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LTC RN Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

MM slash DD slash YYYY

AGE OF PATIENTS CARED FOR

Newborn/ Neonate (birth to 30 days)(Required)
Infant (1 month to 1 year)(Required)
Toddler (1 year to 3 years)(Required)
Preschooler (3 years to 5 years)(Required)
School Age Child (5 years to 12 years)(Required)
Adolescents (12 years to 18 years)(Required)
Young Adults (18 years to 39 years)(Required)
Middle Adults (39 years to 64 years)(Required)
Older Adults (64 years to 79 years)(Required)
Elderly Adults (over 79+ years)(Required)

GENERAL SKILLS

Standard Precautions(Required)
Isolation Precautions(Required)
Pediatric Respiratory/ Cardiac Arrest(Required)
Adult Respiratory/ Cardiac Arrest(Required)
Crash Carts(Required)
Defibrillators(Required)
Care of Patients in Restraints(Required)
Pain Management(Required)
Automated Med Dispensing Systems
Care Planning & Discharge Planning(Required)
Patient/ Family Education(Required)
Electronic Documentation
Patient Head to Toe Assessment(Required)

MEDICATION-KNOWLEDGE AND USE OF

Pouring from Stock Medications(Required)
Narcotic Administration(Required)
IV Push/ Drip Medications(Required)
Antibiotics(Required)
Oral(Required)
Topical(Required)
Otic(Required)
Rectal(Required)
Vaginal(Required)
Ophthalmic(Required)
Continuous Subcutaneous Infusion Pumps(Required)
Total Parenteral Nutrition (TPN)(Required)
Peripheral Parenteral Nutrition(Required)
Patient Controlled Analgesia (PCA)(Required)

PHLEBOTOMY/ IV THERAPY

Blood Draw- Peripheral(Required)
Blood Draw- Central Line/ Port(Required)
Insertion, Care and Maintenance of Peripheral IV(Required)
Care and Maintenance of Central Lines(Required)
Care and Maintenance of Implanted Port- A- Cath(Required)
Mixing IVs(Required)
Regulating IVs(Required)
IV Infusion Pumps(Required)
Blood/ Blood Product Administration(Required)

CARDIAC:

Recognizing Basic & Life- Threatening Dysrhythmia(Required)
Congestive Heart Failure(Required)
Pulse Checks(Required)
Use of Doppler Cardiac Monitors(Required)
Taking EKGs- 12 Lead(Required)
Use of Automatic BP Cuff (ie Dinamap)(Required)

Care of Patient With:

Heart Failure(Required)
CHF(Required)
MI(Required)
Arrhythmias(Required)
Hypertension(Required)
Hypotension(Required)
CAD(Required)

Knowledge and Use of:

Anticoagulants(Required)
Nitrates (Oral, Topical)(Required)
Antiarrhythmics (Oral)(Required)
Antihypertensives (Oral)(Required)

RESPIRATORY

COPD(Required)
Asthma Exacerbation(Required)
Tracheostomy(Required)
Pneumonia(Required)
Emphysema(Required)
Pre/ Post Thoracic Surgery(Required)
Chest Tubes(Required)
Collection of Sputum Specimen(Required)
O2 Cannulas/ Masks(Required)
Non- rebreather Mask(Required)
Nebulizer Set- up/ Use(Required)
Incentive Spirometry(Required)
Chest PT(Required)
Suctioning (Oral/ Nasotracheal)(Required)
Suctioning (Tracheostomy Tube)(Required)
Ventilator Patient (Mouth Care, Suctioning, Ambu bag)(Required)

Knowledge and Use of:

Bronchodilators (Oral, IV, Inhaler)(Required)
Steroids(Required)

NEURO:

Spinal Cord Injury- Acute(Required)
Spinal Cord Injury- Long Term(Required)
CVA/Stroke(Required)
Neuromuscular Disease(Required)
Alzheimer's Disease(Required)
Wandering(Required)
Hallucinations(Required)
Anxiety(Required)
Agitation(Required)
Reality Orientation(Required)
Assessing Levels of Consciousness(Required)
Pupil Checks(Required)
Seizure Precautions(Required)
Stroke Precautions(Required)
Swallow Precautions(Required)
Assisting with Lumbar Puncture(Required)
Use of Hyper/ Hypothermia Blanket(Required)

