VIRGINIA MASON MEDICAL CENTER



|St. James Healthcare ~ Medical Surgical Nursing |

|NURSING BASIC SKILLS INVENTORY |

|[Self-Assessment & Preceptor Review of Skills] |

Name: __________________________ Milestone Meeting (Date): __________

New Grad: Y □ N □

Preceptor: _______________________ Submitted To HR (Date): __________

The Nursing Basic Skills Inventory is to assist you and your preceptor to early identify basic skills that you have or do not have for the purpose of developing a continuing learning plan. The self-assessment will help your preceptor and / or clinical nurse educator select learning experiences to individualize your orientation and learning plan.

This Nursing Basic Skills Inventory is first completed by you during general nursing orientation for initial review with an assigned preceptor. It consists of three basic areas: 1) Physical Assessment Skills (theory / critical thinking),

2) Psychomotor (technical) and 3) Scavenger Checklist (unit orientation).

Instructions: Please self-evaluate your level of skill performance and complete the following inventory according to the rating scale below during Week 1 of the Orientation Grid. This inventory should be reviewed with a Clinical Educator and a Preceptor prior to starting orientation on the unit. In addition, complete the Scavenger Checklist for each category for review with your preceptor. Preceptors reviewing a skill may initial in the “COMMENT / INITIAL” section. Milestone meeting(s) will be scheduled with your Clinical Director and / or Supervisor prior to transition to night shift or at the end of unit orientation where opportunity will be given to review the skills inventory checklist and your individual learning plan.

Rating Scale:

| CERTIFICATION(S) |RATING |MO/YR LAST PERFORMED |COMMENTS / INITIALS |

| |

|Milestone Meeting Date: |

|PHYSICAL ASSESSMENTS SKILLS | Rating | Comments / Initials |

|CATEGORIES | | |

| |

|Physical Assessment (auscultation) | | | | | |

|Rhythm Recognition | | | | | |

|Peripheral Circulation Checks | | | | | |

|AV Fistula/Graft | | | | | |

|Unit Equipment: |

|Telemetry equipment and application | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|II. Respiratory |

|Physical Assessment (auscultation) | | | | | |

|Normal and Abnormal Breath Sounds | | | | | |

|Normal and Abnormal Blood Gases | | | | | |

|Normal and Abnormal SaO2 (pulse oximetry) | | | | | |

|Normal and Abnormal EtCO2 (capnography) | | | | | |

|Nasal Suction | | | | | |

|Tracheal Suction | | | | | |

|Airway Management: |

|Head Tilt/Chin Lift/Jaw Thrust | | | | | |

|Oral & Nasal Conduit | | | | | |

|- Ambu Bag | | | | | |

|Demonstrates Correct Application of Oxygen: |

|Nasal Cannula | | | | | |

|Mask | | | | | |

|Non-Rebreather | | | | | |

|Ventimask | | | | | |

|Tracheostomy Care | | | | | |

|Unit Equipment: |

|Non-Invasive Oximetry Monitor | | | | | |

|Atrium Oasis Chest Drain | | | | | |

|Atrium Pneumatic (portable) Chest Drain | | | | | |

|Wall Suction | | | | | |

|Yankauer & Catheter Suction | | | | | |

|Sterile Suction Kit | | | | | |

|Trach Care Kit | | | | | |

|Oxygen Tank (portable) | | | | | |

|Other: |

| | |

|Physical Assessment Skills | Rating | Comments / Initials |

| |

|Physical Assessment (auscultation / palpation) | | | | | |

|Assess Normal / Abnormal (pain / acscites) | | | | | |

|Assess Hepatobiliary Disturbance (jaundice) | | | | | |

|Assess Nutritional / Hydration Status | | | | | |

|Assess patient on tube feeding | | | | | |

|Bowel Protocol | | | | | |

|Fecal Impaction | | | | | |

|Ostomy Care | | | | | |

|Protocol Sets (i.e. pancreas / liver) | | | | | |

|Unit Equipment: |

|Core Pak Tube | | | | | |

|NG Tube | | | | | |

|PEG Tube | | | | | |

|Gastrostomy Replacement Tube | | | | | |

|Kangaroo Pump & Tubing Set | | | | | |

|NPO sign | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|IV. Genitourinary |

