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LVN / LPN Skills
Checklist
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NAME
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LAST 4 OF SSN
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DATE
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I hereby certify that
ALL information I have provided to IMCS Group on this skills checklist and
all other documentation, is true and accurate. I understand and acknowledge
that any misrepresentation or omission may result in disqualification from
employment and/or immediate termination.
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Instructions: This checklist is
meant to serve as a general guideline for our client facilities as to the
level of your skills within your nursing specialty. Please use the scale
below to describe your experience/expertise in each area listed below.
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Proficiency Scale:
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1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
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Rating Stars (Click)
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Skills
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1
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2
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3
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4
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Activities of daily living
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Admission of patient
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Administration of
medication
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Ambulation
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Application of heat and
cold
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Aseptic Technique
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Assist with medical
examination
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Bathing: Sitz, tub, bed,
shower
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Bandaging
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Binders
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Body Alignment
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Body Systems Review (Head
to Toe data collection)
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Cast care
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Catheterization / Foley
catheter care
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Charting
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Colostomy Care and
irrigation
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CPR
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Crutch walking
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Decubitus Care
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Diabetic tests and
preparation forms
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Diabetic blood glucose
testing
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Discharge patients
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Dosage computation
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Draping
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Dressing (sterile)
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Ear drops
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Elimination needs
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Enemas, cleansing,
retention, Harris flush
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Restraints
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Infection Control: Standard
Universal Precautions
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Infection Control: Reverse
Isolation
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Infection Control: TB/
Airborne Precautions
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Infections Control: MRSA/
VRE Precautions
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Isolation procedure for
specimen collection
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IVs: Monitor rate and
infusion site
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Medications: Oral, IM, SQ
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Mouth care
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Nail Care
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Neurological Check
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Nutritional check
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Observations: Response to
treatments/ meds
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Observations: Signs of
significant body system changes
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Observations: Signs of
shock
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Observations: Signs of pain
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Observes safety procedures
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O2 administration
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Pain assessment
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Patient care plans (revise
and update)
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Patient safety standards/
precautions
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Positioning patient
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Postural drainage
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Pre-op and post-op care
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Provide comfort, safety and
privacy
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Pulse oxymetry
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Range of motion
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Report observations/
changes
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Hand hygiene
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Skin care
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Specimen collection:
routine urine
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Specimen collection: clean
catch
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Specimen collection: 12
& 24 hour specimen
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Specimen collection:
stool
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Specimen collection:
culture
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Specimen collection:
sputum
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Specimen collection: from
foley catheter
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Suppositories
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Suction-oral
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Surgical Preps
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Computerized charting
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Trach care/suctioning
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Telephone manners
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Topical Medication
Application
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Traction
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Transfer/ transport
patients: wheelchair
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Transfer/ transport
patients: gurney
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Transfer/ transport
patients: to chair
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Urine test for glucose/
acetone
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Vital Signs
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Weight: Bed scales and
standing scales
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IV therapy certified
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Rating Stars
(Click)
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EMR
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1
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2
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3
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4
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Epic
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Cerner
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Eclipsys
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McKesson
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Meditech
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Other Computerized System
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Computerized Physician
Order Entry
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Bar Coding for Medication
Administration
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MY EXPERIENCE IS
PRIMARILY IN:
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Unit
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No. of Years
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Unit
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No. of Years
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BURN
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POST PARTUM
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CRITICAL UNIT
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LABOR & DELIVERY
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PACU
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NEWBORN NURSERY
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NEUROLOGY
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LEVEL II NICU
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TELEMETRY
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LEVEL III NICU
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MEDICAL
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PICU
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SURGICAL
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PEDIATRICS
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ONCOLOGY
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OB/GYN
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ORTHOPEDICS
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PSYCHIATRY
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OPERATING ROOM
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RRT
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EMERGENCY ROOM
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CRT
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TRAUMA CENTER
LEVEL 1
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COMMUNITY ER
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RURAL ER
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Rating Stars
(Click)
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AGE APPROPRIATE CARE
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1
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2
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3
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4
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Newborn/Neonatal (birth –
30 days)
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Infant (30 days-1 year)
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Toddler (1-3 years)
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Preschool (3-5 years)
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School Age Children (5-12
years)
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Adolescent (12-17 years)
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Young Adults (18-44 years)
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Middle Adults (45-64 years)
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Older Adults (>65 years)
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