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0914400Licensed Nurse Competency Checklist00Licensed Nurse Competency Checklist42767257276465State logo added here. If not, delete text box00State logo added here. If not, delete text box0203771500 Licensed Nurse Competency ChecklistName:______________________________ Title: ___________________________ Hire Date:_______________Skill AreaEvaluation(Check One)Method of Evaluation(Check One)D = Skills DemonstrationO = Performance ObservationW = Written TestV = Verbal TestVerification (Initials/Date)CompetencyDemonstrated/Meets StandardsNeeds Additional TrainingDOWVAdmission History and Physical Nursing AssessmentAdjustment Charting AdmissionReadmissionRoom ChangeCatheters Catheterization – FemaleCatheterization – MaleFoley Insertion/RemovalChange of Condition Change of Condition(cont.) Change of Condition(cont.)AssessmentVital SignsNeurological AssessmentLOCPupillary AssessmentSpeechMotor FunctionExtremity StrengthPainRespiratory AssessmentBreath SoundsCough, SputumSOBSkin/nailbeds or lips-colorOxygen useCardiovascular AssessmentHeart rate, rhythmApical PulseEdemaHeart SoundsNeck veinCapillary RefillChest, jaw or arm painGastrointestinal AssessmentInspectionAuscultation Bowel SoundsAbd aorta bruitPalpationN,V,DDate of last BMAppetiteBowel IncontinenceGenitourinary AssessmentColor, odor, amountPain w/urinationAbd discomfortFeverQuality of StreamBladder IncontinenceChartingNeuro Checks24 Hour Report BoardCharting AntidepressantBehaviorI&OAppetite Monitoring/Weight ChangesNotification MDResident RepresentativeResidentMedicareMedicareWeekly Summaries Weekly Summaries(cont.) ChartingProblem ChartingIncident/Accident/Event Charting and NotificationAllegation of Abuse, Neglect, MisconductAssessment/Documentation/POC/NotificationAssessment/Documentation/POC/Notification (cont.)Fall RiskPainNutrition/Hydration/WeightRestraints – Chemical/PhysicalSkinColorDiaphoresisRashReddened AreasPressure UlcersNon-pressure woundsIncisionsSkin TearsBruisiingAbrasionsClinical AssessmentColostomy/Ileostomy Appliance ChangeDiabetic Monitoring/Blood Glucose MonitoringDiabetic Monitoring/Blood Glucose MonitoringDischarge/Transfer Documentation Process NotificationEar DropsEar DropsEmergency Codes Fire, Tornado, Elopement, Missing ResidentEnemaEnemaEye DropsEye DropsGastrostomy Daily CareInsertion (Mandatory Class if LPN) Heparin – Sub InjectionHeparin – Sub InjectionInsulin Mixed DoseSingle DoseSliding ScaleIV Therapy IV Therapy(cont.) Insertion (RN Only)Heparin Flush (RN Only)IV Fluid to Mechanical Pump (RN Only)IV Push Medications (RN OnlyIV Piggy Back Medications (RN Only)Central Venous CathetersLab Specimen CollectionTranscription of OrdersMedications Medications(cont.)Administer and Record Oral MedsAdminister and Record IM MedsAdminister and Record Sub Q MedsChecks – apical, B/P, etc. appropriatelyDiscontinue/Destroy MedicationsPunch Card SystemRecord PRN Medication/TreatmentMantouxNarc CountPatchesPain Scale and InterventionsNG TubesFlushesInsertionPlacement CheckNebulizerNebulizerNitroglycerin Ointment PRNNitroglycerin Ointment PRNOccurrence Form – Med ErrorOccurrence Form – Med ErrorOral AssessmentOral AssessmentOxygen Therapy ConcentratorLiquid O2Oxygen Therapy(cont.)Portable Tanks Pain ManagementPain ManagementTreatments Treatments(cont.)Skin-Pressure Ulcers Documentation Skin-Pressure Ulcers Assessment/MeasurementSkin-Pressure UlcersSterile TechniqueOintmentsPressure ReliefSplint ApplicationTEDSOther PhonePhoneP&P Manual and UsageP&P Manual and UsagePost Mortem CarePost Mortem CareRectal Checks-Suppository InsertionRectal Checks-Suppository InsertionReport/Assignment SheetReport/Assignment SheetRestorative NursingRestorative Nursing(cont.)Can measure resident self-performance per RAI manualCan identify staff level of assistance per RAI manualCompletes tools to measure:Voluntary / Involuntary ROMContracturesFeeding assist. levelAmbulationBed MobilityDressing / Grooming / BathingIdentifies documentation requirements and understands minutes recordingRounds (Team Leader)Rounds (Team Leader)Suctioning, Oral/NasopharyngealSuctioning, Oral/NasopharyngealSubra Pubic Cath Daily CareInsertionTranscription of OrdersTranscription of OrdersTrach Care Routine (Changing Ties, etc.)SuctioningVentilator Care Ventilator CareTube Feeding Tube Feeding GravityTube Feeding (cont.)Tube Feeding PumpStandard Precautions Blood SpillsIsolation TechniquesInfection ControlHand washingOther (Describe) Other (Describe)*I certify that I have received orientation in the above mentioned areas.center0*Employee:______________________________________________________________Initials Signature Date00*Employee:______________________________________________________________Initials Signature Date-2857571755Evaluator/Orientator:______________________________________________________________Initials Signature Date00Evaluator/Orientator:______________________________________________________________Initials Signature Date(Place in Employment File)(PLACE IN EMPLOYMENT FILE) ................
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