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BASIC NURSING CLINICAL SKILLS CHECKLIST

Mentee: ________________________ Mentor: ________________________ Facility: _______________________ Date: _________________________

Please summarize the mentees demonstrated no!led"e and s ills usin" the s#ores $elo!%
& None'No demonstrated skills at all; does not perform the task(s) completely. Needs a lot of support. ( Limited'Mentee demonstrates very limited strengths skills in this area and needs additional support. ) Some'Mentee demonstrates some a!ility skills in this area. * Stron"'Mentee demonstrates strong skills strengths in this area. + E,#ellent'Mentee demonstrates e"cellent skills strengths in this area. NA'Not applica!le. #se $hen you consider the indicator inappropriate given the purpose and conte"t of the session. -K'Don%t kno$. RL'&kill or care limitation clearly related to resource limits. -emonstrated Kno!led"e.S ills '. 0. 2. 5. /riefly descri!es the purpose of the mentoring program to the patient (i.e.* $hat the clinical mentor is doing there). 1reates trusting supportive rapport $ith patient (encourages open communication). 3akes a systematic and organi4ed approach $hen conducting the !aseline assessment. +sks a!out and records chief complaints* including the duration of the pro!lem. S#ore
('()* N+* D,* -.)

Comments

/asic Nursing 1linical &kills 1hecklist 673819 1linical Mentoring 3oolkit

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-emonstrated Kno!led"e.S ills ). :. ;. >. 3akes and records medical history. 3akes and records social history. Demonstrates competency in <9= staging. -ecords and completes patient self7appraisal and assessment of symptoms. +sks or ans$ers @uestions in a clear* concise manner.

S#ore
('()* N+* D,* -.)

Comments

?.

'A. 3akes and records vital signs. ''. 1onducts complete physical e"am in a systematic manner. '0. 1onducts appropriate targeted physical e"am !ased on findings from history and chief complaint. '2. 6dentifies a!normal physical findings. '5. +ssesses la!oratory values (if availa!le) and documents on intake form. '). Documents accurate and complete findings. ':. Develops nursing7care plan from information o!tained during assessment.

/asic Nursing 1linical &kills 1hecklist 673819 1linical Mentoring 3oolkit

-emonstrated Kno!led"e.S ills ';. Bresents medical and social history* patient self7appraisal* physical e"am findings* and la! assessment to physician.

S#ore
('()* N+* D,* -.)

Comments

/asic Nursing 1linical &kills 1hecklist 673819 1linical Mentoring 3oolkit

Brie/ e0aluation o/ stren"ths 1in#ludin" !hat s ills im2ro0ed sin#e the last e0aluation3%

Re#ommendations to im2ro0e mentees 2ra#ti#e 1mar re#ommendations a"reed u2on /or ne,t 0isit3%

E,am2les o/ in/ormation 4ou shared or s ills 4ou demonstrated that !ere aimed to!ards im2ro0in" the mentees 2ra#ti#e%

5entors si"nature% 666666666666666666666666666666666666666666666 Nurse mentees si"nature% ______________________________________ -ate% 66666666666666666666666666

/asic Nursing 1linical &kills 1hecklist 673819 1linical Mentoring 3oolkit