Knowledge and Use of:

Anticonvulsant(Required)
Sedative(Required)

SENSORY DEFICITS-CARE OF PATIENTS WITH:

Dentures(Required)
Hearing Aids(Required)
Hearing Loss(Required)
Prosthetic eye(Required)
Contact Lens Care(Required)
Blindness(Required)
Macular Degeneration(Required)

GASTROINTESTINAL- CARE OF PATIENTS WITH:

Nasogastric tubes (i.e. Salem Sump, Levine)(Required)
Nasointestinal Tubes (i.e. Cantor, Miller- Abbott)(Required)
Jejunostomy, Gastrostomy, Cecostomy Tubes(Required)
Colostomy, Ileostomy(Required)
Bronchoscopy Lung/ Wedge Resection(Required)

GI GENERAL

Collection of Stool Specimens(Required)
Bowel Preparation and Cleansing Procedures(Required)
Administration of Tube Feedings via Flexible Tubes(Required)
Bowel Disimpaction(Required)
Bowel Retraining(Required)
Sitz Bath Treatments(Required)
Insertion and Checking Placement/ Patency NG Tubes(Required)

ENDOCRINE- CARE OF PATIENTS WITH:

Diabetes(Required)
Hyper/ hypoglycemia(Required)

ENDOCRINE GENERAL

Blood Glucose Monitoring(Required)
Performing Fingersticks(Required)
Use of Blood Glucose Meter Device(Required)
Use of Visual Blood Glucose Strips(Required)

Knowledge and Use of:

Single Type Insulin(Required)
Mixed Insulins(Required)
Insulin Infusion(Required)

RENAL/ GU- CARE OF PATIENTS WITH:

Incontinence(Required)
Urinary Retention(Required)
UTI(Required)
Insertion of Foley Catheter- Female(Required)
Insertion of Foley Catheter- Male(Required)
Straight Catheterization- Male(Required)
Straight Catheterization- Female(Required)
Insertion of Suprapubic Catheter(Required)
Application of Condom Catheter(Required)
Bladder Retraining(Required)
Urinary Diversion(Required)
Bladder Irrigation (Continuous and Intermittent)(Required)

Peritoneal Dialysis

Manual(Required)
Automatic Cycler Machine(Required)

ORTHOPEDIC- CARE OF PATIENTS WITH:

Total Joint Replacement(Required)
Rheumatic/ Arthritic Disease(Required)
Amputation(Required)
Fracture(Required)

ORTHOPEDIC GENERAL

Cast Care(Required)
CMS Checks(Required)
Traction- Skin(Required)
Traction- Skeletal(Required)
Range of Motion(Required)
Use of Assistive Devices(Required)
Application of Splints of Extremities(Required)
Continuous Passive Motion Machine (CPM)(Required)
Transfer Techniques(Required)
Use of Sliding Board(Required)
Gait Training/ Retraining(Required)
Application of Prosthetic Devices(Required)
Application of Orthotic Devices(Required)

WOUND/ SKIN- CARE OF PATIENTS WITH:

Pressure Sores(Required)
Leg Ulcers(Required)
Burns(Required)

WOUND/ SKIN GENERAL

Acute Dressing Changes(Required)
Wound Care(Required)
Irrigations(Required)
Identifying Common Skin Problems(Required)
Recognizing Normal Skin Changes(Required)
Use of Special Pressure Relief Devices(Required)
Pressure Relief Mattress/ Seat Cushion(Required)

ADDITIONAL SKILLS- CARE OF PATIENTS WITH:

Hemovacs(Required)
Jackson-Pratt Tubes(Required)
Penrose Drains(Required)
T-Tubes(Required)
Wound Vac(Required)

OTHER SKILLS

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