Licensed Practical Nurse
Skills Checklist
Name
Email
Total years of LPN Nursing Experience:
Has knowledge of and can provide care and assist patients with the following tasks:
Please indicate your level of experience by checking 1 box in each of the category below---(1-Less experience ----> 4-More experience):
1. Theory, or only prior observation
2. Less than one-year current experience or any previous experience
3. One- Two years current experience or need minimal assistance
4. Two plus years experience of functions independently.
A. GENERAL NURSING:
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2
3
4
1. Admit and Orient Patients
2. Discharge Patients
3. Vital Sign Monitoring
4. Pulse Oximetry
5. Urine Dipstics
6. Blood Glucose Monitoring
7. Wound Care
8. Dressing Changes
9. Positioning/Transferring
10. Pre-Operative Care/Preparation
11. Post Anesthesia Care:
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a) General
1
2
3
4
b) Block
1
2
3
4
c) Spinal
1
2
3
4
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1
2
3
4
12. Restraints- Apply/Monitor
1
2
3
4
13. Isolation Techniques
1
2
3
4
14. Advance Directives
1
2
3
4
15. Postmortem Care
1
2
3
4
16. Assist/Perform Bathing
1
2
3
4
17. Complete Bed Bath/Total Assist
1
2
3
4
18. Assist with Toileting Activities
1
2
3
4
19. Assist with Oral Hygiene
1
2
3
4
20. Documentation
1
2
3
4
21. Reporting to Supervisor
1
2
3
4
B. CARDIAC CARE
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1. Use of Cardiac Monitors
1
2
3
4
2. Telemetry
1
2
3
4
3. Perform 12- lead EKG
1
2
3
4
4. Assist with Code
1
2
3
4
5. Assist Care of Patient with:
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3
4
a) Acute MI
1
2
3
4
b) Congestive Heart Failure
1
2
3
4
c) Pre/Post Cardiac Surgery
1
2
3
4
d) Aneurysm
1
2
3
4
e) Permanent/Temporary Pacemaker
1
2
3
4
C. ORTHOPEDIC
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1. Crutch Walking
1
2
3
4
2. Cast Care
1
2
3
4
3. Traction
1
2
3
4
4. Assist Care of Patient With:
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4
i) Amputation
1
2
3
4
ii) Skeletal Traction
1
2
3
4
iii) Arthroscopy/Arthrotomy
1
2
3
4
iv) Total Hip Replacement
1
2
3
4
v) Total Knee Replacement
1
2
3
4
D. VASCULAR
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1. Apply Noninvasive BP Monitor
1
2
3
4
2. Monitor non invasive BP Monitor
1
2
3
4
3. Draw Blood for Lab Studies
1
2
3
4
4. Discontinue Peripherals IVs
1
2
3
4
5. Intake and Output
1
2
3
4
6. Peripheral Pulses
1
2
3
4
7. Ultrasonic Doppler
1
2
3
4
8. Apply Antiembolism Stockings
1
2
3
4
E. RESPIRATORY
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1. Open/Monitor Airwaay
1
2
3
4
2. Assist with intubation (ETT)
1
2
3
4
3. O2 Saturation Spot Checks
1
2
3
4
4. O2 Saturation Monitors
1
2
3
4
5. Incentive Spirometry
1
2
3
4
6. Nasal Cannula
1
2
3
4
7. Face Masks
1
2
3
4
8. Assist Care of Patient With:
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2
3
4
a) Asthma/COPD
1
2
3
4
b) Pre/Post Thoracic Surgery
1
2
3
4
c) Tracheostomy
1
2
3
4
d) Chest Tubes
1
2
3
4
F. NEUROLOGY:
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1. Neurological Evaluation
1
2
3
4
2. Glasscow Coma Scale
1
2
3
4
3. Assist with Lumbar Puncture
1
2
3
4
4. Seizure Precautions
1
2
3
4
5. Assist Care of Patient With:
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2
3
4
a. Open/Closed Head Injury
1
2
3
4
b. CVA
1
2
3
4
c. Spinal cord Injury
1
2
3
4
d. Craniotomy
1
2
3
4
e. Drug Overdose/DTs
1
2
3
4
G. GASTROINTESTINAL:
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4
1. Assist with Nutritional Evaluation
1
2
3
4
2. Assist with Feedings
1
2
3
4
3. Monitor NG Tube
1
2
3
4
4. Gastotomy Tube Monitor/Feed
1
2
3
4
5. Ostomy Care
1
2
3
4
6. Assist Care of Patient With:
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3
4
a. GI Bleed
1
2
3
4
b. Abdominal Wounds
1
2
3
4
c. Drains
1
2
3
4
H. MED/IV THERAPY:
IV Certified ?
Yes
No
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4
1. Administer PO Medications
1
2
3
4
2. Administer NG/GT Medications
1
2
3
4
3. Administer IM/SQ Medications
1
2
3
4
4. Use of Heparin/Saline locks
1
2
3
4
5. Needless Systems
1
2
3
4
6. Pain Assessment/Pain Scale
1
2
3
4
7. Peripheral IV Insertion
1
2
3
4
8. Mix IV infusion with Additives
1
2
3
4
9. Administer IV Medications
1
2
3
4
10. Infusion Pumps
1
2
3
4
11. Discontinue Peripheral IV's
1
2
3
4
I. GENITOURINAL
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1. Straight/Foley Cath Female
1
2
3
4
2. Straight/Foley Cath Male
1
2
3
4
3. Obtain/Instruct Clean Catch Urine
1
2
3
4
4. Assist Care of Patient With:
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3
4
a. Shunts & Fistula
1
2
3
4
b. Renal Failure
1
2
3
4
c. Nephrectomy
1
2
3
4
d. Renal Transplant
1
2
3
4
e. Mastectomy
1
2
3
4
f. Hysterectomy
1
2
3
4
g. Prostate Surgery
1
2
3
4
J. OTHER:
1. Assist Care of Patient With:
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a. Diabetes
1
2
3
4
b. AIDS
1
2
3
4
c. Multiple Trauma
1
2
3
4
d. Burns
1
2
3
4
e. Oncology
1
2
3
4
f. Bone Marrow Transplant
1
2
3
4
g. Liver Trasnplant
1
2
3
4
K. AGE SPECIFIC PRACTICE CRITERIA
1. Able to adapt care to incorporate normal growth and development 2.Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level. 3. Can ensure a safe environment reflecting specific needs of various age groups.
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A. Newborn/Neonate (birth- 30 days)
1
2
3
4
B. Infant (30 days- 1 year)
1
2
3
4
C. Toddler (1-3 years)
1
2
3
4
D. Preschooler (3-5 Years)
1
2
3
4
E. School age children (5-12 years)
1
2
3
4
F. Adolescent (12-18 years)
1
2
3
4
G. Young adults (18-39 years)
1
2
3
4
H. Middle adults (39-64 years)
1
2
3
4
I. Older adults (64+ years)
1
2
3
4
Are you familiar with computer charting ?
Yes
No
If Yes , what systems have you used:
Do you speak any other languages other than English?
Yes
No
If yes, what language/s?
I hereby certify that the information I have provided on this skills checklist is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.I hereby authorize Urgent Medical Staffing Solutions to release this checklist to facilities in relation to consideration of my employment.
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