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LPN

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 Specific Care

Newborn/Neonatal (Birth- 30 days)*

Infant (30 days- 1 yr)*

Toddler (1-3 yrs)*

Preschool (3-5 yrs)*

School Age Children (5-12 yrs)*

Adolescent (12-18 yrs)*

Young Adults (18- 39 yrs)*

Middle Adults (39-64 yrs)*

Older Adults (64+ yrs)*

Clinical Areas

Burn Unit*

Cardiac Care*

Emergency Department*

Intensive Care Unit*

Step Down*

Gynecology*

Labor and Delivery*

Medical*

Mother/Baby*

Neurology*

Nursery*

Obstetrics*

OR*

Oncology*

Orthopedics*

Pediatrics*

Post Partum*

Psychiatry*

Rehabilitation*

Renal/Dialysis*

Respiratory*

Surgical*

Telemetry*

Doctor’s Office*

Health Department*

Corrections*

Home Health*

Long Term Care*

Hospice*

Respite Care*

Outpatient Clinic*

Nursing Home*

Core Skills

Admissions of a Patient*

Transfer of a Patient*

Discharge of a Patient*

Assist with Emergency Situations/Codes*

Vital Signs*

Post Mortem Care*

Assist with Defibrillation*

Assist with Cardioversion*

Documentation*

Patient and Family Education*

Assessment of Abuse*

Restraints*

Body Mechanics*

Aseptic Technique*

Isolation Precautions*

Cardiovascular - Care of Patients With

Auscultation (rate, rhythm)*

Blood Pressure/Non-invasive*

Doppler*

Heart Sounds/Murmurs*

Abdominal Aortic Aneurysm/Bypass*

Angina*

Cardiac Arrest*

Cardiomyopathy*

Carotid Endarterectomy*

Congestive Heart Failure*

Femoral-Popliteal Bypass*

Myocarditis*

Status Post MI*

Post Angioplasty*

Post Cardiac Cath*

Thrombophlebitis*

Temporary Pacemaker*

Permanent Pacemaker*

Cardiac Enzymes*

Blood Chemistries*

Basic Arrhythmia Interpretation*

Lead Placement*

Pulmonary - Care of Patients With

Ventilator/Weaning*

Breath Sounds*

Rate and Work of Breathing*

Arterial Blood Gases (ABG)*

Asthma*

COPD*

Tracheostomy*

Lobectomy*

Pneumonectomy*

Pneumonia*

Pulomonary Embolism*

Thoracotomy*

Tuberculosis*

Pulmonary Edema*

Pneumothorax*

Laryngospasm*

Endotracheal Tube/Suctioning*

Nasal Airway/Suctioning*

Oropharyngeal/Suctioning*

Sputum Specimen Collection*

Tracheostomy/Suctioning*

Assist with Intubation*

Assist with Thoracentesis*

Chest Tube Management*

Chest Physiotherapy*

Incentive Spirometry*

Pulse Oximetry*

Bag and Mask*

Face Mask*

Nasal Cannula*

Portable O2 Tank*

Neurological - Care of Patients With

Glascow Coma Scale*

Level of Consciousness*

Assist with Lumbar Puncture*

Use of Hypo-Hyperthermia Blanket*

Aneurysm Precautions*

Basal Skull Fracture*

Closed Head Injuries*

Coma*

CVA*

TIA*

Delerium Tremens*

Encephalitis*

Meningitis*

Neuromuscular Disorders*

Psychiatric Disorders*

Seizures*

Overdose*

Guillain- Barre Syndrome*

Externalized VP Shunts*

Post Craniotomy*

Spinal Cord Injuries*

Orthopedic - Care Of Patients With

Circulation checks*

Gait*

Range of Motion*

Skin*

Wheelchair Use*

Cane/Crutches/Walker Use*

Amputation*

Arthroscopic Surgery*

Cast*

Splint*

Knee Immobilizer*

Osteoporosis*

Pinned Fractures*

Total Joint Replacements*

Continuous Passive Motion Devices*

Cervical Collar*

Prosthetics*

Traction- Bucks/Skeletal*

Auto Transfuser*

Gastrointestinal - Care Of Patients With

Abdominal/ bowel sounds*

Fluid Balance*

Placement of NG tube*

Placement of Flexible Feeding Tube*

Administration of Tube Feeding*

Feeding Pumps*

Gravity Feeding*

Salem Sump to Suction*

Care of Gastrostomy Tube*

Colostomy Care*

Bowel Obstruction*

GI Bleeding*

GI Surgery*

Hepatitis*

Inflammatory Bowel Disease*

Liver Failure*

Liver Transplant*

Paralytic Ileus*

Colostomy/Ileostomy*

Abdominal Trauma*

Renal/Genitournary - Care of Patients With

Fluid Balance*

Urinary Output*

BUN &Creatinine*

Catheter Care*

Specimen Collection- Routine*

Specimen Collection- 24 Hours*

Specimen Collection- Clean Catch*

Insertion & Care of Straight and Foley Catheters- Female*

Insertion & Care of Straight and Foley Catheters- Male*

Hemodialysis*

Nephrectomy*

Peritoneal Dialysis*

Renal Failure*

Renal Transplant*

TURP*

Ileal Conduit*

Bladder Irrigations*

Urinary Tract Infections*

Gyn Surgery*

Renal trauma*

Endocrine/Metabolic - Care of Patients With

S/S Diabetic Coma*

S/S Insulin Coma*

Blood Glucose Monitoring*

Performing Finger/Heel Stick*

Sliding Scale Insulin Protocols*

Adrenal Disorders (Addison’s)*

Diabetes Mellitus*

Diabetes Insipidus (Pituitary Disorder)*

Diabetic Ketoacidosis*

Hyperthyroidism*

Hypothyroidism*

Thyroidectomy*

Wound Management

Assess Skin for Impending Breakdown*

Surgical Wound Healing*

Sterile Dressing Change*

Wound Vac*

Wet to Dry Dressings*

First Degree Burns*

Second Degree Burns*

Third Degree Burns*

Decubitus Ulcers*

Surgical Wounds with Drains*

Traumatic Wounds*

Wound Care Irrigations*

Multiple Abdominal Wounds and Drains*

Gunshot Wound*

Stab Wound*

Lacerations*

Abrasions*

Oncology - Care Of Patients With

Bone Marrow Transplant*

Inpatient Chemotherapy*

Leukemia*

Radiation Implant*

Lymphoma*

Depressed Immune System*

Radiation Therapy*

Fresh Oncology Surgery*

Infectious Diseases - Care of Patients With

HIV*

MRSA*

C. Difficile*

VRE*

Hepatitis*

Influenza*

Isolation Precautions*

Intravenous Therapy

Site Assessment*

Administration of Blood & Blood Products*

Drawing Blood from a Central Line*

IV Insertion*

Heplock Flushes*

Administration of IV Fluid*

Administration of IV Piggy Back*

Administration of IV Push Medications*

Access VAD*

Central Line*

Peripheral Line*

Administration TPN/Lipids*

Pain Management

Assessment of Pain Level/Tolerance*

Administration of Narcotic Analgesia*

PCA Pumps*

IV Conscious Sedation*

Epidural Anesthesia*

Miscellaneous

Computerized Charting*

Automated Med. Dispensing Systems*

Safe Needle Devices*

PO Medications*

IM Injections*

SQ Injections*

Z- Track Injections*

Rectal Suppositories*

Nasal Sprays*

Ear Drops*

Eye Drops*

Inhalers*

Assist with Emergency Drugs/Code Cart*

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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