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LPN

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Skills

Activities of Daily Living *

Admission of Patient *

Administration of Medication *

Ambulation *

Application of Heat and Cold *

Aseptic Technique *

Assist with Medical Examination *

Bathing (Sitz, Tub, Bed, Shower) *

Bandaging *

Binders *

Body Alignment *

Body Systems Review (Head to Toe) *

Cast Care *

Catheterization / Foley Catheter Care *

Charting *

Colostomy Care and Irrigation *

CPR *

Crutch Walking *

Decubitus Care *

Diabetic Tests and Preparation Forms *

Diabetic Blood Glucose Testing *

Discharge Patients *

Dosage Computation *

Draping *

Dressing (Sterile) *

Ear Drops *

Elimination Needs *

Enemas (Cleansing, Retention, Harris Flush) *

Restraints *

Infection Control (Standard Universal Precautions) *

Infection Control (Reverse Isolation) *

Infection Control (TB/Airborne Precautions) *

Infection Control (MRSA/VRE Precautions) *

Isolation Procedure for Specimen Collection *

IVs (Monitor Rate and Infusion Site) *

Medications (Oral, IM, SQ) *

Mouth Care *

Nail Care *

Neurological Check *

Nutritional Check *

Observations (Response to Treatments/Meds) *

Observations (Signs of Significant Body System Changes) *

Observations (Signs of Shock) *

Observations (Signs of Pain) *

Observes Safety Procedures *

O2 Administration *

Pain Assessment *

Patient Care Plans (Revise and Update) *

Patient Safety Standards/Precautions *

Positioning Patient *

Postural Drainage *

Pre-op and Post-op Care *

Provide Comfort, Safety and Privacy *

Pulse Oxymetry *

Range of Motion *

Report Observations/Changes *

Hand Hygiene *

Skin Care *

Specimen Collection (Routine Urine) *

Specimen Collection (Clean Catch) *

Specimen Collection (12 & 24 Hour Specimen) *

Specimen Collection (Stool) *

Specimen Collection (Culture) *

Specimen Collection (Sputum) *

Specimen Collection (From Foley Catheter) *

Suppositories *

Suction (Oral) *

Surgical Preps *

Computerized Charting *

Trach Care/Suctioning *

Topical Medication Application *

Traction *

Transfer/Transport Patients (Wheelchair) *

Transfer/Transport Patients (Gurney) *

Transfer/Transport Patients (To Chair) *

Urine Test for Glucose/Acetone *

Vital Signs *

Weight (Bed Scales and Standing Scales) *

IV Therapy Certified *

Age Specific Competencies

Infant (Birth - 1 Year) *

Preschooler (Ages 2-5 Years) *

Childhood (Ages 6-12 Years) *

Adolescents (Ages 13-21 Years) *

Young Adults (Ages 22-39 Years) *

Adults (Ages 40-64 Years) *

Older Adults (Ages 65-79 Years) *

Elderly (Ages 80+ Years) *

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