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ADON Or DON Skills Checklist

Fill Out and Submit your Skills Checklist

I hereby certify that ALL information I have provided 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.

Skills Checklist

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.

Proficiency Scale:

1No Experience

2Need Training

3Able to perform with supervisione

4Able to perform independently

Leadership Domain

Communicates effectively with residents, families, significant others and other team members

Communicates effectively with peers, physicians, and State agencies

Coordinates resident care to the multidisciplinary team via “at risk meetings, QA and A, rehab meetings, etc.

Provides updated resident information to physician, resident, family, legal, consultants, State agencies in accordance with regulations and/or BHC standards

Knowledgeable and able to execute human resource policies as applicable to a variety of people issues.

Delegates as appropriate

Actions demonstrate excellent customer service skills and builds relationships with families and associates.

Monitors the progress of others and associates are held accountable

Enforces regulatory and employee law compliance

Technical Domain

Assesses and monitors staff compliance of infection control and safety programs

Demonstrates excellent technical skills and judgment, as evidenced by: Daily Start up execution, Follow-up 24 hour report, Computer reports, Medicare Reports, 672/802

Assess and monitors accuracy of Facility Scorecard and CMS quality indicator data and initiates corrective action as indicated

Actively participants and contributes to facility QA &A meetings, QR/QRFU and process improvement activities

Promotes survey preparedness at all times

Demonstrates basic working knowledge of Computer i.e. ADT, PO’s, MDS modules and management reports

Demonstrates basic understanding of quality event investigating and reporting process

Maintains a current knowledge of LTC Federal, state regulations including Medicare, Medicaid and JCAHO as applicable

Ensure that RAI functions are completed timely for all residents, i.e. concurrent review, State submissions, careplan meetings, etc

Assess and ensure execution of Facility standards, protocols and policies

Provides and monitors the effectiveness of clinical orientation and ongoing training to all associates

Actively participates in recruiting, hiring and orientation of all associates

Problem Solving Domain

Utilizes the nursing process to structure care to individual resident ‘s needs

Demonstrates the ability to assess and interpret data about the resident’s status and ensure timely interventions are executed

Collaborates with DNS/ Consultants on identified areas of noncompliance and implements necessary corrective actions

Effectively troubleshoots and ensure allocation of staffing resources to meet the needs of the residents/patients

Demonstrates understanding of census as it relates to HOL, expense control and budgeted PPD, i.e. nursing supplies

Assess and monitors discharge, rehospitalization patterns and implements corrective actions as indicated

Age Specific Competencies

Infant (Birth - 1 year)

Preschooler (ages 2-5 years)

Childhood (ages 6-12 years)

Adolescents (ages 13-21 years)

Young Adults (ages 22-39 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79 years)

Elderly (ages 80+ years)

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Reach us

contact@selectsourceintl.com
care@selectsourceintl.com
Phone: +1-952-546-3300
Fax: +1-952-546-3500
13911 Ridgedale Drive, Suite 230
Minnetonka, Minnesota 55305, United States

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