Home Health Rn Skills Checklist

Proficiency Scale & Legend

1 Theory Only/No Experience - Didactic instruction only, no hands-on experience.

2 Limited Experience - Knows procedure/has used equipment but has done so infrequently or not within the last six months.

3 Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.

4 Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.

Cardiovascular

1

2

3

4

Pulmonary

1

2

3

4

Neurological

1

2

3

4

Orthopedics

1

2

3

4

Gastrointestinal

1

2

3

4

Renal/genitourinary

1

2

3

4

Endocrine/metabolic

1

2

3

4

Wound/skin Care

1

2

3

4

Oncology

1

2

3

4

Infectious Disease

1

2

3

4

Infectious/Contagious/Communicable Disease

Isolation Precautions

Phlebotomy/iv Therapy

1

2

3

4

Psychiatric

1

2

3

4

Women\'s Health/maternal-infant Care:

1

2

3

4

Pediatrics

1

2

3

4

Pain Management

1

2

3

4

Palliative And End Of Life Care

1

2

3

4

Medications

1

2

3

4

Home Health

1

2

3

4

Professional Knowledge And Skills

1

2

3

4

Age Specific:

1

2

3

4

Please indicate the frequency with which you provide care for each age group:

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.

Personal Information