Nurse Skills & Procedural Competency List

Step 1 of 31

Introduction

Type(Required)

Orientation Period

Annual

Employee Information

Employee Name(Required)

First Middle Last

Unit(s)(Required)

Harbor

Hearthside

Wellsprings

Horizons

Please complete the following checklist with your preceptor's and return to Staff Development Coordinator. This will be part of your 6 month employee evaluation process. Failure to complete this may affect the outcome of the introductory period evaluation.

*THIS IS A MANDATORY EMPLOYEE PROCESS

Daily Routine

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Shift Report and daily report sheets(Required)

Satisfactory

Unsatisfactory

Shift Round/BED checks(Required)

Satisfactory

Unsatisfactory

Physician Rounds(Required)

Satisfactory

Unsatisfactory

Equipment

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Restrictive Lifting Policy(Required)

Satisfactory

Unsatisfactory

Stand Up Lift(Required)

Satisfactory

Unsatisfactory

Full Body Lift(Required)

Satisfactory

Unsatisfactory

Volaro Lift(Required)

Satisfactory

Unsatisfactory

Specialty Mattresses / Bed(Required)

Satisfactory

Unsatisfactory

Electric Bed(Required)

Satisfactory

Unsatisfactory

Trapeze(Required)

Satisfactory

Unsatisfactory

Bed cradles/Foot boards(Required)

Satisfactory

Unsatisfactory

Stand on and Wheelchair Scales(Required)

Satisfactory

Unsatisfactory

Enteral Pumps(Required)

Satisfactory

Unsatisfactory

IV Pump(Required)

Satisfactory

Unsatisfactory

CPAP/BiPAP machine(Required)

Satisfactory

Unsatisfactory

CMP (continuous passive motion) machine(Required)

Satisfactory

Unsatisfactory

Glucometer (and procedure for disinfection)(Required)

Satisfactory

Unsatisfactory

Nebulizer Machines(Required)

Satisfactory

Unsatisfactory

- Pre and Post Assessment on eMar(Required)

Satisfactory

Unsatisfactory

Cardiac

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Code-CPR & Automatic External Defibrillator (AED) Certification(Required)

Satisfactory

Unsatisfactory

Code Procedure:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Policy and Procedure for C.P.R.(Required)

Satisfactory

Unsatisfactory

How to identify Code Status for Resident(Required)

Satisfactory

Unsatisfactory

Emergency Cart(Required)

Satisfactory

Unsatisfactory

Location and survey of supplies available(Required)

Satisfactory

Unsatisfactory

Procedure for setting up the E-Cylinder(Required)

Satisfactory

Unsatisfactory

Use of A.E.D.(Required)

Satisfactory

Unsatisfactory

Documentation following a CODE Procedure(Required)

Satisfactory

Unsatisfactory

Genitourinary

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Changing a Supra Pubic Catheter(Required)

Satisfactory

Unsatisfactory

Bladder Irrigation(Required)

Satisfactory

Unsatisfactory

Female Catheterization(Required)

Satisfactory

Unsatisfactory

Male catheterization(Required)

Satisfactory

Unsatisfactory

Identification of briefs vs. pull ups and incontinence items in facility(Required)

Satisfactory

Unsatisfactory

Endocrine

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Blood Glucose Testing (Point of Care) and Disinfection of Device(Required)

Satisfactory

Unsatisfactory

Insulin Pen(Required)

Satisfactory

Unsatisfactory

Gastrointestinal

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Enteral Tube Bolus Feeding Administration(Required)

Satisfactory

Unsatisfactory

Gastrostomy Tube Removal and Insertion(Required)

Satisfactory

Unsatisfactory

Medication Administration Via Enteral Tube(Required)

Satisfactory

Unsatisfactory

Dual Flo Eternal Delivery Pump(Required)

Satisfactory

Unsatisfactory

Hemodialysis Access care

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Shunt Care(Required)

