Competencies for Nursing Skills

Associate Degree RN Baccalaureate Degree RN

Administering Blood Products

Obtain and document baseline vital signs according to Same
agency policies and procedures.
Obtain blood transfusion history. Initiate administration of Same
blood products. according to agency policies and
procedures.
Evaluate and document client response to administration Same
of blood products.

Admission, Transfer, Discharge

Admit client to a health-care facility following facility’s Same
policies and procedures.
Transfer client within a health-care facility following Same
facility’s policies and procedures.
Assist client to exit a health-care facility following facility’s Same
policies and guidelines.
Assess client to determine readiness for discharge. Manage the discharge planning process.
Facilitate the continuity of care within and across health- Same
care settings.

Assessment of Vital Signs

Monitor and assess oral, rectal and axillary temperature. Same
Measure and record temperature using an electronic or Same
tympanic thermometer.
Monitor and assess peripheral pulses. Same
Monitor and assess apical pulse. Same
Monitor and assess apical-radial pulse. Same
Monitor and assess blood pressure. Same
Monitor and assess respiratory rate and character. Same

Bowel Elimination
Document characteristics of feces. Same
Perform test for occult blood. Same
Administer enemas for cleansing or retention. Same
Remove a fecal impaction. Same
Provide and teach colostomy and ileostomy care. Same
Administer a rectal suppository. Same
Administer a rectal tube. Same
Develop client’s bowel retraining protocol. Same

Care of the Dying Client

During dying process, provide measures to decrease Same
client’s physical and emotional discomfort.
Evaluate final progress note on client’s chart to determine Same
completeness of information.
Associate Degree RN Baccalaureate Degree RN
Notify appropriate people and departments according to Same
agency’s policies and procedures.
Evaluate family’s response to client’s death and make Develop services that support dying clients and their
referrals as appropriate. families.
Provide care for body after client’s death according to Same
agency’s policies and procedures.

Circulatory Maintenance
Evaluate fetal heart rate pattern. Same
Apply anti-embolism stockings. Same
Obtain cardiopulmonary resuscitation certification. Same

Client Teaching
Assess and document client’s and/or family member’s
knowledge of specific procedure or health problem.
Assess client and significant support person(s) for learning
strengths, capabilities, barriers and educational needs.
Develop an individualized teaching plan based on
assessed needs.
Modify teaching plan based on evaluation of progress
toward meeting identified learning outcomes.
Provide client and significant support person(s) with the
information to make choices regarding health.
Teach client and significant support person(s) the
information and skills needed to achieve desired learning
outcomes.
Evaluate progress of client and significant support
person(s) toward achievement of identified learning
outcomes.
Implement teaching plan using individualized teaching and
learning strategies with clients and/or groups in structured
settings.
Assesses client’s readiness to learn.
Develop materials to provide client and/or family member
with information concerning procedure or health problem.
Same
Same
Same
Same
Using multiple teaching strategies, teach heterogeneous
groups of clients, accounting for individual differences.
Implement teaching plan using individualized teaching and
learning strategies with clients and/or groups in
unstructured settings.

