HOME CARE RN SKILLS CHECKLIST

NAME: SIGNATURE: DATE:

By accurately filling out this checklist, you will help us match your skills and interests with available assignments.
Please place an “X” in the column that best describes your experience level with each skill. See the Levels of Proficiency below.
1 – Can function well independently • 2 – Experienced, but may need review • 3 – Limited or no experience

CARDIOVASCULAR SYSTEM NEUROLOGICAL PROBLEMS GENITOURINARY PROBLEMS

Skills (check appropriate box) 1 2 3 Skills (check appropriate box) 1 2 3 Skills (check appropriate box) 1 2 3
Chest tightness/pain Assessment of levels of consciousness Assessment of Renal System
Hypertension/Hypotension Assess sensory-motor functions of extremities Assessment of Genitourinary System
Acute MI Assess Cranial Nerves Care of Patient With
Syncope Seizure Precautions • Cancer of prostate
Arrhythmias Traction • Cancer of female reproductive system
Other/Arteriosclerosis • Cervical • Cancer of the kidneys
Temporary External Pacemaker • Lumbar • Renal failure
Internal Pacemaker Care of Patient With • Cancer of the bladder
Pulse Checks • Seizures • Peritoneal dialysis
Taking EKG Rhythm Strips • Spinal cord injury • Hemodialysis
Administration of Antiarrhythmics: • Head Trauma • Urinary Diversion (i.e. ileal conduit)
• Oral • CVA Insertion of Foley Catheter
• IV • Drug Overdose • Female
• Topical • Neuromuscular Disease • Male
• Patient Teaching (MS, Parkinson’s, myasthenia gravis) Bladder irrigations
Administration of Antihypertensives Administration of Anticonvulsants: • Intermittent
• Oral • Oral • Continuous
• IV • IV • Care of Nephrostomy Tube
• Patient Teaching Administration of Steroids: • Collection of Urine Specimens
• Oral • Interpretation of home urinalysis
RESPIRATORY SYSTEM • IV • A-V Fistula/Shunt Care
Skills (check appropriate box) 1 2 3 • Stryker Frames Administration Diuretics & Patient Teaching:
• Oral
Asthma GASTROINTESTINAL PROBLEMS • IV
COPD
Skills (check appropriate box) 1 2 3 • Blood Glucose Monitoring, Testing,
TB
Patient Teaching
Pleurisy Assessment of GI System
• Bladder Training & Teaching
Emphysema • Inflammatory Bowel Disease
Pneumonia • Malabsorption Syndrome
Lung Cancer • Cancer of the Colon ORTHOPEDIC PROBLEMS
Pulmonary Emboli • Cancer of the Esophagus
Identifying rales/rhonchi/wheezes • Cancer of the Rectum Skills (check appropriate box) 1 2 3
Chest Physiotherapy • Fistulas & Shunts Assessment of Vascular System
Incentive Spirometry • Colostomy, Ileostomy, Jejunostomy, Circulation Checks
Nasotracheal Suctioning gastrostomy Care of Patient With
Oxygen Delivery Devices • Dehiscence • Total Knee Replacement
Ultrasonic Nebulizer • Cirrhosis • Total Hip Replacement
IPPB • Liver Failure • Total Joint Replacement
Care of Patient With • Liver Transplant • Rheumatic/arthritic disease
• Tracheostomy • Insertion & Maintenance of Nasogastric • Amputation of an Extremity
• Chest Tubes tubes (Salem Pump, Levine) • Cast Care
• Ventilator • Administration of tube feedings Traction
• Collection of Sputum Specimens • NG lavage • Skin
Administration of Oxygen • NG gavage • Skeletal
• Face Masks Gastrointestinal tubes (Cantor, etc.) • Range of Motion Exercises
• Nasal Cannula Tubal Irrigations • Use of Assisting Devices
Administration of Bronchodilators Bowel Preparations & Cleansing Enemas (Canes, Walkers, Wheelchairs, etc.)
• Oral Removal of Fecal Impaction • Care of Prosthetic/Orthopedic
• IV Bowel Training & Teaching Devices/Patient Teching
• Aerosols Administration of medication via
• Use of Ambu Bag nasogastric tube
• Inserting Oral Airways Wound Care & Dressing Changes
Revised 04/2014 Amazing Hearts Homecare and Staffing LLC. www.amazingheartshas.com
 HOME CARE RN SKILLS CHECKLIST
PAGE 2
INSTRUCTIONS
Put an “X” in the column that best describes your experience level with each skill
1 – Can function well independently • 2 – Experienced, may need review • 3 – Limited or no experienc

WOUND & SKIN PROBLEMS IV ADMINISTRATION SPECIAL PATIENT CONSIDERATIONS

Skills (check appropriate box) 1 2 3 Skills (check appropriate box) 1 2 3 Skills (check appropriate box) 1 2 3
Assessment of Integumentary System Antineoplastic Drugs (chemotherapy) Patient with a Terminal Illness
Dressing Changes Antibiotics Patient with AIDS
Care of Patient With Lipids Anaphylactic Shock
• Open Draining Sores TPN Cardiac Arrest
• Decubitus Ulcers Blood & Blood Products Respiratory Arrest
• Leg Ulcers Heparin Flushes Pain Management
• Burns Pain Control Medication via Cardiopulmonary Resuscitation
• Irrigation of Wounds continuous infusions (narcotics) Documentation of:
• Wound Care IV Push Medications • Skilled Nursing Care
• Wound Debridement • Patient-Family Teaching
• Patient Teaching of Wound Care COLLECTION OF SPECIMENS • Initial Home Assessments
• Universal Safety Precautions Documentation Using:
Skills (check appropriate box) 1 2 3 • Medicare 485/486 forms
HOME IV THERAPY Sputum • Other:
Stool • Other:
Skills (check appropriate box) 1 2 3 Urine Diabetes Teaching & Care
Starting Peripheral IVs Venipuncture for lab work Skin, Foot & Nail Care
Steel Needles (scalp vein, wing tipped) Insulin Administration & Teaching
Over the Needle Plastic Cannulas ADMINISTRATION OF MEDICATIONS Post Cataract Care
Heparin Locks Assessment of Home Environment
Maintain & Discontinuing IV Therapy Skills (check appropriate box) 1 2 3 Care of Patients with Alzheimer’s or
Care/Maintenance of Central Venous Catheters Oral other forms of dementia
• Hickman Catheter IM
• Boviac Catheter SQ
• Quinton Catheter IV
• Groshong Catheter IVP
• IV Dressing Site Changes Intradermal
• Implantable Venous Access Devices Ear Drops
• IV Infusion Controllers/Pumps Eye Drops
• Volumetric Controllers/Pumps Topical
• Nonvolumetric Controllers/Pumps
• Prepare and Mix IV
• Calculate & Regulate IVs

Other Skills:

Experience
Intermittent Home Health Care Experience: ____ years Experience with Medicare-certifed agency Yes No
Private Duty Home Care Experience: ____ years IV Therapy Certified Yes No
Experience with Adults ____ years Venipuncture Certified Yes No
Experience with Peds ____ years Chemotherapy Certified Yes No
Experience with Infants ____ years
I certify that all information provided herein is true and correct to the best of my knowledge.

NAME: SIGNATURE: DATE:

RN Supervisor: SIGNATURE: DATE:

Revised 04/2014 Amazing Hearts Homecare and Staffing LLC. www.amazingheartshas.com