Satisfactory

Unsatisfactory

Report packet for dialysis handoff communication(Required)

Satisfactory

Unsatisfactory

Infection Control

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Handwashing(Required)

Satisfactory

Unsatisfactory

Proper use of ABHR(Required)

Satisfactory

Unsatisfactory

Applying and removing PPE(Required)

Satisfactory

Unsatisfactory

Standard, Contact, Droplet, and Airborne Precautions(Required)

Satisfactory

Unsatisfactory

COVID-19 Infection Control Precautions(Required)

Satisfactory

Unsatisfactory

Facemask and Faceshield Facility Policy(Required)

Satisfactory

Unsatisfactory

Medication MISC

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Medication Administration(Required)

Satisfactory

Unsatisfactory

Injections-Subcutaneous, Intramuscular, Intradermal(Required)

Satisfactory

Unsatisfactory

Needle Safety(Required)

Satisfactory

Unsatisfactory

Neurology

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Neurological Assessment(Required)

Satisfactory

Unsatisfactory

Anti-psychotic medication guidelines review(Required)

Satisfactory

Unsatisfactory

Chemical Restraints/Sleep Inducing Medications(Required)

Satisfactory

Unsatisfactory

Policy and Procedure(Required)

Satisfactory

Unsatisfactory

Various Forms(Required)

Satisfactory

Unsatisfactory

I.V. Therapy

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Starting a Peripheral I.V. – if need IV class please write it here(Required)

Satisfactory

Unsatisfactory

Antibiotic Administration(Required)

Satisfactory

Unsatisfactory

Implanted Venous Port (Port-a-cath)(Required)

Satisfactory

Unsatisfactory

Use of I.V. Pump and various I.V. Tubing(Required)

Satisfactory

Unsatisfactory

Ortho/Skin

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Wound Care- (Assessment, Measuring, Documenting, and Dressing wounds).(Required)

Satisfactory

Unsatisfactory

Alert charting and skin assessment documentation on skin grid(Required)

Satisfactory

Unsatisfactory

Dressing Change (clean)(Required)

Satisfactory

Unsatisfactory

Midline Dressing Change(Required)

Satisfactory

Unsatisfactory

Peripheral IV Dressing Change(Required)

Satisfactory

Unsatisfactory

Respiratory

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Aerosol Therapy(Required)

Satisfactory

Unsatisfactory

Respiratory Assessment(Required)

Satisfactory

Unsatisfactory

Oxygen Administration (nasal cannula, venture mask, non-rebreather mask)(Required)

Satisfactory

Unsatisfactory

Suctioning(Required)

Satisfactory

Unsatisfactory

Trach care and Trach Tube replacement(Required)

Satisfactory

Unsatisfactory

Condition Change

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Identifies changes in resident’s condition and follow reporting procedure.(Required)

Satisfactory

Unsatisfactory

Placing resident on Alert Charting as indicated.(Required)

Satisfactory

Unsatisfactory

Notification of Physician(Required)

Satisfactory

Unsatisfactory

Notification of Responsible Party(Required)

Satisfactory

Unsatisfactory

Medicare Charting(Required)

Satisfactory

Unsatisfactory

Death Procedure

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Policy and Procedure(Required)

Satisfactory

Unsatisfactory

Physicians Order(Required)

Satisfactory

Unsatisfactory

Various Forms(Required)

Satisfactory

Unsatisfactory

Coroner Notification(Required)

Satisfactory

Unsatisfactory

Death & Burial Transit Permit(Required)

Satisfactory

Unsatisfactory

Elopement (wandering)

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Policy and Procedure(Required)

Satisfactory

Unsatisfactory

Forms(Required)

Satisfactory

Unsatisfactory

Disaster Procedures:

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Policy and Procedure for Disaster Situations(Required)

Satisfactory

Unsatisfactory

Able to locate Disaster Manual, Disaster cart(Required)

Satisfactory

Unsatisfactory

Demonstrates Procedure for Fire Drill, use of Fire Panel(Required)

