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Home Health RN

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.

  • 0 = Not Applicable
  • 1 = No Experience
  • 2 = Some Experience
  • 3 = Intermittent Experience
  • 4 = Experienced
  • 5 = Very Experienced
*Required
n/a
1
2
3
4
5

* Required

Age

Newborn (birth-30 days)*

Infant (30 days - 1 year)*

Toddler (1 - 3 years)*

Preschooler (3 - 5 years)*

School Age (5 - 12 years)*

Adolescents (12 - 18 years)*

Young Adults (18 - 39 years)*

Middle Adults (39 - 64 years)*

Older Adults (64+ years)*

General Skills

Standard Precautions*

Isolation Precautions*

Pediatric Respiratory/Cardiac Arrest*

Adult Respiratory/Cardiac Arrest*

Care Planning & Discharge Planning*

Patient/Family Education*

Pain Management*

Patient Head to Toe Assessment*

Electronic Documentation*

Cardiovascular

Assessment:

Angina*

Apical Pulse Rate/Rhythm*

Cardiac Auscultation (Rate, Rhythm)*

Clinical Identification of Arrhythmias*

Fluid Overload*

Peripheral Pulses/Circulation Checks*

Interpretation of Lab Results:

PT/PTT/INR*

Serum Electrolytes*

Equipment & Procedures:

Holter Monitor*

Pacemaker/AID*

Care of Patient With:

Hypotension*

CAD/Post Myocardial Infarction (MI)*

Congestive Heart Failure (CHF)*

Fluid Retention*

Hypertension*

Pre/Post Cardiac Surgery*

Pre/Post Vascular Surgery*

Pulmonary

Assessment:

Auscultation of Lung Sounds/Rate & Work of Breathing*

Pulse Oximetry*

ABGs*

Equipment & Procedures:

Administration of O2 via Nasal Cannula*

Apnea Monitor*

Chest Percussion*

Incentive Spirometry*

Orotracheal and Nasotracheal Suctioning*

Sputum Specimen Collection*

Nebulizer*

CPAP*

BiPAP*

Ventilator Management*

Care of Patient With:

Asthma*

Chronic Obstructive Pulmonary Disease (COPD)*

Lung Cancer*

Primary Pulmonary Hypertension*

Pulmonary Fibrosis*

Pulmonary Emboli*

Neurological

Assessment:

Neurological Signs/Level of Consciousness (LOC)*

Neuro-Motor/Sensory Functions*

Equipment & Procedures:

Seizure Precautions*

Traction*

Care of Patient With:

Alzheimer’s Disease*

Dementia*

Degenerative Neurological Disorders (ALS, MS, etc.)*

Cerebral Tumors*

Post-Cerebrovascular Accident*

Guillain-Barre Syndrome*

Hemiparesis*

Meningitis*

Parkinson’s Disease*

Seizure Disorders*

Paraplegia/Quadriplegia*

Traumatic Brain Injury (TBI)*

Stroke*

Orthopedics

Assessment:

Incision Checks*

Circulation/Skin Checks*

Gait*

Range of Motion*

Equipment & Procedures:

Range of Motion (Active & Passive)*

Cast/Brace*

Crutch/Walking*

Assistive Devices*

TENS Units*

Wheelchairs*

Lift Equipment*

Total Hip/Knee/Joint Replacement*

Gastrointestinal

Assessment:

Bowel Habits*

Fluid Balance*

Nutritional Status*

Equipment & Procedures:

Colostomy/Ileostomy Care*

Long-Term Feeding Tube*

Nasogastric (NG) Tube*

PEG/Gastronomy Tube*

Drainage Devices/Tubes*

Tube Feeding*

Feeding Pumps*

Care of Patient With:

Bowel Obstruction*

Fecal Incontinence*

Gastrointestinal Bleeding (G.I. Bleed)*

Post-Gastrointestinal Surgery*

Hepatitis*

Inflammatory Bowel Disease*

Liver Failure/Transplant*

Renal/Genitourinary

Assessment:

Arterio-Venous Fistula/Shunt*

Fluid Balance*

Interpretation of Lab Results:

Blood Urea Nitrogen (BUN)*

Serum Creatinine*

Serum Electrolytes*

Equipment & Procedures:

3-Way Bladder Catheter*

Foley Catheter Insertion/Maintenance*

Straight Catheterization*

Self-Catheterization*

Ileostomy*

Irrigations*

Nephrostomy Tube*

Suprapubic Catheter*

Care of Patient With:

