LPN/LVN - Ambulatory Care Skills Checklist

LPN/LVN - Ambulatory Care All the fields are mandatory

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Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency : -	1 = Never Performed	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always

General Assessment Proficiency Frequency

Respiratory

1

2

3

4

1

2

3

4

Gastrointestinal

1

2

3

4

1

2

3

4

Cardiovascular

1

2

3

4

1

2

3

4

Endocrine

1

2

3

4

1

2

3

4

Neurological

1

2

3

4

1

2

3

4

Integumentary

1

2

3

4

1

2

3

4

Reproductive

1

2

3

4

1

2

3

4

PO/Sublingual

1

2

3

4

1

2

3

4

IM/Z-track injections

1

2

3

4

1

2

3

4

SQ injections

1

2

3

4

1

2

3

4

Intradermal injections

1

2

3

4

1

2

3

4

Opthalmic drops/ointments

1

2

3

4

1

2

3

4

Rectal/Vaginal suppositories

1

2

3

4

1

2

3

4

Nasal drops/sprays

1

2

3

4

1

2

3

4

Topical ointments/sprays

1

2

3

4

1

2

3

4

Immunizations/vaccinations

1

2

3

4

1

2

3

4

Turning and Repositioning

1

2

3

4

1

2

3

4

Transfer patient to/from exam table

1

2

3

4

1

2

3

4

Transfer patient to/from wheelchair

1

2

3

4

1

2

3

4

Assit with ambulation

1

2

3

4

1

2

3

4

Assist and transfer to/from toilet

1

2

3

4

1

2

3

4

Lift patient with/without assistance

1

2

3

4

1

2

3

4

Transfer patient to/from stretcher

1

2

3

4

1

2

3

4

Hoyer lift

1

2

3

4

1

2

3

4

Glucose monitor (point-of-care)

1

2

3

4

1

2

3

4

Wall suction

1

2

3

4

1

2

3

4

Oxygen set up (nasal cannula, mask, nonrebreather, etc.)

1

2

3

4

1

2

3

4

Heating pads

1

2

3

4

1

2

3

4

Chest tube drainage system

1

2

3

4

1

2

3

4

Indwelling urinary catheter

1

2

3

4

1

2

3

4

Feeding pump (enteral)

1

2

3

4

1

2

3

4

IV pump/infusion device

1

2

3

4

1

2

3

4

Incentive spirometer

1

2

3

4

1

2

3

4

TED hose (application)

1

2

3

4

1

2

3

4

Scale

1

2

3

4

1

2

3

4

Slit lamp

1

2

3

4

1

2

3

4

Exam Table

1

2

3

4

1

2

3

4

Personal protective equipment (PPE)

1

2

3

4

1

2

3

4

Crash cart/defibrillator

1

2

3

4

1

2

3

4

AED

1

2

3

4

1

2

3

4

Thermometer

1

2

3

4

1

2

3

4

Blood pressure cuff (manual, electronic)

1

2

3

4

1

2

3

4

Pulse oximetry

1

2

3

4

1

2

3

4

Surgical drain devices

1

2

3

4

1

2

3

4

Wound Vac

1

2

3

4

1

2

3

4

Doppler

1

2

3

4

1

2

3

4

Bladder scanner

1

2

3

4

1

2

3

4

TENS unit

1

2

3

4

1

2

3

4

EKG

1

2

3

4

1

2

3

4

Greet/admit patients to ambulatory setting

1

2

3

4

1

2

3

4

Triage

1

2

3

4

1

2

3

4

Initial assessment, including vital signs and pain

1

2

3

4

1

2

3

4

Check-in process

1

2

3

4

1

2

3

4

Check-out process

1

2

3

4

1

2

3

4

Creation of nursing care plan

1

2

3

4

1

2

3

4

Documentation of care

1

2

3

4

1

2

3

4

Documentation of assessment findings

1

2

3

4

1

2

3

4

Documentation of diagnostic tests/results

1

2

3

4

1

2

3

4

Initiate order/order sets

1

2

3

4

1

2

3

4

Review orders/chart checks

1

2

3

4

1

2

3

4

Verbal and telephone and read-back process

1

2

3

4

1

2

3

4

Prescription refills

1

2

3

4

1

2

3

4

Patient education- Medications

1

2

3

4

1

2

3

4

Patient education- Disease process

1

2

3

4

1

2

3

4

Patient education- Followup and community resources

1

2

3

4

1

2

3

4

Patient identification/identifiers

1

2

3

4

1

2

3

4

Hand-off communication

1

2

3

4

1

2

3

4

SBAR

1

2

3

4

1

2

3

4

Team huddles

1

2

3

4

1

2

3

4

Electronic medication administration record (MAR)

1

2

3

4

1

2

3

4

Electronic medical record (EMR)

1

2

3

4

1

2

3

4

Notify provider of critical lab values

1

2

3

4

1

2

3

4

Transfer of patient to hospital

1

2

3

4

1

2

3

4

HIPAA/Protected health information

1

2

3

4

1

2

3

4

Blood

1

2

3

4

1

2

3

4

Urine- Clean catch

1

2

3

4

1

2

3

4

Urine- Straight cath

1

2

3

4

1

2

3

4

Urine- Analysis/dipstick

1

2

3

4

1

2

3

4

Stool

1

2

3

4

1

2

3

4

Sputum

1

2

3

4

1

2

3

4

Labeling of specimens

1

2

3

4

1

2

3

4

Transporting of specimens

1

2

3

4

1

2

3

4

Following chain of command

1

2

3

4

1

2

3

4

BLS protocol

1

2

3

4

1

2

3

4

Safe handling of hazardous medications

1

2

3

4

1

2

3

4

Medication exchange with pharmacy

1

2

3

4

1

2

3

4

Waste of controlled substances

1

2

3

4

1

2

3

4

Indications for 911

1

2

3

4

1

2

3

4

Fire response

1

2

3

4

1

2

3

4

Tornado response

1

2

3

4

1

2

3

4

Disruptive patient/family

1

2

3

4

1

2

3

4

De-escalation techniques

1

2

3

4

1

2

3

4

Infant abduction

1

2

3

4

1

2

3

4

Institution of communicable disease precautions (contact, droplet, airborne)

1

2

3

4

1

2

3

4

Rapid response

1

2

3

4

1

2

3

4

Code Blue / cardiopulmonary arrest

1

2

3

4

1

2

3

4

Advance directives

1

2

3

4

1

2

3

4

DNR orders

1

2

3

4

1

2

3

4

Delegation to unlicensed assistive personnel

1

2

3

4

1

2

3

4

Scope of practice

1

2

3

4

1

2

3

4

Universal time-out procedure

1

2

3

4

1

2

3

4

Use of communication boards

1

2

3

4

1

2

3

4

Culturally diverse care considerations

1

2

3

4

1

2

3

4

Evidence-based practice principles

1

2

3

4

1

2

3

4

Infant (Birth to 1year)

1

2

3

4

1

2

3

4

Toddler (1-3 years)

1

2

3

4

1

2

3

4

Pre-school (3-6 years)

1

2

3

4

1

2

3

4

School Age (6-12 years)

1

2

3

4

1

2

3

4

Adolescent (12-18 years)

1

2

3

4

1

2

3

4

Young Adult (18-30 years)

1

2

3

4

1

2

3

4

Mature Adult (30-60 years)

1

2

3

4

1

2

3

4

Elderly (>60 years)

1

2

3

4

1

2

3

4

Years Experience in Clinical Specialty :

Most recent facility worked at :

I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.