"SELF EVALUATION"
NURSING SKILLS PROFICIENCY CHECKLIST

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     Last Name: 
    First Name: 
Middle Initial: 
RN  Years Experience: 
LPN Years Experience:

DIRECTIONS: Select the box that best describes your level of proficiency in each of the skills presented.

LEVELS OF PROFICIENCY KEY:

HP = Highly Proficient; Extensively experienced; Able to supervise and/or train others. SE = Some Experience;
Need review and assistance or supervision.
VE = Very Experienced; Can perform well, without assistance or supervision. NE = No Experience
EX = Experienced; Competent;
Can perform independently;
May need initial review or supervision.
PROFICIENCY LEVEL
GENERAL SKILLS: HP VE EX SE NE
Physical Assessments
Principles of Body Mechanics
Universal Precautions
Patient Transfer - Bed To Chair
Patient Transfer - Bed To Cart
Patient Transfer - Chair To Chair
Patient Transfer - Horizontal Lift
Range of Motion Exercises
Post Mortum Care
Opening A Sterile Pack
Adding Items To A Sterile Field
Sterile Dressing Changes
Wound Irrigation
Decubitus Ulcer Care
Immunization Requirements
Insertion of IV Catheter
Care of Central IV Lines
Insertion of Pic Catheter
IV Medication Administration
Intradermal Injections
Intramuscular Injections
Intramuscular Z-Track Technique
Subcutaneous Injections
Med. Administration-Nasal
Med. Administration - Ophthalmic
Med. Administration - Rectal
Med. Administration - Otic
Med. Administration - Vaginal
Ear Irrigation
Eye Irrigation
Admin.-Packed Red Blood Cells
Admin.-Whole Blood
Admin.-Cryoprecipitate
Admin.-Platelets
Admin.-Fresh Frozen Plasma
Admin.-Albumin
Admin. - Hyperalimentation/T.P.N.
Preoperative Care
Postoperative Care
Obtaining Urine Cultures
Obtaining Wet Cultures
Obtaining Dry Cultures
Testing for Occult Blood
Assisting-Bone Marrow Biopsy
Assisting-Lumbar Punctures
Assisting-Liver Biopsy
Assisting-Paracentesis
Assisting-Thoracentesis
Knowledge of Normal Lab Values
Urine Testing-Glucose & Ketones
CARDIOPULMONARY: HP VE EX SE NE
EKG Interpretation
Placement of Telemetry Leads
Cardiopulmonary Resuscitation
Clearing Away Obstructions
Placement-Nasopharageal Airway
Use of Ambu Bag
Nasopharygeal Suctioning
Tracheal Suctioning
Care of Tracheostomy
Monitor & Use-Pulse Oximeter
Incentive Spirometry
Chest Percussion
O2 Admin.-Nasal Cannula
O2 Admin.-Face Mask
O2 Admin.-Venti Mask
O2 Admin.-Rebreather Mask
O2 Admin.-Tent
Admin.-Hand Nebulizer Treatment
Collection of Sputum Specimens
GU/GI: HP VE EX SE NE
Enema Administration
Placement of NG Tube
Gastric Lavage
NGT-Irrigation/Meds Admin.
Gastric Tube-Irrigation/Meds Admin.
Gastric Tube Care
T-Tube Care
JP Tube Care
Hemovac Care
Colostomy Care
Ileostomy Care
Care after Ileostomy
Urostomy Care
Urinary Straight Catheterazation
Foley Cath Insertion-Male
Foley Cath Insertion-Female
Foley Cath Care
Foley Cath Irrigations
Foley Cath-Continuous Irrigations
Foley Cath-Obtaining Specimens
Suprapubic Cath Care
Removal of Fecal Impactions
Assisting-Peritoneal Lavage

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