Self Assessment: LPN
Name:
Directions: Indicate your level of skill and experience by checking the boxes below according to the definitions listed.	Highly Skilled: Able to instruct and supervisor Skilled: Able to function independently Limited Skill: Experienced, but may need review No Experience: No direct experience
Core Skills:	Highly Skilled	Skilled	Limited Skill	No Experience
Admission of Patient
Discharge of Patient
Emergency Situations
Vital Signs
Post Mortem Care
Documentation
Specimen Collection
Patient/Family Education
Assessment of Abuse
Restraints
Body Mechanics
Aseptic Technique
Isolation Precautions
Medication Administration:
PO Medications
IM Injections
SQ Injections
Z-Track
Rectal Suppositories
Nasal Sprays
Ear Drops
Eye Drops
Inhalers
Emergency Drugs/Code
Calculations
IV Push
Heplock Flushes
Initiation of IV
Administration of IV Fluid
Wound Management:
Skin Assessment
Surgical Wound Healing
Sterile Dressing Change
Infectious Disease Management:
Universal Precautions
Isolation Technique
Reverse Isolation
Fever Management
Pain Management:
Pain Scales
Pain Tolerance
Assessment
Age Specific Care:
Newborn/Neonatal
Infant (30 days - 1 yr)
Toddler (1-3 yrs)
Preschool (3-5 yrs)
School Age (5-18 yrs)
Adolescent (12-18 yrs)
Young Adults (18-39 yrs)
Middle Adults (39-64 yrs)
Older Adults (64+ yrs)
Nursing Unit Experience: Please indicate number of years
Medical Surgical
Telemetry
Orthopedics
Oncology
Labor and Delivery
Pediatrics/NICU/PICU
PACU
Psychiatry
Operating Room
Hemodialysis
ICU/CCU
CVICU
ER
Case Management
Dialysis
Certifications:
BCLS       ACLS       NRP       Other
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