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Hospice 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 of Patients Cared For

Newborn/Neonate (birth to 30 days)*

Infant (1 month to 1 year)*

Toddler (1 year to 3 years)*

Preschooler (3 years to 5 years)*

School Age Child (5 years to 12 years)*

Adolescents (12 years to 18 years)*

Young Adults (18 years to 39 years)*

Middle Adults (39 years to 64 years)*

Older Adults (64 years to 79 years)*

Elderly Adults (over 79+ years)*

Work Setting

Home Hospice*

Inpatient Hospice*

Pediatric Hospice*

Home Health/Hospice Setting*

Assessment

Intake Assessment*

Assessment Interview*

Physical Exam*

Coping Status*

Environmental Status*

Plan of Care

Set Goals with Patient/Family*

Collaborate with Other Team Members*

Collaborate with Other Team Members*

Symptom Management

Urgent Assessment of Symptoms*

Reduce Symptoms to Level Acceptable to Patient*

Report Symptoms/Management to Provider*

Treat Underlying Cause*

Severity Scale*

Management of Nausea*

Management of Constipation*

Management of Fatigue*

Anorexia/Cachexia*

Restlessness*

Educate Family of Symptom Management*

Pain Management

Identify Source of Pain*

Pain Severity*

PAINAD Scale for Non-verbal Patient*

Reduce Pain to Level Acceptable to Patient*

WHO 3-Step Ladder*

Non-Pharmacological Management of Pain*

Pharmacological Management of Pain*

Effects of Pharmacological Treatment*

Nociceptive/Neuropathic/Mixed Pain*

Management of Nociceptive Pain*

Management of Neuropathic Pain*

Educate Family on Pain Management*

Wound Care

Positioning Techniques*

Bed/Support Surface Selection*

Pressure Ulcer Staging/Management*

Response to Treatment*

Evaluate Factors that Impede Healing*

Educate Family on Positioning/Shearing*

Medication Administration

Equianalgesic Conversion Formula*

Titration of Opioids*

IV Pump Management*

Evaluate Effectiveness of Medications*

Family Management of Medications*

Disposal of Medications*

After Death

Family/Cultural Rituals/Rites*

Patient Care after Death*

Coordinate Mortuary Services*

Bereavement Services*

Compliance

Scope and Frequency of Services*

Medicare/State Regulations for Hospice*

Document Progression of Decline*

DME Authorization & Documentation of Need/Order*

OASIS-C*

Professional Knowledge and Skills

Identify Source of Suffering*

Palliative Care Philosophy*

Patient/Family Directs Goals of Care*

Maximize Quality of Life*

Cultural Diversity*

Supervision of Ancillary Staff*

National Patient Safety Goals/Core Measures*

Fall Risk Assessment/Prevention*

Infection Prevention*

Isolation Precautions*

Interpretation and Communication of Lab Values*

Electronic Documentation*

Automated Medication Dispensing Systems*

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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