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)
Proficiency Scale
1
2
3
4
General Duties
Admit/Orient Involuntary
Clients
Admit/Orient Voluntary
Clients
Advance Directives
Ambulatory Cuffs
Assist Activities of Daily
Living
Assist with Personal
Hygiene
Cultural Diversity
Discharge Clients
Discharge Planning
Documentation-Computer
Documentation-Written
Full Restraints
HIPAA Regulations
Initial Interview
Initial Screening
Assessment
Isolation Techniques
Mutli-Disciplinary Planning
Oxygen Administration
Participate in
Interdisciplinary Team
Patient Teaching
Reassess/Update Plan of
Care
Referral to Community
Resources
Supervise Unlicensed
Personnel
Vital Signs
Wrist Restraints
Rating Stars
(Click)
Eating Disorders
1
2
3
4
Anorexia Nervosa
Bulimia Nervosa
Obesity
Interventions/Therapies
Assultive Behavior
Rating Stars
(Click)
Care of Psychiatric
Disorders
1
2
3
4
Anxiety Disorders
Bipolar Disorder
Catatonic Psychotic
Disorder
Delusional Disorders
Depression
Dissociative Identity
Disorder
Hallucinations
Obsessive/Compulsive
Disorder
Panic Attacks
Paranoid Psychotic Disorder
Phobias
Schizophrenia
Suicidal Ideation/Attempts
Rating Stars
(Click)
Assist with Psychotherapy
1
2
3
4
Behavioral
Couple/Family
Group
Individual
Rating Stars
(Click)
Personality Disorders
1
2
3
4
Cluster A-Paranoid/Schizoid
Cluster
B-Antisocial/Borderline
Cluster C-Anxious/Fearful
Rating Stars
(Click)
Cognitive Disorders
1
2
3
4
Alzheimer's (Dementia)
Amnestic Disorders
Delirium
Dementia
Rating Stars
(Click)
Certified "Management
of Assultive Behavior"
1
2
3
4
Crisis Intervention
Drug & Alcohol
Education
Education or Vocational
Training
Teach Independent Living
Skills
Therapeutic
Communication
Therapeutic Milieu
Rating Stars
(Click)
Assist with Alternative
Therapies:
1
2
3
4
Biofeedback
ElectroConvulsive Therapy
Expressive Therapy (Art,
Movement)
Guided Imagery
Massage Therapy
Mediation
Recreational Therapy
Therapeutic Touch
Rating Stars
(Click)
Meds/IV Therapy
1
2
3
4
Administer IM & SQ
Meds
Administer PO Medications
Administer Topical
Medications
Identify Appropriate Level
of Care
Discontinue Peripheral IV's
Pain Assessment/Management
Rating Stars
(Click)
Substance-Related
Disorders:
1
2
3
4
ADHD
Alcohol-Related
Developemntal/Autistic
Disorders
Drug-Related
Mental Retardation
Post Traumatic Stress
Disorder
Sexual Abuse/Assault
Sexual Disorders
Somatoform Disorders (Pain
etc.)
Survivor of Abuse/Violence
Rating Stars
(Click)
Psychotropic Agents:
1
2
3
4
Antianxiety Agents
Anticholinergics/Antiparkinsons
Anticonvulsants
Antidepressants/Mood
Elevators
Antimanic Agents
Antipsychotic Agents
Hypnotics
Management
of Med Side Effects
Recognition of Med Side
Effects
Years of Experience
Continuum of Care Settings Hospital Settings