Transcription of Skilled Nursing Competency Self Assessment
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Skilled Nursing Competency Self Assessment
DirectionsPlease circle a value for each question to provide us and the interested facilities with an Assessment of your clinical experience. These values confirm your strengths within your specialty and assist the facility in the selection process of the healthcare Nursing Competency Self Assessment 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0057 Skilled Nursing 1 of 5_____Print Name Last 4 Digits of SS# DateExperience0 Not Applicable1 No Experience2 Some Experience (Require Assistance)3 Intermittent Experience (May Require Assistance)4 Experienced (Performs without Assistance)5 Very Experienced (Able to Teach/Supervise)General SkillsExperienceAdvanced directives0 1 2 3 4 5 Awareness of HCAHPS0 1 2 3 4 5 Patient/family teaching0 1 2 3 4 5 Discharge planning0 1 2 3 4 5UR/medicare review0 1 2 3 4 5 Lift/transfer devices0 1 2 3 4 5 Specialty beds0 1 2 3 4 5 Restrictive devices (restraints)0 1
Directions Please circle a value for each question to provide us and the interested facilities with an assessment of your clinical experience. These values confirm your
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