Communication
Effectively use communication skills during assessment, Same
intervention, evaluation, and teaching.
Express oneself effectively using a variety of media in Same
different contexts.
Adapt communication methods to clients with special Same
needs (e.g., sensory or psychological disabilities).
Produce clear, accurate, and relevant writing. Same
Use therapeutic communication within the nurse–client Same
relationship.
Maintain confidentiality of nurse–client interactions. Same
Appropriately, accurately, and effectively communicate Evaluate effectiveness of communication patterns.
with diverse groups and disciplines using a variety of
strategies.
Elicit and clarify client preferences and values. Same
Evaluate dynamics of family interactions. Same
Associate Degree RN
Evaluate data concerning coping mechanisms of
client/family/support system.
Provide emotional support to client/family/support system.
Evaluate strengths of client and family/significant other.
Evaluate need for alternative methods of communicating
with client.
Use assertive communication skills in interactions with
clients and other health-care providers.
Communicate data concerning client to appropriate
members of the health-care team.
Communicate the need for consultation/referral to
interdisciplinary care team.
Collaborate with other health-team members to provide
nursing care.
Critical Thinking
Within acquired knowledge base, create alternative
courses of action, develop reasonable hypotheses, and
develop new solutions to problems.
Develop an awareness of personal values and feelings
and examine basis for them.
Evaluate credibility of sources used to justify beliefs.
Examine assumptions that underlie thoughts and
behaviors.
Seek out evidence and give rationale when questioned.
Delegation and Supervision
Provide assistive personnel with relevant instruction to
support achievement of client outcomes.
Coordinate the implementation of an individualized plan of
care for clients and significant support person(s).
Delegate aspects of client care to qualified assistive
personnel.
Supervise and evaluate activities of assistive personnel.
Baccalaureate Degree RN
Same
Same
Same
Same
Teach assertive communication skills to clients,
unlicensed assistive nursing personnel, and other licensed
nurses.
Same
Identifies and plans for services to assure continuity in
meeting health-care needs during transition from one
setting to another.
Collaborate with community members in planning care for
the community.
Same
Same
Same
Same
Use critical thinking to further develop working
hypotheses, using patterns and inconsistencies in data.
Specify aspects of nursing care that can appropriately be
delegated to unlicensed health-care providers and
assistive personnel.
Coordinate and/or implements plan of care for clients with
multiple nursing diagnoses, especially both physiological
and psychosocial diagnoses.
Delegate performance of nursing interventions.
Delegate nursing care given by others while retaining
accountability for the quality of care given to the client.
Supervise performance of nursing interventions.
Supervise nursing care given by others while retaining
accountability for the quality of care given to the client.
Manage community-based care for a group of clients.
Direct care for clients whose conditions are changing.
Direct care for clients in situations with a potential for
variation in client condition.
Supervise implementation of a comprehensive client
teaching plan.
Associate Degree RN
Documentation
Maintain privacy of client’s record.
Accurately document data according to agency’s policies
and procedures.
Use common abbreviations and nomenclature for
recording information in the client’s record.
Health Assessment
Using a systematic process, perform a head-to-toe
assessment.
Assess physical, cognitive, and psychosocial abilities of
individuals in all developmental stages.
Assess family structure, roles of family members, and
family’s strengths and weaknesses.
Evaluate an individual’s capacity to assume
responsibilities for self-care.
Assess community resources to determine possible
referral sources.
Use assessment findings to diagnose and evaluate quality
of care, and to deliver high-quality care.
Evaluate family’s emotional reaction to client’s illness
(e.g., chronic disorder, terminal illness).
Evaluate client’s emotional response to treatment.
Evaluate adequacy of client’s support systems.
Assist in diagnostic procedures used to determine client’s
health status.
Health Promotion
Facilitate parental attachment with newborn.
Determine the need for a health promotion program.
Evaluate risk factors related to client’s potential for
accident/injury/disease.
Baccalaureate Degree RN
Same
Same
Same
Establish a reporting and recording system to provide for
continuity and accountability of programs in designated
structured and unstructured settings (e.g., school health,
occupational health, community).
Perform a holistic assessment of the individual across the
lifespan.
Perform a risk assessment of the individual and family,
including lifestyle, family and genetic history, and other
risk factors.
Same
Perform assessment of using a family genogram.
Perform a community assessment for diverse populations.
Perform an assessment of the environment in which
health care is being provided.
Establish processes to identify health risks in designated
structured and unstructured settings (e.g., school health,
occupational health, community).
Integrate data from client, other health-care personnel,
and other systems to which client is linked (e.g., work,
church, neighborhood).
Modify data collection tools to make them appropriate to
client’s situation (e.g., language and culture, literacy level,
sensory deficit).
Perform family assessment.
Same
Same
Same
Same
Same
Develop and implement a health promotion program.
Same
Associate Degree RN Baccalaureate Degree RN
Evaluate client’s knowledge of disease prevention. Same
Evaluate client’s knowledge of lifestyle choices (e.g., Same
smoking, diet, exercise).

