Skilled Nursing 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

  General Skills         Rating Stars (Click) 1 2 3 4
  Advanced directives  
  Awareness of HCAHPS  
  Patient/family teaching  
  Discharge planning  
  UR/medicare review  
  Lift/transfer devices  
  Specialty beds  
  Restrictive devices (restraints)  
  End of life care/palliative care  
  Automated Medication Dispensing System  
  Pyxis  
  Omnicell  
  or other  
  National Patient Safety Goals  
  Accurate patient identification  
  Effective communication  
  Awareness of patient rights  
  Interpretation & communication of lab values  
  Medication administration  
  Labeling (medications & specimens)  
  Medication reconciliation  
  Anticoagulation therapy  
  Pain assessment & management  
  Infection control  
  Universal precautions  
  Isolation  
  Minimize risk for falls  
  Prevention of pressure ulcers  
  Cardiac         Rating Stars (Click) 1 2 3 4
  Assessment of heart sounds  
  Identification of arrhythmias (rate/rhythm)  
  Pacemakers/AID�s  
  Cardiac arrest/CPR  
  Hypertension  
  Pre/post MI  
  CHF  
  Post cardiac surgery  
  Fluid & electrolyte imbalances  
  Anticoagulants  
  Antiarrhythmics  
  Beta blockers  
  Nitroglycerin  
  Diuretics  
  Respiratory         Rating Stars (Click) 1 2 3 4
  Assessment/auscultation of lung sounds  
  Establishing an airway  
  Chest PT  
  Incentive spirometry  
  Supplemental oxygen (cannula  
  facemask)  
  Tracheostomy care  
  Suctioning (tracheostomy & nasotracheal)  
  Nebulizer use  
  Pneumonia  
  Asthma  
  COPD  
  Emphysema  
  Bronchodilators  
  Expectorants  
  Corticosteroids  
  Neurology         Rating Stars (Click) 1 2 3 4
  Assessment of neuro signs  
  Seizure precautions  
  TBI (Traumatic Brain Injury: history of)  
  Seizure activity  
  Spinal cord injury  
  Stroke (CVA)  
  Multiple sclerosis  
  Alzheimer�s disease  
  Parkinson�s disease  
  ALS (Amyotrophic Lateral Sclerosis)  
  Antiseizure medications  
  Antiemetics  
  Laxatives  
  Enemas  
  Bowel prep  
  Gastrointestinal         Rating Stars (Click) 1 2 3 4
  NG tube (insertion/removal)  
  Long term feeding tubes (dobhoff/keofeed)  
  Gastrostomy tube  
  Tube feedings  
  Monitoring input/output  
  Colostomy/ileostomy  
  GI bleed  
  Feeding devices/adaptive equipment  
  Dietary restrictions  
  GT/PEG feedings  
  Antiemetics  
  Laxatives  
  Enemas  
  Bowel prep  
  Gastrointestinal         Rating Stars (Click) 1 2 3 4
  Foley catheter insertion/removal  
  GU irrigations  
  Nephrostomy tube  
  Suprapubic catheter  
  Ileo conduit  
  Use of bladder scan equipment  
  Shunts and fistulas  
  Straight catheterizations  
  Incontinence/bladder training  
  Chronic renal failure/dialysis  
  Peritoneal dialysis  
  Orthopedic         Rating Stars (Click) 1 2 3 4
  Total joint replacement  
  Arthroscopic surgery  
  Cast care  
  Pulse/CMS checks  
  Suture/staple removal  
  Prosthesis application  
  Standard extremity braces  
  Amputation  
  Stump wrapping  
  Laminectomy  
  Assistive devices  
  CPM machines  
  IV Therapy         Rating Stars (Click) 1 2 3 4
  Start & maintain Ivs  
  Blood draw: venous  
  Central line care (PICC)  
  Blood draw: central line PICC  
  Care & management of ports  
  Infusion pumps  
  Administration of blood/blood products  
  Skin         Rating Stars (Click) 1 2 3 4
  Wound care/surgical  
  Wound care/medical  
  Dressing changes  
  Skin assessment  
  Wound vac  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Newborn/neonate (birth-30 days)  
  Infant (31 days-1 year)  
  Toddler (2-3 years)  
  Preschool (ages 4-5 years)  
  School age (ages 6-12 years)  
  Adolescents (ages 13-21 years)  
  Young adult (ages 22-39 years)  
  Adults (ages 40-64 years)  
  Older adult (ages 65-79 years)  
  Elderly (ages 80+ years)