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CNA Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | Patient Rights | 1 | 2 | 3 | 4 | ||
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"Communicates
and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)" |
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"Involves
the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives." |
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"Complies
with nursing staff responsibility included in the hospital policy related
to Organ Donation." |
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"Meets
patient and families needs regarding communication, including
interpreter services" |
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Provides accurate information to patient and families in a timely manner. | ||||||
| Rating Stars (Click) | Vital Signs and Weights | 1 | 2 | 3 | 4 | ||
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Obtaining and Recording | ||||||
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BP, including Orthostatic | ||||||
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Pulse, Radia | ||||||
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Temperature, Oral | ||||||
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Temperature, Rectal | ||||||
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Temperature, Axillary | ||||||
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Temperature, Tympanic | ||||||
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Respirations | ||||||
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Weight, Pounds and Kilograms | ||||||
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Recognizing Cardiac Arrest | ||||||
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Activating Code Team | ||||||
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Bringing Emergency Equipment to Room | ||||||
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Providing Appropriate Code Support | ||||||
| Use of Electronic VS equipment: | |||||||
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Automatic BP machine (Dynamap) | ||||||
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Electronic Thermometer | ||||||
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Applying Oximeter | ||||||
| Scale Use: | |||||||
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Standing | ||||||
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Chair | ||||||
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Bed | ||||||
| GI /GU | |||||||
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Report Abnormal Findings | ||||||
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Bowel Function | ||||||
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Bladder Function | ||||||
| Administering Enemas: | |||||||
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Tap Water | ||||||
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Fleets | ||||||
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Return Flow | ||||||
| Rating Stars (Click) | Vital Signs and Weights | 1 | 2 | 3 | 4 | ||
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Placing and Removing Bed Pan | ||||||
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Clamping Catheter | ||||||
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Emptying Foley Bag | ||||||
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Placing Condom Catheter | ||||||
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Emptying and Replacing Ostomy Bag (Established Ostomy) | ||||||
| Rating Stars (Click) | Nutrition | 1 | 2 | 3 | 4 | ||
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Estimating Intake | ||||||
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Setting up for Meals | ||||||
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Feeding Patients | ||||||
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Aspiration Precautions | ||||||
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Nourishments | ||||||
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Counting Calories | ||||||
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Fluid Restriction | ||||||
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NPO | ||||||
| Rating Stars (Click) | Specimens | 1 | 2 | 3 | 4 | ||
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Collecting Stool | ||||||
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Collecting Sputum | ||||||
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Labeling Specimens and Preparing for Transport | ||||||
| Collecting Urine: | |||||||
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Clean Catch | ||||||
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24 Hour | ||||||
| Rating Stars (Click) | Hygiene /Skin | 1 | 2 | 3 | 4 | ||
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Risk Factorsfor Skin Breakdown | ||||||
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Observing Pressure Points for Redness or Breakdown | ||||||
| Bathing /Daisy Hygiene: | |||||||
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Bathing (Shower /Tub /Arjo) | ||||||
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Oral Care, Including Patients who are NPO,Comatose, Patients with | ||||||
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Pen Care | ||||||
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Foot Care for Patients with Impaired Circulation or Sensation | ||||||
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Incontinence Care | ||||||
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Shaving and Precautions | ||||||
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Reducing Pressure and Friction | ||||||
| Use of Pressure and Friction Reduction Devices: | |||||||
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Special Beds/Mattresses | ||||||
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Heels and Elbow Protection | ||||||
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Foot Cradles | ||||||
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Use of Shower Chair | ||||||
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Use of Bath/Shower Boat | ||||||
| Rating Stars (Click) | Infection Control | 1 | 2 | 3 | 4 | ||
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Reverse Isolation | ||||||
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Body Substance isolation | ||||||
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TB Precautions | ||||||
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MRSA Precautions | ||||||
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Hand Washing | ||||||
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Infectious/Hazardous Waste Disposal | ||||||
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Supply/Equipment Disposal | ||||||
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Use of Disposable Therrnomete | ||||||
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Use of CPR Mask/Bag | ||||||
| Proper use of Specific Barrier, Methods: | |||||||