Satisfactory

Unsatisfactory

Demonstrates Procedure for Fire Extinguisher(Required)

Satisfactory

Unsatisfactory

Communication

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Is able to effectively communicate with both residents and other members of the Health Care Team.(Required)

Satisfactory

Unsatisfactory

Verbalizes Understanding of Holiday Health Care Code of Conduct(Required)

Satisfactory

Unsatisfactory

Point Click Care Documentation

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Admission Procedure(Required)

Satisfactory

Unsatisfactory

Re-Admission Procedure(Required)

Satisfactory

Unsatisfactory

Transfer to Hospital Procedure(Required)

Satisfactory

Unsatisfactory

Transfer to Another Healthcare Facility Checklist(Required)

Satisfactory

Unsatisfactory

Skin Checklist for Incident/Accident Report(Required)

Satisfactory

Unsatisfactory

Falls Checklist for Incident/Accident Report(Required)

Satisfactory

Unsatisfactory

Resident Appointment in PCC Checklist(Required)

Satisfactory

Unsatisfactory

Sending message to transport in PCC regarding scheduled appointments(Required)

Satisfactory

Unsatisfactory

Behavioral Intervention Checklist(Required)

Satisfactory

Unsatisfactory

Post Mortem Check List Procedure Review(Required)

Satisfactory

Unsatisfactory

Bloodborne Pathogen Exposure Plan Procedure Checklist Review(Required)

Satisfactory

Unsatisfactory

Suspected UTI protocol and checklist, procedure in PCC(Required)

Satisfactory

Unsatisfactory

Alert Charting Procedures and aware of Alert Charting Binders(Required)

Satisfactory

Unsatisfactory

CarePlans

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Follows the resident’s careplan that implements person center care and cultural competencies.(Required)

Satisfactory

Unsatisfactory

Promotes resident’s independence with ADL’s.(Required)

Satisfactory

Unsatisfactory

MEDICATION CART

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Medication Cart – review and demonstrates understanding of function(Required)

Satisfactory

Unsatisfactory

Verbalizes and Demonstrates how to refill medication card(Required)

Satisfactory

Unsatisfactory

Controlled substance count oncoming shift(Required)

Satisfactory

Unsatisfactory

Controlled substance count offgoing shift(Required)

Satisfactory

Unsatisfactory

How to contact PCA for EDK Authorization Code(Required)

Satisfactory

Unsatisfactory

EDK – medication cart and system – understands and demonstrates use of EDK card and cart.(Required)

Satisfactory

Unsatisfactory

Federal & State Regulations

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Contents(Required)

Satisfactory

Unsatisfactory

Location(Required)

Satisfactory

Unsatisfactory

Hazard Communication

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Policy and Procedure(Required)

Satisfactory

Unsatisfactory

Use and Location of M.S.D.S Sheets(Required)

Satisfactory

Unsatisfactory

HIPAA & Confidentiality

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Understands HIPAA in regards to PHI and EPHI.(Required)

Satisfactory

Unsatisfactory

-Resident(Required)

Satisfactory

Unsatisfactory

-Employee(Required)

Satisfactory

Unsatisfactory

Hospice

Satisfactory-shows competency with procedure and adequate knowledge of policy and procedure.

Unsatisfactory-does not show competency with procedure and adequate knowledge of policy and procedure, NEEDS REVIEW.

Policy and Procedure(Required)

Satisfactory

Unsatisfactory

Various Forms(Required)

Satisfactory

Unsatisfactory

Comment

Comments

Skills and Procedural Competency Acknowledgement:

Acknowledgement(Required)

I acknowledged that I have verbalized and/or demonstrated the tasks as checked above and that I have a clear understanding of each item checked. I also acknowledge that this training has adequately prepared me to preform said task/item.(Required)

Nurse Signature(Required)

Date(Required)

MM slash DD slash YYYY

Name

This field is for validation purposes and should be left unchanged.