ADEX Medical Staffing - CNA Skills Checklist

CNA Skills Checklist

This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment with ADEX Medical Staffing, LLC.

Proficency Scale:

1 = No Experience - Theory only

2 = Limited Experience - Infrequent

3 = Moderate Experience - Able to perform independently

4 = Proficient - Able to perform proficiently and instruct

Frequency Scale:

1 = Never Observed

2 = Less than 6 times a year

3 = 1 or 2 Times a Month

4 = Daily or Weekly

Personal Information
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	Proficiency				Frequency
General Nursing	1	2	3	4	1	2	3	4
Admit & Orient Patients
Discharge Patients
Vital Sign Monitoring
Pulse Oximetry
Urine Dipstick
Blood Glucose Monitoring
Wound Care
Dressing Changes
Positioning / Transferring
Pre-Operative Care / Preparation

	Proficiency				Frequency
Post-Anesthesia Care	1	2	3	4	1	2	3	4
General
Spinal
Block
Restraints - Apply/Monitor
Isolation Techniques
Advance Directives
Postmortem Care
Assist / Perform Bathing
Complete Bed Bath / Total Assist
Assist with Toileting Activities
Assist with Oral Hygiene
Documentation
Reporting to Supervisor

	Proficiency				Frequency
Cardiac	1	2	3	4	1	2	3	4
Use of Cardiac Monitors
Telemetry
Perform 12-lead EKG
Assist with Code
Acute MI
Congestive Heart Failure
Pre / Post Cardiac Cath
Pre / Post Cardiac Surgery
Aneurysm
Permanent Pacemaker
Temporary Pacemaker

	Proficiency				Frequency
Orthopedic	1	2	3	4	1	2	3	4
Crutch Walking
Cast Care
Traction
Amputation
Skeletal Traction
Arthroscopy / Arthrotomy
Total Hip Replacement
Total Knee Replacement

	Proficiency				Frequency
Genitourinary	1	2	3	4	1	2	3	4
Straight / Foley Cath Female
Straight / Foley Cath Male
Obtain / Instruct Clean Catch Urine
Shunts & Fistulas
Renal Failure
Nephrectomy
Renal Transplant
Mastectomy
Hysterectomy
Prostate surgery

	Proficiency				Frequency
Vascular	1	2	3	4	1	2	3	4
Apply Noninvasive BP Monitor
Monitor Noninvasive BP Monitor
Draw Blood for Lab Studies
Discontinue Peripheral IVs
Intake and Output
Peripheral Pulses
Ultrasonic Doppler
Apply Antiembolism Stockings

	Proficiency				Frequency
Respiratory	1	2	3	4	1	2	3	4
Open / Monitor Airway
Assist with Intubation (ETT)
Assist with Extubation
O2 Saturation Spot Checks
O2 Saturation Monitors
Incentive Spirometry
Nasal Cannula
Face Masks
Asthma / COPD
Pre / Post Thoracic Surgery
Tracheostomy
Chest Tubes

	Proficiency				Frequency
Neurology	1	2	3	4	1	2	3	4
Neurological Evaluation
Glascow Coma Scale
Assist with Lumbar Puncture
Seizure Precautions
Open / Closed Head Injury
CVA
Spinal Cord Injury
Craniotomy
Drug Overdose / DTs

	Proficiency				Frequency
Gastrointestinal	1	2	3	4	1	2	3	4
Assist with Nutritional Evaluation
Assist with Feedings
Monitor NG Tube
Gastrostomy Tube Monitor / Feed
Ostomy Care
GI Bleed
Abdominal Wounds
Drains

	Proficiency				Frequency
Other	1	2	3	4	1	2	3	4
Diabetes
AIDS
Multiple Trauma
Burns
Oncology
Bone Marrow Transplant
Liver Transplant

	Proficiency				Frequency
Age Specific Skills	1	2	3	4	1	2	3	4
Newborn (birth-30 days)
Adolescents (12 - 18 years)
Infant (30 days - 1 year)
Young Adults (18 - 39 years)
Toddler (1 - 3 years)
Middle Adults (39 - 64 years)
Preschooler (3 - 5 years)
Older Adults (64+ years)
School Age (5 - 12 years)

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The information represented above is true and correct to the best of my knowledge. I authorize ADEX Medical Staffing, LLC to share this skills checklist with its clients.
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Form Reviewed by ADEX Clinician - 11/16/2010