Supervisor/Preceptor Comments: Previous Instruction, Experience Review, or Skill Demonstration For Repeat Review Review of Skill Skills Pain Management D A B C E of Date and (Required) Done Initials Date and Complete Initials Needed Assessment and Competency Competency documentation of pain using pain scale Utilization of pain relief medications Utilization of hot/cold therapies Teaching pain management techniques Other: State specific requirements: Supervisor/Preceptor Comments: Previous Instruction, Experience Review, or Skill Demonstration For Repeat Review Review of Skills Laboratory Testing D A B C E of Date and (Required) Done Initials Date and Complete Initials Needed culture and sensitivity Competency Competency Collection of urine samples *CLIA - Fingerstick sugars Equipment: *CLIA - Fingerstick PT INRs Equipment: *Heel Other: specific requirements:
Supervisor/Preceptor Comments: Previous Experience Instruction, Review, or Skill Demonstration Pain Management (Required) A B C D E Review of Needed Review of Complete Skill Done Date and Initials Competency For Repeat Skills Date and Initials Competency Assessment and documentation of pain using pain scale Utilization of pain relief medications Utilization of hot/cold therapies Teaching pain management techniques Other: State specific requirements: Supervisor/Preceptor Comments: Previous Experience Instruction, Review, or Skill Demonstration Laboratory Testing (Required) A B C D E Review of Needed Review of Complete Done Date and Initials Competency For Repeat Skills Date and Initials Competency culture and sensitivity Collection of urine samples *CLIA - Fingerstick sugars Equipment: *CLIA - Fingerstick PT INRs Equipment: *Heel Other: specific requirements:
Nursing+-+RN+Skills+Experience+Check+List+2016+.docx