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
Hospice RN – 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 of Patients Cared For
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 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (79+ years)
*
0
1
2
3
4
5
Work Setting
Home Hospice
*
0
1
2
3
4
5
Inpatient Hospice
*
0
1
2
3
4
5
Pediatric Hospice
*
0
1
2
3
4
5
Home Health/Hospice Setting
*
0
1
2
3
4
5
Assessment
Intake Assessment
*
0
1
2
3
4
5
Assessment Interview
*
0
1
2
3
4
5
Physical Exam
*
0
1
2
3
4
5
Coping Status
*
0
1
2
3
4
5
Environmental Status
*
0
1
2
3
4
5
Plan of Care
Set Goals with Patient/Family
*
0
1
2
3
4
5
Collaborate with Other Team Members
*
0
1
2
3
4
5
Symptom Management
Urgent Assessment of Symptoms
*
0
1
2
3
4
5
Reduce Symptoms to Level Acceptable to Patient
*
0
1
2
3
4
5
Report Symptoms/Management to Provider
*
0
1
2
3
4
5
Treat Underlying Cause
*
0
1
2
3
4
5
Severity Scale
*
0
1
2
3
4
5
Management of Nausea
*
0
1
2
3
4
5
Management of Constipation
*
0
1
2
3
4
5
Management of Fatigue
*
0
1
2
3
4
5
Anorexia/Cachexia
*
0
1
2
3
4
5
Restlessness
*
0
1
2
3
4
5
Educate Family of Symptom Management
*
0
1
2
3
4
5
Pain Management
Identify Source of Pain
*
0
1
2
3
4
5
Pain Severity
*
0
1
2
3
4
5
PAINAD Scale for Non-Verbal Patient
*
0
1
2
3
4
5
Reduce Pain to Level Acceptable to Patient
*
0
1
2
3
4
5
WHO 3-Step Ladder
*
0
1
2
3
4
5
Non-Pharmacological Management of Pain
*
0
1
2
3
4
5
Pharmacological Management of Pain
*
0
1
2
3
4
5
Effects of Pharmacological Treatment
*
0
1
2
3
4
5
Nociceptive/Neuropathic/Mixed Pain
*
0
1
2
3
4
5
Management of Nociceptive Pain
*
0
1
2
3
4
5
Management of Neuropathic Pain
*
0
1
2
3
4
5
Educate Family on Pain Management
*
0
1
2
3
4
5
Wound Care
Positioning Techniques
*
0
1
2
3
4
5
Bed/Support Surface Selection
*
0
1
2
3
4
5
Pressure Ulcer Staging/Management
*
0
1
2
3
4
5
Response to Treatment
*
0
1
2
3
4
5
Evaluate Factors that Impede Healing
*
0
1
2
3
4
5
Educate Family on Positioning/Shearing
*
0
1
2
3
4
5
Pediatrics
Developmentally Appropriate Assessment
*
0
1
2
3
4
5
Parental/Sibling Support
*
0
1
2
3
4
5
Pediatric Support Team Collaboration
*
0
1
2
3
4
5
Medication Administration
Equianalgesic Conversion Formula
*
0
1
2
3
4
5
Titration of Opioids
*
0
1
2
3
4
5
IV Pump Management
*
0
1
2
3
4
5
Evaluate Effectiveness of Medications
*
0
1
2
3
4
5
Family Management of Medications
*
0
1
2
3
4
5
Disposal of Medications
*
0
1
2
3
4
5
After Death
Family/Cultural Rituals/Rites
*
0
1
2
3
4
5
Patient Care after Death
*
0
1
2
3
4
5
Coordinate Mortuary Services
*
0
1
2
3
4
5
Bereavement Services
*
0
1
2
3
4
5
Compliance
Scope and Frequency of Services
*
0
1
2
3
4
5
Medicare/State Regulations for Hospice
*
0
1
2
3
4
5
Document Progression of Decline
*
0
1
2
3
4
5
DME Authorization & Documentation of Need/Order
*
0
1
2
3
4
5
OASIS-C
*
0
1
2
3
4
5
Professional Knowledge and Skills
Identify Source of Suffering
*
0
1
2
3
4
5
Palliative Care Philosophy
*
0
1
2
3
4
5
Patient/Family Directs Goals of Care
*
0
1
2
3
4
5
Maximize Quality of Life
*
0
1
2
3
4
5
Cultural Diversity
*
0
1
2
3
4
5
Supervision of Ancillary Staff
*
0
1
2
3
4
5
National Patient Safety Goals/Core Measures
*
0
1
2
3
4
5
Fall Risk Assessment/Prevention
*
0
1
2
3
4
5
Infection Prevention
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Interpretation and Communication of Lab Values
*
0
1
2
3
4
5
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Automated Medication Dispensing Systems
*
0
1
2
3
4
5
Automated Medication Dispensing Systems - List Types
*
Other Skills
*
0
1
2
3
4
5
Other Skills - List Types
*
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
*