Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
1.877.891.4286
1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
LPN – Skills Checklist
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 Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Age Specific Care
Newborn/Neonate (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age Child (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64+ years)
*
0
1
2
3
4
5
Clinical Areas
Burn Unit
*
0
1
2
3
4
5
Cardiac Care
*
0
1
2
3
4
5
Emergency Department
*
0
1
2
3
4
5
Intensive Care Unit
*
0
1
2
3
4
5
Step Down
*
0
1
2
3
4
5
Gynecology
*
0
1
2
3
4
5
Labor and Delivery
*
0
1
2
3
4
5
Medical
*
0
1
2
3
4
5
Mother/Baby
*
0
1
2
3
4
5
Neurology
*
0
1
2
3
4
5
Obstetrics
*
0
1
2
3
4
5
OR
*
0
1
2
3
4
5
Oncology
*
0
1
2
3
4
5
Orthopedics
*
0
1
2
3
4
5
Pediatrics
*
0
1
2
3
4
5
Post Partum
*
0
1
2
3
4
5
Psychiatry
*
0
1
2
3
4
5
Rehabilitation
*
0
1
2
3
4
5
Renal/Dialysis
*
0
1
2
3
4
5
Respiratory
*
0
1
2
3
4
5
Surgical
*
0
1
2
3
4
5
Telemetry
*
0
1
2
3
4
5
Doctor's Office
*
0
1
2
3
4
5
Health Department
*
0
1
2
3
4
5
Corrections
*
0
1
2
3
4
5
Home Health
*
0
1
2
3
4
5
Long Term Care
*
0
1
2
3
4
5
Hospice
*
0
1
2
3
4
5
Respite Care
*
0
1
2
3
4
5
Outpatient Clinic
*
0
1
2
3
4
5
Nursing Home
*
0
1
2
3
4
5
Core Skills
Admissions of a Patient
*
0
1
2
3
4
5
Transfer of a Patient
*
0
1
2
3
4
5
Discharge of a Patient
*
0
1
2
3
4
5
Assist with Emergency Situations/Codes
*
0
1
2
3
4
5
Vital Signs
*
0
1
2
3
4
5
Post Mortem Care
*
0
1
2
3
4
5
Assist with Defibrillation
*
0
1
2
3
4
5
Assist with Cardioversion
*
0
1
2
3
4
5
Documentation
*
0
1
2
3
4
5
Patient and Family Education
*
0
1
2
3
4
5
Assessment of Abuse
*
0
1
2
3
4
5
Restraints
*
0
1
2
3
4
5
Body Mechanics
*
0
1
2
3
4
5
Aseptic Technique
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Cardiovascular - Care of Patient With:
Auscultation (rate, rhythm)
*
0
1
2
3
4
5
Blood Pressure/Non-Invasive
*
0
1
2
3
4
5
Doppler
*
0
1
2
3
4
5
Heart Sounds/Murmurs
*
0
1
2
3
4
5
Abdominal Aortic Aneurysm/Bypass
*
0
1
2
3
4
5
Angina
*
0
1
2
3
4
5
Cardiac Arrest
*
0
1
2
3
4
5
Cardiomyopathy
*
0
1
2
3
4
5
Carotid Endarterectomy
*
0
1
2
3
4
5
Congestive Heart Failure
*
0
1
2
3
4
5
Femoral-Popliteal Bypass
*
0
1
2
3
4
5
Myocarditis
*
0
1
2
3
4
5
Status Post MI
*
0
1
2
3
4
5
Post Angioplasty
*
0
1
