Long Term Care RN

Long-Term Care RN

Name*
Full Name
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale:
No Experience
Theory or observation only during the past 12 months

Limited Experience
Performed less than 12 times within the past 12 months and may need a review

Experienced
Performed at least once per month within the past 12 months and may need minimal assistance

Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient

Cardiovascular

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - Ausculation (rate, thythm)
Assessment - Blood pressure/non-invasive
Assessment - Doppler
Assessment - Heart sounds/murmurs
Assessment - Pulses/circulation
Care of patient - Congestive Heart Failure
Care of patient - Hypertension
Medications - Oral and topical nitrates
Medications - Oral anticoagulants
Monitoring - Arrhythmia interpretation

Pulmonary

	No Experience	Limited Experience	Experienced	Highly Skilled
Airway Management - Nasal/suctioning
Airway Management - Tracheostomy/suctioning
Assessment - Breath sounds
Assessment - Rate and work of breathing
Care of patient - COPD
Care of patient - Pneumonia
Oxygen therapy and medication delivery via Bag and mask
Oxygen therapy and medication delivery via External CPAP
Oxygen therapy and medication delivery via Portable O2 Tank
Oxygen therapy and medication delivery via Trach collar
Perform - Chest physiotherapy
Perform- Obtain sputum specimen
Teach and understand Incentive spirometry

Neurological

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - Level of consiousness
Assist with lumbar puncture
Care of patient - CVA
Care of patient - Neuromuscular disease
Care of patient - Seizures
Care of patient - Spinal cord injury
Medications - Anticonvulsants

Gastrointestinal

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - Abdominal/bowl sounds
Assessment - Fluid balance
Assessment - Nutrition
Care of patient - Colostomy
Equipment - Feeding Pump
Equipment - Flexible feeding tube (e.g. Corpak)
Interpret - Blood chemistry
Perform - Administer tube feeding

Renal/Genitourinary

	No Experience	Limited Experience	Experienced	Highly skilled
Assessment - A-V Fistula
Assessment - Fluid and electrolyte balance
Care of patient - Supra-pubic catheter
Care of patient- Urinary tract infection
Interpret - BUN and Creatinine
Interpret - Serum electrolytes
Perform - Insert and care for Foley
Perform - Urine specimen collection (routine)

Endocrine/Metabolic

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - S/S diabetic coma
Assessment - S/S insulin reaction
Care of patient - Diabetes mellitus
Medications - Insulin
Perform - Blood glucose monitoring : Finger stick

Orthopedics

	No Experience	Limited Experience	Experienced	Highly skilled
Assessment - Circulation checks
Assessment - Gait
Assessment - Range of motion
Assessment - Skin
Care of patient - Amputation
Care of patient - Cast
Care of patient - Pinned fractures
Care of patient - Total hip replacement
Equipment - Continuous Passive Motion (CPM)
Equipment - Support Device - Cervical collar
Equipment - Support Device - Gait belt
Equipment - Support Device - Traction

Wound Management

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - Skin for impending breakdown
Assessment - Statis ulcers
Assessment - Surgical wound healing
Care of patient - Staged decubitis ulcers
Care of patient - Surgical wounds with drain(s)
Equipment - Air fluidized, low air loss beds
Perform - Sterile dressing change
Perform - Wound care/irrigation

Pain Management

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - Pain level/tolerance
Care of patient - Peripheral line/dressing
Care of patient - IV Conscious Sedation
Care of patient - Patient Controlled Analgesia (PCA)
Perform - Non-Pharmalogic Pain Management

Phlebotomy/IV Therapy
No Experience Limited Experience Experienced Highly Skilled
Care of patient - Portacath
Perform - Draw blood from central line
Perform - Draw venous blood
Perform - Start IV (heparin lock)
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