< PCT Skills Checklist
  PCT Skills Checklist
   LAST 4 OF SSN      
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

Rating Stars (Click) Patient Rights 1 2 3 4  
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)
Involves the patient and family and respects their role in determining the
nature of care to be provided, including Advance Directives.
Complies with nursing staff responsibility included in the hospital policy related to
Organ Donation.
Meets patient and families needs regarding communication, including interpreter
Provides accurate information to patient and families in a timely manner.  
Rating Stars (Click) Vital Signs and Weights 1 2 3 4  
  Obtaining and Recording    
BP, including Orthostatic  
Pulse, Radia  
Temperature, Oral  
Temperature, Rectal  
Temperature, Axillary  
Temperature, Tympanic  
Weight, Pounds and Kilograms  
Recognizing Cardiac Arrest  
Activating Code Team  
Bringing Emergency Equipment to Room  
Providing Appropriate Code Support  
  Use of Electronic VS equipment:    
Automatic BP machine (Dynamap)  
Electronic Thermometer  
Applying Oximeter  
  Scale Use:    
  GI /GU    
Report Abnormal Findings  
Bowel Function  
Bladder Function  
  Administering Enemas:    
Tap Water  
Return Flow  
Rating Stars (Click) Vital Signs and Weights 1 2 3 4  
Placing and Removing Bed Pan  
Clamping Catheter  
Emptying Foley Bag  
Placing Condom Catheter  
Emptying and Replacing Ostomy Bag (Established Ostomy)  
Rating Stars (Click) Nutrition 1 2 3 4  
Estimating Intake  
Setting up for Meals  
Feeding Patients  
Aspiration Precautions  
Counting Calories  
Fluid Restriction  
Rating Stars (Click) Specimens 1 2 3 4  
Collecting Stool  
Collecting Sputum  
Labeling Specimens and Preparing for Transport  
  Collecting Urine:    
Clean Catch  
24 Hour  
Rating Stars (Click) Hygiene /Skin 1 2 3 4  
Risk Factorsfor Skin Breakdown  
Observing Pressure Points for Redness or Breakdown  
  Bathing /Daisy Hygiene:    
Bathing (Shower /Tub /Arjo)  
Oral Care, Including Patients who are NPO,Comatose, Patients with  
Pen Care  
Foot Care for Patients with Impaired Circulation or Sensation  
Incontinence Care  
Shaving and Precautions  
Reducing Pressure and Friction  
  Use of Pressure and Friction Reduction Devices:    
Special Beds/Mattresses  
Heels and Elbow Protection  
Foot Cradles  
Use of Shower Chair  
Use of Bath/Shower Boat  
Rating Stars (Click) Infection Control 1 2 3 4  
Reverse Isolation  
Body Substance isolation  
TB Precautions  
MRSA Precautions  
Hand Washing  
Infectious/Hazardous Waste Disposal  
Supply/Equipment Disposal  
Use of Disposable Therrnomete  
Use of CPR Mask/Bag  
  Proper use of Specific Barrier, Methods:    
Mask / Goggles  
Rating Stars (Click) Safety and Activity 1 2 3 4  
Determining Patient ID  
Identifying Safety Hazards  
Determining Need for Additional Help  
Assessing Safety and ADL Needs  
Assessing Safety and ADL Needs  
Recognizing Abuse: Substance, Physical, Emotional, etc  
MaintainingClean, Orderly Work Area  
Disposing of Sharps  
Handling Hazardous Materials  
Proper Body Mechanics  
ROM Exercises  
Transferring to Bed,WC, Commode, etc  
Turning and Positioning  
Patient Safety Module  
Reporting Broken Equipment  
Responding to Safety Hazards  
Use of HoyerLift (Dextra /Maxi)  
Bed Operation  
Use of Wheel Locks  
Use of Alarms: Bed, Patient, Unit  
Use of CaIl Light  
Documenting Use of Restraints  
Use of Transfer Belt  
Use of Gait Belt for Ambulation  
Use of Seizure Pads  
  Applicationof Restraints:    
Belt Including Seat Belt  
Rating Stars (Click) Care Routines 1 2 3 4  
  New Admissions and Transfers:    
Inventory andDispositionof Belongings, Useof Checklist  
Room Orientation, Call Bell  
  Post-op Patients:    
Transferring into Bed  
Call Bell  
Assist with Turns  
ROM Exercises  
  Maintaining 02 Therapy:    
Replacing Mask or Nasal Caunula if Needed  
Notifying Nurse of Problems  
Basic Comfort Measures  
  Preparation For and Transfer to SNF:    
Early Bath  
Preparing Belongings  
Preparingfor and Explaining Routinesto Patient  
Post Mortem Care  
Use ofIncentive Spirometer  
  Removing /Replacing:    
Antiembolic Stockings  
Sequential Stockings  
Rating Stars (Click) Communication 1 2 3 4  
Using Appropriate Abbreviations  
Identifying UnusuaI Patient Incidents that Require Reporting  
Reinforcing RN Teaching With Patient  
Selecting and Using Forms Appropriately  
Using Alternate Communication Tools /Devices  
  Communicating to RN:    
Changes in Patient Condition  
Patient Needs, Complaints and Concerns  
Unusual Incidents  
  Recording and Reporting:    
Vital Signs  
Bathing /Hygiene  
Turning and Repositioning  
Ambulation and Activity  
Diet intake, Calorie Count  
Bowel Movements  
  1 & 0:    
Shift Volumes and Totals  
Marking and /or Measuring Amount of Urine, Gastric Fluid, NG Drainage,
Emesis, Diarrhea
Rating Stars (Click) Unit Activity 1 2 3 4  
Identifying Unusual Incidents on the Unit that Require Reporting  
Locating and Using Appropriate Reference Materials: Hospital, Patient Care
Charging for Patient Care Items  
Completing Risk Management Reports as Needed  
Obtaining Needed Supplies and Equipment  
Reporting and Following up on Faulty Equipment and Supplies  
Using Telephone System  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Infant (Birth - 1 year)  
Preschooler (ages 2-5 years)  
Childhood (ages 6-12 years)  
Adolescents (ages 13-21 years)  
Young Adults (ages 22-39 years)  
Adults (ages 40-64 years)  
Older Adults (ages 65-79 years)  
Elderly (ages 80+ years)