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Gloves | ||||||
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Gown | ||||||
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Mask / Goggles | ||||||
| Rating Stars (Click) | Safety and Activity | 1 | 2 | 3 | 4 | ||
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Determining Patient ID | ||||||
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Identifying Safety Hazards | ||||||
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Determining Need for Additional Help | ||||||
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Assessing Safety and ADL Needs | ||||||
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Assessing Safety and ADL Needs | ||||||
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Recognizing Abuse: Substance, Physical, Emotional, etc | ||||||
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MaintainingClean, Orderly Work Area | ||||||
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Disposing of Sharps | ||||||
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Handling Hazardous Materials | ||||||
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Proper Body Mechanics | ||||||
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ROM Exercises | ||||||
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Transferring to Bed,WC, Commode, etc | ||||||
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Turning and Positioning | ||||||
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Patient Safety Module | ||||||
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Reporting Broken Equipment | ||||||
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Responding to Safety Hazards | ||||||
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Use of HoyerLift (Dextra /Maxi) | ||||||
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Bed Operation | ||||||
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Use of Wheel Locks | ||||||
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Use of Alarms: Bed, Patient, Unit | ||||||
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Use of CaIl Light | ||||||
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Documenting Use of Restraints | ||||||
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Use of Transfer Belt | ||||||
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Use of Gait Belt for Ambulation | ||||||
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Use of Seizure Pads | ||||||
| Application of Restraints: | |||||||
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Belt Including Seat Belt | ||||||
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Wrist/Ankle | ||||||
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Vest | ||||||
| Rating Stars (Click) | Care Routines | 1 | 2 | 3 | 4 | ||
| New Admissions and Transfers: | |||||||
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Inventory andDispositionof Belongings, Useof Checklist | ||||||
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Room Orientation, Call Bell | ||||||
| Post-op Patients: | |||||||
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Transferring into Bed | ||||||
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Call Bell | ||||||
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Assist with Turns | ||||||
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ROM Exercises | ||||||
| Maintaining 02 Therapy: | |||||||
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Replacing Mask or Nasal Caunula if Needed | ||||||
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Notifying Nurse of Problems | ||||||
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Basic Comfort Measures | ||||||
| Preparation For and Transfer to SNF: | |||||||
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Early Bath | ||||||
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Preparing Belongings | ||||||
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Preparingfor and Explaining Routinesto Patient | ||||||
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Post Mortem Care | ||||||
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Use ofIncentive Spirometer | ||||||
| Removing /Replacing: | |||||||
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Antiembolic Stockings | ||||||
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Sequential Stockings | ||||||
| Rating Stars (Click) | Communication | 1 | 2 | 3 | 4 | ||
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Using Appropriate Abbreviations | ||||||
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Identifying UnusuaI Patient Incidents that Require Reporting | ||||||
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Reinforcing RN Teaching With Patient | ||||||
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Selecting and Using Forms Appropriately | ||||||
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Using Alternate Communication Tools /Devices | ||||||
| Communicating to RN: | |||||||
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Changes in Patient Condition | ||||||
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Patient Needs, Complaints and Concerns | ||||||
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Unusual Incidents | ||||||
| Recording and Reporting: | |||||||
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Vital Signs | ||||||
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Bathing /Hygiene | ||||||
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Turning and Repositioning | ||||||
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Ambulation and Activity | ||||||
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Diet intake, Calorie Count | ||||||
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Bowel Movements | ||||||
| 1 & 0: | |||||||
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Shift Volumes and Totals | ||||||
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Marking
and /or Measuring Amount of Urine, Gastric Fluid, NG Drainage, Emesis, Diarrhea |
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| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Elderly (ages 80+ years) | ||||||
| Rating Stars (Click) | Unit Activity | 1 | 2 | 3 | 4 | ||
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Identifying Unusual Incidents on the Unit that Require Reporting | ||||||
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"Locating
and Using Appropriate Reference Materials: Hospital, Patient Care and" |
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Charging for Patient Care Items | ||||||
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Completing Risk Management Reports as Needed | ||||||
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Obtaining Needed Supplies and Equipment | ||||||
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Reporting and Following up on Faulty Equipment and Supplies | ||||||
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Using
Telephone System |
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