Nurse Connection...
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Nurse Connection of Wyoming, Inc.
Certified Nurse's Assistant Checklist

Please rate your skills and experience using the following criteria

1=NO EXPERIENCE Never Performed this task

2= LIMITED EXPERIENCE Performed this task infrequently and need practice

3= MODERATE EXPERIENCE Performed this task several times but need a resource person for comfort

4=EXPERIENCED AND COMPETENT Performed this task frequently and proficiently

5= EXPERIENCED AND COULD TRAIN Proficient at performing this task and could train another nurse


Based on the above criteria, please circle the corresponding number that applies
AMBULATING BOWEL & BLADDER (ELIMINATION)

Cane  1 2 3 4 5   Bed Pan/Urinal & Fracture Pan  1 2 3 4 5

Walker 1 2 3 4 5  Bedside Commode  1 2 3 4 5

Standby Assistant  1 2 3 4 5   Measure & Record Output  1 2 3 4 5

Foley Catheter Care  1 2 3 4 5

PERSONAL CARE

External Catheter Care  1 2 3 4 5

Bath--Bed   1 2 3 4 5   Enemas: Tap, H20, Fleet  1 2 3 4 5

Bath--Tub   1 2 3 4 5   Soap Suds   1 2 3 4 5

Bath--Shower   1 2 3 4 5

Skin Care--Back Rub, Applying 

TRANSFER TECHNIQUES

Lotion, Decubitus Care 1 2 3 4 5   Gait Belt   1 2 3 4 5

Shampoo   1 2 3 4 5    Weigh Bearing  1 2 3 4 5

Nail Care   1 2 3 4 5   Hoyer   1 2 3 4 5

Oral Hygiene   1 2 3 4 5    2-Person Transfer  1 2 3 4 5

Shaving: Safety/Electric Razor   1 2 3 4 5    Slide Board   1 2 3 4 5

Dressing--Assisting   1 2 3 4 5    Wheelchair   1 2 3 4 5

Dressing--Complete   1 2 3 4 5

Perineal Care--Male   1 2 3 4 5 

POSITIONING/TURNING

Perineal Care--Female   1 2 3 4 5    Supine  1 2 3 4 5

Side Lying   1 2 3 4 5

ENVIRONMENT

Use of Draw Sheet  1 2 3 4 5

Linen Change--Unoccupied Bed   1 2 3 4 5    Range of Motion Exercises   1 2 3 4 5

Linen Change--Occupied Bed   1 2 3 4 5    In Chair  1 2 3 4 5

Light Housekeeping  1 2 3 4 5

Meal/Snack Preparation   1 2 3 4 5


 TAKE & RECORD VITAL SIGNS

Temperature--Axillary   1 2 3 4 5

NUTRITION/HYDRATION

Temperature--Oral   1 2 3 4 5

Encourage Fluids   1 2 3 4 5    Temperature--Rectal   1 2 3 4 5

Assist in Feeding   1 2 3 4 5    Pulse--Radical 1 2 3 4 5

Feeding Techniques   1 2 3 4 5   Pulse--Apical   1 2 3 4 5

Measure & Record Input & Output  1 2 3 4 5    Pulse--Brachial  1 2 3 4 5

Respirations   1 2 3 4 5

INFECTION CONTROL

Blood Pressure   1 2 3 4 5

Handwashing  1 2 3 4 5    Height & Weight 1 2 3 4 5

Universal Precautions  1 2 3 4 5

COMMUNICATIONS OXYGEN THERAPY

Verbal & Non-Verbal with Flow Rate 1 2 3 4 5   

Cognatively Impaired Pts  1 2 3 4 5    Water to Humidifier  1 2 3 4 5

Cannula/Mask Placement   1 2 3 4 5

SPECIMEN COLLECTIONS MEDICATION REMINDERS

Urine   1 2 3 4 5    Verbal Prompts  1 2 3 4 5

Stool   1 2 3 4 5    Inquire if Med has been taken   1 2 3 4 5

Sputum  1 2 3 4 5

OBSERVATIONS/REPORTING/DOCUMENTATION SAFETY DEVICES

Change in Body Functions   1 2 3 4 5    Vest Restraint  1 2 3 4 5

Change in Behavior   1 2 3 4 5    Soft Ankle Restraints 1 2 3 4 5

Change in Routines   1 2 3 4 5    Wrist Restraints  1 2 3 4 5

Padded Side Rails  1 2 3 4 5

 

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