2
3
4
5
Post Cardiac Cath
*
0
1
2
3
4
5
Thrombophlebitis
*
0
1
2
3
4
5
Temporary Pacemaker
*
0
1
2
3
4
5
Permanent Pacemaker
*
0
1
2
3
4
5
Cardiac Enzymes
*
0
1
2
3
4
5
Blood Chemistries
*
0
1
2
3
4
5
Basic Arrhythmia Interpretation
*
0
1
2
3
4
5
Lead Placement
*
0
1
2
3
4
5
Pulmonary - Care of Patient With:
Ventilator/Weaning
*
0
1
2
3
4
5
Breath Sounds
*
0
1
2
3
4
5
Rate and Work of Breathing
*
0
1
2
3
4
5
Arterial Blood Gases (ABG)
*
0
1
2
3
4
5
Asthma
*
0
1
2
3
4
5
COPD
*
0
1
2
3
4
5
Tracheostomy
*
0
1
2
3
4
5
Lobectomy
*
0
1
2
3
4
5
Pneumonia
*
0
1
2
3
4
5
Pulomonary Embolism
*
0
1
2
3
4
5
Thoracotomy
*
0
1
2
3
4
5
Tuberculosis
*
0
1
2
3
4
5
Pulmonary Edema
*
0
1
2
3
4
5
Pneumothorax
*
0
1
2
3
4
5
Laryngospasm
*
0
1
2
3
4
5
Endotracheal Tube/Suctioning
*
0
1
2
3
4
5
Nasal Airway/Suctioning
*
0
1
2
3
4
5
Oropharyngeal/Suctioning
*
0
1
2
3
4
5
Sputum Specimen Collection
*
0
1
2
3
4
5
Tracheostomy/Suctioning
*
0
1
2
3
4
5
Assist with Intubation
*
0
1
2
3
4
5
Assist with Thoracentesis
*
0
1
2
3
4
5
Chest Tube Management
*
0
1
2
3
4
5
Chest Physiotherapy
*
0
1
2
3
4
5
Incentive Spirometry
*
0
1
2
3
4
5
Pulse Oximetry
*
0
1
2
3
4
5
Bag and Mask
*
0
1
2
3
4
5
Face Mask
*
0
1
2
3
4
5
Nasal Cannula
*
0
1
2
3
4
5
Portable O2 Tank
*
0
1
2
3
4
5
Neurological - Care of Patient With:
Glascow Coma Scale
*
0
1
2
3
4
5
Level of Consciousness
*
0
1
2
3
4
5
Assist with Lumbar Puncture
*
0
1
2
3
4
5
Use of Hypo/Hyperthermia Blanket
*
0
1
2
3
4
5
Aneurysm Precautions
*
0
1
2
3
4
5
Basal Skull Fracture
*
0
1
2
3
4
5
Closed Head Injuries
*
0
1
2
3
4
5
Coma
*
0
1
2
3
4
5
CVA
*
0
1
2
3
4
5
TIA
*
0
1
2
3
4
5
Delerium Tremens
*
0
1
2
3
4
5
Encephalitis
*
0
1
2
3
4
5
Meningitis
*
0
1
2
3
4
5
Neuromuscular Disorders
*
0
1
2
3
4
5
Psychiatric Disorders
*
0
1
2
3
4
5
Seizures
*
0
1
2
3
4
5
Overdose
*
0
1
2
3
4
5
Guillain-Barre Syndrome
*
0
1
2
3
4
5
Externalized VP Shunts
*
0
1
2
3
4
5
Post Craniotomy
*
0
1
2
3
4
5
Spinal Cord Injuries
*
0
1
2
3
4
5
Orthopaedics - Care of Patient With:
Circulation Checks
*
0
1
2
3
4
5
Gait
*
0
1
2
3
4
5
Range of Motion
*
0
1
2
3
4
5
Skin
*
0
1
2
3
4
5
Wheelchair Use
*
0
1
2
3
4
5
Cane/Crutches/Walker Use
*
0
1
2
3
4
5
Amputation
*
0
1
2
3
4
5
Anthroscopic Surgery
*
0
1
2
3
4
5
Cast
*
0
1
2
3
4
5
Splint
*
0
1
2
3
4
5
Knee Immobilizer
*
0
1
2
3
4
5
Osteoporosis
*
0
