NURS 320 Clinical Skills Checklist

Student Name:

Clinical Faculty:

Semester/Year:

Clinical Site:

Instructions:

Complete this checklist every clinical day. This checklist must be uploaded to Canvas after completion of clinical hours. Both clinical faculty and student signatures are required before uploading on DAY 6 Clinical.

Rating Scale: O = Observed | A = Assisted | P = Performed | N/A = No Opportunity

Clinical Skills Assessment

Skill	Week 1	Week 2	Week 3	Week 4	Week 5	Week 6
Head-To-Toe Assessment
Focused Assessment
Vital signs
3-Lead or 5-Lead ECG placement
Receiving i-SBAR Hand-off from an RN
Working collaboratively with any member of the healthcare team (CNA, PCT, PCP, NP, PA etc)
i-SBAR Hand-off to an RN
Pre-procedure checklist
Medication Administration: PO (SL, PO, Buccal)
Medication Administration: subcutaneous injection
Medication Administration: IVP(normal saline flush, pantoprazole)
Familiarization on how to use the IV pump and priming the IV tubing with 0.9% NaCl
Observed or Assisted hanging antibiotics (piggyback)
Observed the preparation, administration and post-monitoring for blood transfusion.
Peripheral IV insertion
Peripheral IV Removal
Indwelling foley catheter insertion
Indwelling foley catheter removal
Straight catheter/condom catheter insertion/application
Enema Administration
Colostomy/Ileostomy Care
Wound Care
Tracheostomy Care
Tracheostomy Suctioning
Post-mortem Care

Protocol Familiarization

Protocol	Knowledgeable	Experienced
Potassium Replacement Protocol
Hyperkalemia Treatment Using Insulin
Heparin Protocol
Insulin Sliding Scale Protocol
Adult Hypoglycemic Treatment Protocol
Low Risk Cardiac Chest Pain/Suspected ACS Protocol
Blood Transfusion Guidelines

Comments:

Student Signature:

Clinical Faculty Signature:

Import Data File

💡 How to Save Your Work:

Save to Browser: Stores data locally (only on this computer/browser)
Export Data File: Downloads your data as a .json file you can save anywhere and reload later
Import Data File: Load a previously exported .json file to restore your data
Print Form: Creates a PDF with your current entries

AdventHealth University

NURS 320 Adult Health II

Clinical Skills Checklist - DEU Clinical Model

Instructions:

Clinical Skills Assessment

Protocol Familiarization