Hemodialysis (Receiving in an Out Pt. Clinic Setting)*

Home Hemodialysis*

Peritoneal Dialysis*

End stage Renal Disease*

Acute Renal Failure*

Shunts and Fistulas*

Urinary Incontinence*

Endocrine/Metabolic

Assessment:

Diabetic Skin Assessment*

Hyperglycemia*

Hypoglycemia*

Interpretation of Lab Results:

Hemoglobin A1C*

Serum Glucose*

Equipment & Procedures:

Glucometers*

Insulin Pumps*

Care of Patient With:

Diabetes*

Post-Transplantation Surgery*

Wound/Skin Care Management

Assessment:

Wound Assessment Scale*

Skin Assessment*

Surgical Wound Healing*

Skin Grafts*

Pressure Ulcer Staging/Management*

Evaluate Factors that Impede Healing*

Equipment & Procedures:

Burns*

Care of Pressure Ulcers*

Dry and Wet to Dry Dressing Changes*

Positioning of Patients*

Specialty Beds*

Special Mattresses and Positioning Devices*

Wound Care (Sterile)*

Wound Cultures*

Wound Irrigations*

Wound Vac*

Care of Patient With:

Burns*

Pressure Ulcers*

Surgical Wounds*

Skin Grafts*

Oncology

Assessment:

Immune Status*

Symptom Management*

Signs/Symptoms of Infection*

Interpretation of Lab Results:

CBC with Differential*

CMP*

Equipment & Procedures:

Reverse Isolation*

Drawing Blood Cultures*

Care of Patient With:

Radiation Therapy*

Leukemia/Lymphoma*

Post-Oncology Surgery*

Infectious Disease

Assessment:

Signs/Symptoms of Infection*

Interpretation of Lab Results:

Blood Counts*

Culture and Sensitivity*

Equipment & Procedures:

Isolation Precautions*

Care of Patient With:

C. Diff*

HIV Infection*

Tuberculosis*

MRSA*

VRE*

Psychiatry

Assessment:

Monitoring Symptoms*

Compliance with Medications*

Care of Patient With:

Cognitive Disorders*

Schizophrenia/Psychotic Disorders*

Substance-Related Disorders*

Mood Disorders (Anxiety/Depression, etc)*

Miscellaneous

APS/ CPS Reporting*

Fall Assessment and Prevention*

National Patient Safety Goals*

Safety Assessment*

Recognizing Failure to Thrive Across the Lifespan*

Advanced Directives*

Discharge Planning*

Discharge Screens - Specific Indicators of Patient's Ability*

SIMS-InterQual-Criteria for SSO Waiver*

Milliman and Robertson Criteria*

Patient and Family Education*

Pain Assessment*

Case Management

Experience as a Case Manager*

Telephone Assessments/Triage/Case Management*

Catastrophic Case Management*

MCM-Medical Case Management*

Intensity of Service-Diagnosis and Therapeutic Services*

Complete and Submit All Billing*

Identify and Provide Emergency Crisis Services as Necessary*

Diagnosis Related Grouping*

Appropriateness of Care – Patient’s Ability*

ICD 10*

CPT*

Prior Authorization*

Job Related Computer Skills*

Ensure Outcomes Met in Length of Stay*

Document All Client Encounters*

Knowledge of Community Health Care and Vocational Services*

Ability to Assess, Plan, Implement, and Evaluate Individual Patient Care Programs and Treatment Plans*

Experience With

Long-term/Short-term Disability*

Management of Complaints*

Medicare/Medicaid*

Pre-certifications*

Private Insurance*

Telephone Assessments*

Utilization Review*

Workman’s Compensation*

Documentation

Diagnosis Coding (ICD Coding)*

Document Plan of Care (Form 485)*

OASIS Documentation*

Infusion Therapy

Insertion of:

Peripheral IV - Adult*

Peripheral IV - Child*

Care and Maintenance:

Peripheral IV*

Heparin/Saline Lock*

Hickman/Broviac*

Port-a-Cath*

Multilumen Catheters*

Power PICC*

Power Port*

Dressing Changes*

Cap Changes*

Flushing Lines (Frequency/Solution)*

Vascular Access Devices*

Adverse Reactions*

Medication Knowledge and Use Of:

IV Fluids*

TPN/Lipids*

Chemotherapy*

Inhalation Medication*

IM and SQ Medications*

Pain and Controlled Analgesia*

Insulin Administration*

PCA Pump*

Discontinuing IV Therapy:

Peripheral IV*

PICC/Midline*

Certifications

NAHC

Other Skills
Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

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