1
2
3
4
5
Pinned Fractures
*
0
1
2
3
4
5
Total Joint Replacements
*
0
1
2
3
4
5
Continuous Passive Motion Devices
*
0
1
2
3
4
5
Cervical Collar
*
0
1
2
3
4
5
Prosthetics
*
0
1
2
3
4
5
Traction - Bucks/Skeletal
*
0
1
2
3
4
5
Auto Transfuser
*
0
1
2
3
4
5
Gastrointestinal - Care of Patient With:
Abdominal/Bowel Sounds
*
0
1
2
3
4
5
Fluid Balance
*
0
1
2
3
4
5
Placement of NG Tube
*
0
1
2
3
4
5
Placement of Flexible Feeding Tube
*
0
1
2
3
4
5
Administration of Tube Feeding
*
0
1
2
3
4
5
Feeding Pumps
*
0
1
2
3
4
5
Gravity Feeding
*
0
1
2
3
4
5
Salem Sump to Suction
*
0
1
2
3
4
5
Care of Gastrostomy Tube
*
0
1
2
3
4
5
Colostomy Care
*
0
1
2
3
4
5
Bowel Obstruction
*
0
1
2
3
4
5
GI Bleeding
*
0
1
2
3
4
5
GI Surgery
*
0
1
2
3
4
5
Hepatitis
*
0
1
2
3
4
5
Inflammatory Bowel Disease
*
0
1
2
3
4
5
Liver Failure
*
0
1
2
3
4
5
Liver Transplant
*
0
1
2
3
4
5
Paralytic Ileus
*
0
1
2
3
4
5
Colostomy/Ileostomy
*
0
1
2
3
4
5
Abdominal Trauma
*
0
1
2
3
4
5
Renal/Genitourinary - Care of Patient with:
Fluid Balance
*
0
1
2
3
4
5
Urinary Output
*
0
1
2
3
4
5
BUN & Creatinine
*
0
1
2
3
4
5
Catheter Care
*
0
1
2
3
4
5
Specimen Collection - Routine
*
0
1
2
3
4
5
Specimen Collection - 24 Hours
*
0
1
2
3
4
5
Specimen Collection - Clean Catch
*
0
1
2
3
4
5
Insertion & Care of Straight and Foley Catheters - Female
*
0
1
2
3
4
5
Insertion & Care of Straight and Foley Catheters - Male
*
0
1
2
3
4
5
Hemodialysis
*
0
1
2
3
4
5
Nephrectomy
*
0
1
2
3
4
5
Peritoneal Dialysis
*
0
1
2
3
4
5
Renal Failure
*
0
1
2
3
4
5
Renal Transplant
*
0
1
2
3
4
5
TURP
*
0
1
2
3
4
5
Ileal Conduit
*
0
1
2
3
4
5
Bladder Irrigations
*
0
1
2
3
4
5
Urinary Tract Infections
*
0
1
2
3
4
5
Gyn Surgery
*
0
1
2
3
4
5
Renal Trauma
*
0
1
2
3
4
5
Endocrine/Metabolic - Care of Patient With:
S/S Diabetic Coma
*
0
1
2
3
4
5
S/S Insulin Coma
*
0
1
2
3
4
5
Blood Glucose Monitoring
*
0
1
2
3
4
5
Performing Finger/Heel Stick
*
0
1
2
3
4
5
Sliding Scale Insulin Protocols
*
0
1
2
3
4
5
Adrenal Disorders (Addison's)
*
0
1
2
3
4
5
Diabetes Mellitus
*
0
1
2
3
4
5
Diabetes Insipidus (Pituitary Disorder)
*
0
1
2
3
4
5
Diabetic Ketoacidosis
*
0
1
2
3
4
5
Hyperthyroidism
*
0
1
2
3
4
5
Thyroidectomy
*
0
1
2
3
4
5
Wound Management
Assess Skin for Impending Breakdown
*
0
1
2
3
4
5
Surgical Wound Healing
*
0
1
2
3
4
5
Sterile Dressing Change
*
0
1
2
3
4
5
