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SKILLS CHECKLIST - RN/LPN Download Microsoft Word Document Please fill out the checklist for your certification. RN/LPN Skills Checklist Check skill level (Code) (1) Skilled with no assistance required (2) Minimal experience with assistance required (3) No training or experience Last Name First Name Date     BCLS Certification   Date Received: Expiration Date     ACLS Certification   Date Received: Expiration Date     Other Certifications   Date Received: Expiration Date     Settings Worked: - select one- Acute Long-Term Care Ambulatory Home Health Other PRECAUTIONS   Select skill level   Isolation, regular - select skill level - - 1 - - 2 - - 3 - Isolation, reverse - select skill level - - 1 - - 2 - - 3 - Enteric Isolation - select skill level - - 1 - - 2 - - 3 - Respiratory Isolation - select skill level - - 1 - - 2 - - 3 - Universal Precautions - select skill level - - 1 - - 2 - - 3 - Sterile Dressing Changes - select skill level - - 1 - - 2 - - 3 - MEDICATIONS   Select skill level   Unit Dose - select skill level - - 1 - - 2 - - 3 - Medication Pass (1-10 patients) - select skill level - - 1 - - 2 - - 3 - Medication Pass (11-20 patients) - select skill level - - 1 - - 2 - - 3 - Pediatric Conversions - select skill level - - 1 - - 2 - - 3 - IV Additives - select skill level - - 1 - - 2 - - 3 - IV Piggy Backs - select skill level - - 1 - - 2 - - 3 - IV THERAPY   Select skill level   IV Certified - select skill level - - 1 - - 2 - - 3 - Heparin Locks - select skill level - - 1 - - 2 - - 3 - Initiating IV Lines - select skill level - - 1 - - 2 - - 3 - CVP Lines and Dressing Change - select skill level - - 1 - - 2 - - 3 - Infusion Pumps - select skill level - - 1 - - 2 - - 3 - Hanging Blood/Blood Products - select skill level - - 1 - - 2 - - 3 - Care of Cutdown - select skill level - - 1 - - 2 - - 3 - IV Therapy Administration - select skill level - - 1 - - 2 - - 3 - Arterial Blood Gases (sample) - select skill level - - 1 - - 2 - - 3 - RESPIRATORY THERAPY   Select skill level   Suctioning Oral/Nasal Pharyngeal - select skill level - - 1 - - 2 - - 3 - Tracheostomy care - select skill level - - 1 - - 2 - - 3 - Oxygen Equipment - select skill level - - 1 - - 2 - - 3 - Ventilators - select skill level - - 1 - - 2 - - 3 - Endotracheal Tubes - select skill level - - 1 - - 2 - - 3 - Chest Tubes - select skill level - - 1 - - 2 - - 3 - GI TUBES CARE   Select skill level   Miller Abbott - select skill level - - 1 - - 2 - - 3 - Blakemore - select skill level - - 1 - - 2 - - 3 - G-Tube - select skill level - - 1 - - 2 - - 3 - J-Tube - select skill level - - 1 - - 2 - - 3 - N/G Tube Care and Placement - select skill level - - 1 - - 2 - - 3 - GU SYSTEM CARE   Select skill level   Foley Catheter Care - select skill level - - 1 - - 2 - - 3 - Foley Catheter Insertion - select skill level - - 1 - - 2 - - 3 - Suprapubic Catheter Care - select skill level - - 1 - - 2 - - 3 - ORTHOPEDICS   Select skill level   Circo-Electric Bed - select skill level - - 1 - - 2 - - 3 - Crutchfield Traction - select skill level - - 1 - - 2 - - 3 - Balanced Traction - select skill level - - 1 - - 2 - - 3 - Cast Care - select skill level - - 1 - - 2 - - 3 - ADDITIONAL NURSING SKILLS   Select skill level   Telemetry skills - select skill level - - 1 - - 2 - - 3 - Arrythmia Interpretation - select skill level - - 1 - - 2 - - 3 - Perform 12 Lead EKG - select skill level - - 1 - - 2 - - 3 - Code Assistance - select skill level - - 1 - - 2 - - 3 - Neurological checks - select skill level - - 1 - - 2 - - 3 - Arterial Blood Gas Interpretation - select skill level - - 1 - - 2 - - 3 - Lab result interpretation - select skill level - - 1 - - 2 - - 3 - ICU Nursing Experience - select skill level - - 1 - - 2 - - 3 - OR/Recovery Room Experience - select skill level - - 1 - - 2 - - 3 - ER Experience - select skill level - - 1 - - 2 - - 3 - Renal Dialysis