|Physical Assessment | | | | | |

|Female Catheterization | | | | | |

|Male Catheterization | | | | | |

|Lidocaine topical anesthetic (male / female) | | | | | |

|Urostomy Care | | | | | |

|Foley Catheter / Urimeter Maintenance | | | | | |

|UA: Clean Catch and Random | | | | | |

|UA: Foley collection port for routine / C & S) | | | | | |

|24 Hr Urine Collection (with / no preservative) | | | | | |

|Urostomy Urine Collection | | | | | |

|Pericare with urinary drainage system | | | | | |

|Bladder Scan | | | | | |

|Unit Equipment: |

|GU Basket | | | | | |

|Bladder Scanner | | | | | |

|BARD urinary catheter insertion / drain kit | | | | | |

|Skin Prep (prior to adhesive application) | | | | | |

|CA-UTI guide / patient information sheet | | | | | |

|Castile Soap / misc. skin care products | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|Physical Assessment Skills |Rating | Comments / Initials |

| |

|Physical Assessment | | | | | |

|Visual Acuity | | | | | |

|Ear (otoscope) | | | | | |

|Ear Irrigation | | | | | |

|Throat (tongue blade/light source) | | | | | |

|Neck (shape/suppleness/nodules or lumps) | | | | | |

|Lab: Throat (rapid strept vs. B-Strept) | | | | | |

|Lab Samples: Other | | | | | |

|Unit Supplies: |

|Throat Swabs | | | | | |

|Flash light | | | | | |

|Otoscope | | | | | |

|Opthalmoscope | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|VI. Integumentary |

|Physical Assessment | | | | | |

|Braden Scale: Skin Staging | | | | | |

|Pressure Ulcer Protocol | | | | | |

|Wound Checks/Assessment/Documentation | | | | | |

|Wound VAC Pump | | | | | |

|Hill Rom Specialty Bed | | | | | |

|Wound Care: Cleansing and Dressing | | | | | |

|Wet to Dry | | | | | |

|Wound Culture (aerobic / anaerobic) | | | | | |

|Unit Supplies: |

|Misc. Tapes / Tegaderm | | | | | |

|Wound Cleansers | | | | | |

|Wound Staging Measurement Tool | | | | | |

|VAC Pump | | | | | |

|VAC Silver | | | | | |

|VAC Equipment Instruction Wall Chart | | | | | |

|VAC Wound Guide / Tutorials | | | | | |

|Hydrocolloid (3-M) misc. applications | | | | | |

|Foam (3-M) | | | | | |

|Alginate (3-M) | | | | | |

|Tube Gauze | | | | | |

|- Polymem | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|Physical Assessment Skills |Rating | Comments / Initials |

| |

|Physical Assessment | | | | | |

|Activity / Mobility level | | | | | |

|CMS (Circulation, Movement, Sensation) | | | | | |

|Self-care / ADLs | | | | | |

|Orthopedic Fx: Extremity / Shoulder / Pelvis | | | | | |

|Heat / Cold Application | | | | | |

|Polar Care | | | | | |

|Bucks Traction | | | | | |

|Knee Immobilizer | | | | | |

|Sling | | | | | |

|Ted Hose | | | | | |

|AVI Boot | | | | | |

|Compression Boot | | | | | |

|Ace Wraps | | | | | |

|Ceiling Lift | | | | | |

|Unit Equipment: |

|Assistive Devices (walker / cane / crutches) | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|VIII. Neurological |

|Physical Assessment | | | | | |

|LOC / Glasgow Coma Scale | | | | | |

|Hearing / Speech / Vision | | | | | |

|Gait and Extremity Strength (equal) | | | | | |

|PERRL | | | | | |

|Dermatomes | | | | | |

|Care of patient with CVA | | | | | |

|Other: |

|Seizure Prevention / Precaution | | | | | |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|IX. Nutritional |