Wound Vac
*
0
1
2
3
4
5
Wet to Dry Dressing
*
0
1
2
3
4
5
First Degree Burns
*
0
1
2
3
4
5
Second Degree Burns
*
0
1
2
3
4
5
Third Degree Burns
*
0
1
2
3
4
5
Decubitus Ulcers
*
0
1
2
3
4
5
Surgical Wounds with Drains
*
0
1
2
3
4
5
Traumatic Wounds
*
0
1
2
3
4
5
Wound Care Irrigations
*
0
1
2
3
4
5
Multiple Abdominal Wounds and Drains
*
0
1
2
3
4
5
Gunshot Wound
*
0
1
2
3
4
5
Stab Wound
*
0
1
2
3
4
5
Lacerations
*
0
1
2
3
4
5
Abrasions
*
0
1
2
3
4
5
Oncology - Care of Patient With:
Bone Marrow Transplant
*
0
1
2
3
4
5
Inpatient Chemotherapy
*
0
1
2
3
4
5
Leukemia
*
0
1
2
3
4
5
Radiation Implant
*
0
1
2
3
4
5
Lymphoma
*
0
1
2
3
4
5
Depressed Immune System
*
0
1
2
3
4
5
Radiation Therapy
*
0
1
2
3
4
5
Fresh Oncology Surgery
*
0
1
2
3
4
5
Infectious Disease - Car of Patient With:
HIV
*
0
1
2
3
4
5
MRSA
*
0
1
2
3
4
5
C. Difficile
*
0
1
2
3
4
5
VRE
*
0
1
2
3
4
5
Hepatitis
*
0
1
2
3
4
5
Influenza
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Intavenous Therapy
Site Assessment
*
0
1
2
3
4
5
Administration of Blood & Blood Products
*
0
1
2
3
4
5
Drawing Blood from a Central Line
*
0
1
2
3
4
5
IV Insertion
*
0
1
2
3
4
5
Heplock Flushes
*
0
1
2
3
4
5
Administration of IV Fluid
*
0
1
2
3
4
5
Administration of Piggy Back
*
0
1
2
3
4
5
Administration of Push Medications
*
0
1
2
3
4
5
Access VAD
*
0
1
2
3
4
5
Central Line
*
0
1
2
3
4
5
Peripheral Line
*
0
1
2
3
4
5
Administration TPN/Lipids
*
0
1
2
3
4
5
Pain Management
Assessment of Pain Level/Tolerance
*
0
1
2
3
4
5
Administration of Narcotic Analgesia
*
0
1
2
3
4
5
PCA Pumps
*
0
1
2
3
4
5
IV Conscious Sedation
*
0
1
2
3
4
5
Epidural Anesthesia
*
0
1
2
3
4
5
Miscellaneous
Computerized Charting
*
0
1
2
3
4
5
Computerized Charting - List Types
*
Automated Med. Dispensing Systems
*
0
1
2
3
4
5
Automated Med. Dispensing Systems - List Types
*
Safe Needle Devices
*
0
1
2
3
4
5
PO Medications
*
0
1
2
3
4
5
IM Injections
*
0
1
2
3
4
5
SQ Injections
*
0
1
2
3
4
5
Z-Track Injections
*
0
1
2
3
4
5
Rectal Suppositories
*
0
1
2
3
4
5
Nasal Sprays
*
0
1
2
3
4
5
Ear Drops
*
0
1
2
3
4
5
Eye Drops
*
0
1
2
3
4
5
Inhalers
*
0
1
2
3
4
5
Assist with Emergency Drugs/Code Cart
*
0
1
2
3
4
5
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
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 Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*