Nursing - select skill level - - 1 - - 2 - - 3 - ONCOLOGY   Select skill level   Care of Oncology Patients - select skill level - - 1 - - 2 - - 3 - Administration of TPN - select skill level - - 1 - - 2 - - 3 - Care of Hickman Catheter - select skill level - - 1 - - 2 - - 3 - Administration of IV Chemotherapy - select skill level - - 1 - - 2 - - 3 - ASSESSMENT OF DISEASE CONDITIONS   Select skill level   Myocardial Infarction - select skill level - - 1 - - 2 - - 3 - GI Bleed - select skill level - - 1 - - 2 - - 3 - Drug Overdose - select skill level - - 1 - - 2 - - 3 - COPD - select skill level - - 1 - - 2 - - 3 - Renal Failure - select skill level - - 1 - - 2 - - 3 - Psychiatric Disorders - select skill level - - 1 - - 2 - - 3 - Diabetes - select skill level - - 1 - - 2 - - 3 - Hypertension - select skill level - - 1 - - 2 - - 3 - Fracture - select skill level - - 1 - - 2 - - 3 - Hypothyroidism/Hyperthyroidism - select skill level - - 1 - - 2 - - 3 - Pressure Ulcers - select skill level - - 1 - - 2 - - 3 - Cirrhosis of Liver - select skill level - - 1 - - 2 - - 3 - Cancer - select skill level - - 1 - - 2 - - 3 - MATERNAL CHILD NURSING   Select skill level   Magnesium Sulfate Infusion - select skill level - - 1 - - 2 - - 3 - Labor Suppresants - select skill level - - 1 - - 2 - - 3 - Oxytocin Induction - select skill level - - 1 - - 2 - - 3 - Vaginal Delivery Assist - select skill level - - 1 - - 2 - - 3 - Forceps Delivery Assist - select skill level - - 1 - - 2 - - 3 - Caesarean patients - select skill level - - 1 - - 2 - - 3 - Labor Assessment - select skill level - - 1 - - 2 - - 3 - Vaginal Examination - select skill level - - 1 - - 2 - - 3 - Use of Doppler/Fetoscope - select skill level - - 1 - - 2 - - 3 - Epidural Care - select skill level - - 1 - - 2 - - 3 - Pain Assessment - select skill level - - 1 - - 2 - - 3 - INTRAPARTUM CARE   Select skill level   Pre-Eclampsia/Eclampsia - select skill level - - 1 - - 2 - - 3 - Multiple Gestation - select skill level - - 1 - - 2 - - 3 - Placenta Previa - select skill level - - 1 - - 2 - - 3 - Abruptio Placenta - select skill level - - 1 - - 2 - - 3 - Malpresentation - select skill level - - 1 - - 2 - - 3 - Premature Labor - select skill level - - 1 - - 2 - - 3 - Diabetes Mellitus - select skill level - - 1 - - 2 - - 3 - Infectious Disease - select skill level - - 1 - - 2 - - 3 - Sickle Cell Disease - select skill level - - 1 - - 2 - - 3 - RH Incompatibilities - select skill level - - 1 - - 2 - - 3 - POST PARTUM ASSESSMENT   Select skill level   Fundus Check - select skill level - - 1 - - 2 - - 3 - Lochia - select skill level - - 1 - - 2 - - 3 - Bladder Distention - select skill level - - 1 - - 2 - - 3 - Episiotomy Incision Care - select skill level - - 1 - - 2 - - 3 - Caesarean Incision Care - select skill level - - 1 - - 2 - - 3 - IMMEDIATE NEONATE CARE   Select skill level   Apgar Scores - select skill level - - 1 - - 2 - - 3 - Suctioning - select skill level - - 1 - - 2 - - 3 - Eye Prophylaxis - select skill level - - 1 - - 2 - - 3 - Cord Blood Samples - select skill level - - 1 - - 2 - - 3 - Well Baby Checks - select skill level - - 1 - - 2 - - 3 - Neonate Resuscitation - select skill level - - 1 - - 2 - - 3 - PEDIATRICS   Select skill level   Calculation of pediatric medication doses - select skill level - - 1 - - 2 - - 3 - Initiating IV Therapy - select skill level - - 1 - - 2 - - 3 - Apnea Monitor - select skill level - - 1 - - 2 - - 3 - Cardiac Monitor - select skill level - - 1 - - 2 - - 3 - CPR Infant/Child - select skill level - - 1 - - 2 - - 3 - Emergency Drug Preparation - select skill level - - 1 - - 2 - - 3 - Tracheostomy Care/Suctioning - select skill level - - 1 - - 2 - - 3 - Assist w/ Lumbar Puncture - select skill level - - 1 - - 2 - - 3 - O2 Use - select skill level - - 1 - - 2 - - 3 - Ventilator - select skill level - - 1 - - 2 - - 3 -

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