|Physical Assessment | | | | | |

|Unit Equipment (list below): |

| | | | | | |

| | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): | | |

| |

|Assessment and Treatment – Acute / Chronic | | | | | |

|Pain Assessment Guidelines / Tool | | | | | |

|SJH Policy – scale / SBAR / documentation | | | | | |

|Other: | |

| | | | | | |

| | | | | | |

|Preceptor Review: |Date: |

|XI. Psychosocial / Spiritual |

|Age Specific (pediatric / adult / geriatric) | | | | | |

|Communication to patients and families | | | | | |

|Suicide Risk | | | | | |

|Addiction / Alcohol Abuse | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |Date: |

|XII. Safety / Fall Risk |

|Fall Risk Assessment | | | | | |

|Fall Risk Documentation | | | | | |

|Bed Alarm | | | | | |

|CDC / National Safety Protocols | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |

|Vital Signs | | | | | |

|Fluid / Electrolyte | | | | | |

|Lab Values Analysis | | | | | |

|Pre-op Assessment | | | | | |

|Post-op Assessment | | | | | |

|Scale Assessments | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): |

|Five Rights | | | | | |

|SJH Role Delineation | | | | | |

|Transportation | | | | | |

|Other: |

| | | | | | |

| | | | | | |

|Preceptor Review (name): | | | |

| |

|Gait Belt |

| | |

|II. Application |

|Ace wrap |

| | |

|III. Bath / Hygiene |

|Bed bath / Shower / Sitz |

| | |

|IV. Environment of Care / Safety |

|Handwashing technique, basic |

| | |

|PSYCHOMOTOR SKILLS |RATING |COMMENTS / INITIALS |SCAVENGER |

| |

|Fingerstick (glucose testing) |

| | |

|VI. Orthopedic Cast Care / Splint / Immobility |

|Positioning of Patient: |

|Lifting, Moving and Turning |

|Active |

| | |

|VII. Chest Tube (CT) |

|Set-up / management CT drain set |

| | |

|VIII. Wound Care |

|Sterile (Surgical Sepsis) | |

|PSYCHOMOTOR SKILLS |RATING |COMMENTS / INITIALS |SCAVENGER |

| |

|Exam for Stool Impaction |

|Bag change / Emptying |

| | |

|X. Feeding |

|Adult Aspiration Precautions |

| | |

| XI. Respiratory |

|Cannula Application |

|Simple Mask |

| | |

|XII. Restraints |

|Wrist (soft) |

| | |

|PSYCHOMOTOR SKILLS |RATING |COMMENTS / INITIALS |SCAVENGER |

| |

|Gastric pH (Gastroccult) |

| | |

| XIV. Tubes & Drains |

|Nasogastric, Gastric, Duodenal, Jejunal tube management |

|- Insertion / securing |

| | |

|MEDICATION SKILLS | RATING |COMMENTS / INITIALS |SCAVENGER |

| |

|Blood / Blood products |

| | |

|XVI. Peripheral Line |

|Administer fluids |

| | |

|MEDICATION SKILLS |RATING |COMMENTS / INITIALS |SCAVENGER |

| |

|Bag / bottle change |

| | |

|XVIII. Pain Management Infusions |

|Patient Controlled Analgesia (PCA) |

| | |

|CARE MANAGEMENT AND DOCUMENTATION SKILLS | RATING |COMMENTS / INITIALS | SCAVENGER |

| |

|AM / PM Rounds | |

| | |

|II. Charting (Computer-Based) |

|I & O | |

| | |

|CARE MANAGEMENT AND DOCUMENTATION SKILLS |RATING |COMMENTS / INITIALS |SCAVENGER |

| |

|Code system | |

| | |

|IV. Computer Skills |

|Email |

| | |

| V. Physical Layout |

|Medication Room | |

| VI. Standard Work / Protocol | |

|Pre-Op Checklist | | | |

| |

| | |

|Electronic Learning / Medical Record / Documentation / Payroll: |

|- The Communicator |

| |

|QUANTROS (tutorial reviewed) |

| | |

-----------------------

1 = No opportunity to perform the skill

2 = Need a review of the skill, supervision or coaching

3 = Able to perform the skill without supervision or coaching

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