| Patient Rights | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) | |||||
| Involves the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives. | |||||
| Complies with nursing staff responsibility included in the hospital policy related to Organ Donation. | |||||
| Meets patient and families needs regarding communication, including interpreter services | |||||
| Provides accurate information to patient and families in a timely manner. | 
| Vital Signs and Weights | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| BP, including Orthostatic | |||||
| Pulse, Radial | |||||
| Temperature, Oral | |||||
| Temperature, Rectal | |||||
| Temperature, Axillary | |||||
| Temperature, Tympanic | |||||
| Respirations | |||||
| Weight, Pounds and Kilograms | |||||
| Recognizing Cardiac Arrest | |||||
| Activating Code Team | |||||
| Bringing Emergency Equipment to Room | |||||
| Providing Appropriate Code Support | |||||
| Automatic BP machine (Dynamap) | |||||
| Electronic Thermometer | |||||
| Applying Oximeter | |||||
| Standing | |||||
| Chair | |||||
| Bed | |||||
| Report Abnormal Findings | |||||
| Bowel Function | |||||
| Bladder Function | |||||
| Tap Water | |||||
| Fleets | |||||
| Return Flow | 
| Vital Signs and Weights | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Placing and Removing Bed Pan | |||||
| Clamping Catheter | |||||
| Emptying Foley Bag | |||||
| Placing Condom Catheter | |||||
| Emptying and Replacing Ostomy Bag (Established Ostomy) | 
| Nutrition | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Estimating Intake | |||||
| Setting up for Meals | |||||
| Feeding Patients | |||||
| Aspiration Precautions | |||||
| Nourishments | |||||
| Counting Calories | |||||
| Fluid Restriction | |||||
| NPO | |||||
| Estimating Intake | 
| Specimens | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Collecting Stool | |||||
| Collecting Sputum | |||||
| Labeling Specimens and Preparing for Transport | |||||
| Clean Catch | |||||
| 24 Hour | 
| Hygiene / Skin | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Risk Factors for Skin Breakdown | |||||
| Observing Pressure Points for Redness or Breakdown | |||||
| Bathing (Shower / Tub / Arjo) | |||||
| Oral Care, Including Patients who are NPO, Comatose, Patients with | |||||
| Pen Care | |||||
| Foot Care for Patients with Impaired Circulation or Sensation | |||||
| Incontinence Care | |||||
| Shaving and Precautions | |||||
| Special Beds / Mattresses | |||||
| Heels and Elbow Protection | |||||
| Foot Cradles | |||||
| Use of Shower Chair | |||||
| Use of Bath / Shower Boat | 
| Infection Control | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Reverse Isolation | |||||
| Body Substance Isolation | |||||
| TB Precautions | |||||
| MRSA Precautions | |||||
| Hand Washing | |||||
| Infectious / Hazardous Waste Disposal | |||||
| Supply / Equipment Disposal | |||||
| Use of Disposable Thermometer | |||||
| Use of CPR Mask / Bag | |||||
| Gloves | |||||
| Gown | |||||
| Mask / Goggles | |||||
| Reverse Isolation | 
| Safety and Activity | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Determining Patient ID | |||||
| Identifying Safety Hazards | |||||
| Determining Need for Additional Help | |||||
| Assessing Safety and ADL Needs | |||||
| Recognizing Abuse: Substance, Physical, Emotional, etc. | |||||
| Maintaining Clean, Orderly Work Area | |||||
| Disposing of Sharps | |||||
| Handling Hazardous Materials | |||||
| Proper Body Mechanics | |||||
| OM Exercises | |||||
| Transferring to Bed, WC, Commode, etc. | |||||
| urning and Positioning | |||||
| Patient Safety Module | |||||
| Reporting Broken Equipment | |||||
| Responding to Safety Hazards | |||||
| Use of Hoyer Lift (Dextra / Maxi) | |||||
| Bed Operation | |||||
| Use of Wheel Locks | |||||
| Use of Alarms: Bed, Patient, Unit | |||||
| Use of Call Light | |||||
| Documenting Use of Restraints | |||||
| Use of Transfer Belt | |||||
| Use of Gait Belt for Ambulation | |||||
| Use of Seizure Pads | |||||
| Belt Including Seat Belt | |||||
| Wrist / Ankle Restraints | |||||
| Vest Restraints | 
| Care Routines | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Inventory and Disposition of Belongings, Use of Checklist | |||||
| Room Orientation, Call Bell | |||||
| Transferring into Bed | |||||
| Assist with Turns | |||||
| ROM Exercises | |||||
| Replacing Mask or Nasal Cannula if Needed | |||||
| Notifying Nurse of Problems | |||||
| Basic Comfort Measures | |||||
| Early Bath | |||||
| Preparing Belongings | |||||
| Preparing for and Explaining Routines to Patient | |||||
| Post Mortem Care | |||||
| Use of Incentive Spirometer | |||||
| Antiembolic Stockings | |||||
| Sequential Stockings | 
| Communication | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Using Appropriate Abbreviations | |||||
| Identifying Unusual Patient Incidents that Require Reporting | |||||
| Reinforcing RN Teaching with Patient | |||||
| Selecting and Using Forms Appropriately | |||||
| Using Alternate Communication Tools / Devices | |||||
| Changes in Patient Condition | |||||
| Patient Needs, Complaints, and Concerns | |||||
| Unusual Incidents | |||||
| Vital Signs | |||||
| Bathing / Hygiene | |||||
| Turning and Repositioning | |||||
| Ambulation and Activity | |||||
| Diet Intake, Calorie Count | |||||
| Bowel Movements | |||||
| Shift Volumes and Totals | |||||
| Marking and/or Measuring Urine, Gastric Fluid, NG Drainage, Emesis, Diarrhea | 
| Unit Activity | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Identifying Unusual Incidents on the Unit that Require Reporting | |||||
| Locating and Using Appropriate Reference Materials: Hospital, Patient Care | |||||
| Charging for Patient Care Items | |||||
| Completing Risk Management Reports as Needed | |||||
| Obtaining Needed Supplies and Equipment | |||||
| Reporting and Following up on Faulty Equipment and Supplies | |||||
| Using Telephone System | 
| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | 
|---|---|---|---|---|---|
| Infant (Birth - 1 year) | |||||
| Preschooler (ages 2-5 years) | |||||
| Childhood (ages 6-12 years) | |||||
| Adolescents (ages 13-21 years) | |||||
| Young Adults (ages 22-39 years) | |||||
| Adults (ages 40-64 years) | |||||
| Older Adults (ages 65-79 years) | |||||
| Elderly (ages 80+ years) |