  
  Aseptic Technique�  
  Assist with medical examination  
  Bathing: Sitz- tub-bed-shower  
  Bandaging�  
  Binders  
  Body Alignment  
  Body Systems Review (Head to Toe data collection)  
  Cast care�  
  Catheterization / Foley catheter care  
  Charting�  
  Colostomy Care and irrigation  
  CPR  
  Crutch walking  
  Decubitus Care� Diabetic tests and preparation forms�  
  Diabetic blood glucose testing�  
  Discharge patients  
  Dosage computation�  
  Draping  
  Dressing (sterile)�  
  Ear drops  
  Elimination needs  
  Enemas- cleansing-retention- Harris flush�  
  Restraints  
  Infection Control: Standard Universal Precautions  
  Infection Control: Reverse Isolation  
  Infection Control: TB/ Airborne Precautions  
  Infections Control: MRSA/ VRE Precautions  
  Isolation procedure for specimen collection  
  IVs: Monitor rate and infusion site  
  Medications: Oral- IM- SQ  
  Mouth care  
  Nail Care  
  Neurological Check  
  Nutritional check  
  Observations: Response to treatments/ meds  
  Observations: Signs of significant body system changes  
  Observations: Signs of shock  
  Observes safety procedures  
  O2 administration  
  Pain assessment  
  Patient care plans (revise and update)  
  Patient safety standards/ precautions  
  Positioning patient  
  Postural drainage  
  Pre-op and post-op care  
  Provide comfort  
  safety and privacy  
  Pulse oxymetry  
  Range of motion  
  Report observations/ changes  
  Hand hygiene  
  Skin care  
  Specimen collection: routine urine  
  Specimen collection: clean catch�  
  Specimen collection: 12 & 24 hour specimen�  
  Specimen collection: stool�  
  Specimen collection: culture  
  Specimen collection: sputum�  
  Specimen collection: from foley catheter  
  Suppositories  
  Suction-oral  
  Surgical Preps  
  Computerized charting�  
  Trach care/suctioning  
  Telephone manners  
  Topical Medication Application  
  Traction  
  Transfer/ transport patients: wheelchair  
  Transfer/ transport patients: gurney  
  Transfer/ transport patients: to chair  
  Urine test for glucose/ acetone  
  Vital Signs  
  Weight: Bed scales and standing scales  
  IV therapy certified  
  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)