Heat and Cold Therapy

Evaluate client’s response to heat therapy. Same
Evaluate client’s response to cold therapy. Same
Evaluate client’s response to sitz bath. Same
Monitor and evaluate client’s response to hypothermia Same
blanket.
Monitor and evaluate infant’s response to radiant warmer. Same

Home Care Management

Evaluate ability of family/support system to provide care
for client.
Evaluate client’s home environment for self-care
modifications (e.g., doorway width, accessibility for
wheelchair, safety bars, etc.).
Same
Develop criteria to evaluate client’s home environment for
self-care modifications (e.g., doorway width, accessibility
for wheelchair, safety bars, etc.).

Infection Control
Use aseptic practices: hand washing, donning and Same
removing a face mask, gowning, donning and removing
disposable gloves, bagging articles, managing equipment
use for isolation clients, assessing vital signs.
Use universal precautions. Same
Use body substances isolation procedures. Same
Evaluate client’s immunization status. Same
Use surgical aseptic practices: hand scrub, donning and Same
removing a sterile gown, donning and removing sterile
gloves, preparing and maintaining a sterile field.
Assist with a sterile procedure. Same

Information and Health-Care Technology

Use technology, analyzes information, and selects
resources effectively.
Demonstrate competence with current technologies.
Use computers for record keeping and documentation in
health-care facilities.
Use technology, synthesizes information, and selects
resources effectively.
Same
Same
Use data management system to evaluate a
comprehensive program for monitoring health of
populations in designated structured and unstructured
settings (e.g., school health, occupational health,
community).

Intravenous Therapy
Perform venipuncture to obtain blood specimens. Same
Perform venipuncture with an over-the-needle device. Same
Prime tubing and hang IV fluids. Same
Load and discontinue a PCA pump. Same
Administer and document IV piggyback medications. Same
Associate Degree RN Baccalaureate Degree RN
Administer and document IV push medications. Same
Calculate IV flow rates. Same
Document medications administered through IV. Same
Discontinue an IV and document procedure. Same
Monitor and maintain an IV site and infusion. Same
Change IV tubing and container. Same
Prime tubing and hang IV fluids. Same
Determine amount of IV fluid infused and left-to-count Same
each shift.
Assess implanted infusion devices. Same
Maintain implanted infusion devices. Same

Medication Administration
Assess family members’ knowledge of medication Same
therapy: reasons for taking medication, daily dosages,
side effects.
Instruct clients and their families in the proper Same
administration of medications.
Accurately calculate medication dosages. Same
Gather information pertinent to the medication(s) ordered: Same
actions, purpose, normal dosage and route, common side
effects, time of onset and peak action, nursing
implications.
Administer and document administration of enteral and Same
parenteral medications per order.
Administer and document administration of topical Same
medications per order.
Evaluate client’s response to medication. Same
Perform eye and/or ear irrigation according to agency Same
guidelines.

Meeting Mobility Needs

Evaluate client’s need for range-of-motion exercises.
Evaluate client’s level of mobility.
Manage care of client who uses assistive devices.
Provide client or family member with list of resources to
contact when mobility or body alignment is impaired.
Evaluate client and/or family members’ ability to perform
range-of-motion exercises.
Same
Same
Same
Evaluate client’s need for range-of-motion exercises.
Evaluate client’s level of mobility.
Manage care of client who uses assistive devices.
Provide client or family member with list of resources to
contact when mobility or body alignment is impaired.
Evaluate client and/or family members’ ability to perform
range-of-motion exercises.
Associate Degree RN
Nursing Process
Analyze collected data to establish a database for client.
Identify client health-care needs to select nursing
diagnostic statements.
Consider complex interactions of actual and potential
nursing diagnoses.
Identify client goals and appropriate nursing interventions.
Develop and communicate nursing care plan.
Implement and document planned nursing interventions.
Establish priorities for nursing care needs of clients.
Evaluate and document the extent to which goals of
nursing care have been achieved.
Pain Management
Evaluate data from comprehensive pain history.
Evaluate and document client’s response to
pharmacological and nonpharmacological interventions.
Document client’s response to interventions used to
prevent or reduce pain.
Assess client when pain is not relieved through ordered
pharmacological and nonpharmacological methods.
Evaluate appropriateness of any pain medication taken by
clients.
Educate clients on correct use of medications.
Baccalaureate Degree RN
Perform comprehensive assessment to determine client’s
ability to manage self-care, including physiological,
psychosocial, developmental, and cognitive factors and
their interaction with each other.
Formulate individualized nursing diagnoses, based on a
synthesis of knowledge from nursing, biological and
behavioral sciences, and humanities, that reflect a health
problem and its etiology.
Consider complex interactions of actual and potential
nursing diagnoses, e.g., 2 or more physiological and/or
psychosocial nursing diagnoses.
Same
Same
Develop comprehensive plan of care in collaboration with
client.
Same
Implement a care plan for individuals, families, and
communities with complex health problems that have
unpredictable outcomes.
Use preventive, supportive, and restorative measures to
promote client comfort, optimum physiological functioning,
and emotional well-being.
Bases care planning on knowledge of primary, secondary
and tertiary levels of prevention.
Same
Participate in obtaining collective data concerning client
outcomes.
Deliver care that reflects an understanding of interactions
among potentially conflicting nursing interventions.
Initiate a comprehensive plan for discharge of client at
time of admission.
Care for clients in an environment that may not have
established protocols.
Care for clients in situations requiring independent
decision making, e.g., community-based practice settings.
Same
Same
Same
Collaborate with other members of health-care team to
identify alternative interventions.
Same
Same
Associate Degree RN Baccalaureate Degree RN
Manage and monitor client receiving epidural analgesia. Same
Teach client to use a PCA device. Same

