Candidate Name: ___________________________
Position Applied For: _______________________
Interviewer / Evaluator: ___________________
Date: ________________
Check each competency the candidate demonstrates during the interview, skills assessment, or simulation. Use the following scale:
✔ = Competent | ⚪ = Needs Improvement | N/A = Not Applicable
| Competency | Description | Status |
|---|---|---|
| Patient Assessment | Collects accurate vitals, performs physical exams, and reviews patient history | |
| Medication Administration | Prepares and administers medications safely and accurately | |
| Infection Control | Follows proper hand hygiene, PPE, and isolation protocols | |
| Patient Communication | Communicates clearly, empathetically, and effectively with patients and families | |
| Documentation | Maintains accurate, complete, and timely records | |
| Professionalism | Demonstrates ethical behavior, reliability, and accountability | |
| Teamwork | Collaborates effectively with colleagues and other healthcare providers | |
| Critical Thinking | Applies sound judgment in patient care and decision-making |
| Role | Competency | Description | Status |
|---|---|---|---|
| RN | IV / Infusion Management | Starts and manages IV lines, monitors infusions | |
| RN | Emergency Response | Responds appropriately to patient deterioration or code situations | |
| LPN | Wound Care | Performs dressing changes and monitors healing | |
| LPN | Medication Support | Administers medications under RN supervision | |
| CNA | Patient Assistance | Assists with bathing, feeding, mobility, and hygiene | |
| CNA | Vital Signs | Measures and records vital signs accurately |
(Specialty competencies can be added in the “Role-Specific” section based on ICU, ER, Pediatrics, Oncology, etc.)
| Specialty | Competency | Description | Status |
|---|---|---|---|
| ICU | Ventilator Management | Operates and monitors ventilators and respiratory support | |
| ICU | Hemodynamic Monitoring | Monitors and interprets cardiac and blood pressure data | |
| ER | Trauma Triage | Prioritizes care for multiple patients under emergency conditions | |
| Pediatrics | Developmental Assessment | Evaluates age-appropriate growth and behavior | |
| Oncology | Chemotherapy Administration | Safely prepares and administers chemo treatments | |
| NICU | Neonatal Care | Monitors and cares for premature or critically ill newborns |
Evaluator Signature: _______________________
This Competency Checklist can be used in conjunction with the Skill Assessment Grid and Behavioral & Situational Questions, providing a complete evaluation framework for RNNation clients.