Perioperative Care
Preoperatively, assess client’s risk for postoperative Same
respiratory complications.
Postoperatively, assess client’s ability to perform Same
respiratory exercises.
Preoperatively, assess client’s risk for postoperative Same
thrombus formation.
Postoperatively, assess client’s ability to perform passive Same
range-of-motion exercises.
Preoperatively, assess client’s willingness and capability Same
to learn exercises.
Preoperatively, assess family members’ willingness to Same
learn and to support client postoperatively.
Postoperatively, assess client’s condition during operative Same
procedure, including range of vital signs, blood volume or
fluid loss, fluid replacement, type of anesthesia, type of
airway and size and extent of surgical wound.

Personal Hygiene of Clients

Provide or assist with personal hygiene on developmental Same
and/or chronological age basis.
Provide or assist with personal hygiene needs as Same
determined by physical limitations and/or diagnosis.
Provide or assist with personal hygiene needs with Same
respect to client’s culture and/or religious values.
Provide or assist with personal hygiene care in hospital, Same
nursing home, or client’s home.
Assess and maintain chest tubes. Same

Safety and Comfort

Implement measures to protect the immunosuppressed Same
client.
Protect the client from injury. Same
Verify identity of the client. Same
Implement agency policies and procedures in the event of Same
client injury.
Follow policies and procedures for agency fires and safety Same
measures.
Follow procedures for handling biohazardous materials. Same
Assess need for restraints or other safety devices. Develop protocols for use of restraints or other safety
devices.
Implement nursing measures to reduce the risk for falls, Same
poisoning, and electrical hazards.
Prepare for internal and external disasters. Same
Develop a plan for reducing environmental stressors (e.g., Same
noise, temperature, pollution).
Associate Degree RN Baccalaureate Degree RN
Evaluate client’s orientation to reality. Same
Evaluate need for measures to maintain client’s skin Same
integrity.

Vascular Access Devices

Assist with insertion of central venous catheters. Same
Change a central venous catheter dressing. Same
Monitor administration of medications/nutrients via a Same
vascular access device.
Measure and monitor central venous pressure. Same
Maintain central vein infusions in adults and children. Same
Change parenteral hyperalimentation dressing and tubing Same

Wound Care And Dressings

Assess and manage wounds, including irrigation, Same
application of dressings, and suture/staple removal.
PCA = patient-controlled analgesia

Sources: Cowan, DT: Competence in nursing practice: A controversial concept––a focused review of literature. Accident &
Emergency Nursing, 151(1), 20–26, 2007.
Dickey, C, et al.: Nursing Skills Identified as Required Competencies. Helene Fuld Educational Mobility Grant. Oklahoma Nursing
Articulation Consortium, Kramer School of Nursing, Oklahoma City University.
Levett-Jones, TL: Facilitating reflective practice and self-assessment of competence through the use of narratives. Nurse Education in
Practice, 7(2): 112–119, 2007.