Full Name* Position* In order for us to assess your skills, identify any further training you may benefit from and select the correct placements for you, we would appreciate if you could complete the form below. Please tick the appropriate box and make any additional comments that you feel are necessary. PART 1 - SKILLS CLINICAL AWARENESS AND SPECIALIST KNOWLEDGE SKILL No Experience Limited Experience Competent Comment Psychotic Disorder Yes Yes Yes Yes Eating Disorder Yes Yes Yes Yes Home Treatment Yes Yes Yes Yes 1-1 specials Yes Yes Yes Yes Depression Yes Yes Yes Yes Suicide/Self Harm Yes Yes Yes Yes Suicide/Self Harm Yes Yes Yes Yes Overdose Yes Yes Yes Yes Learning Disabilities Yes Yes Yes Yes Challenging Behaviour Yes Yes Yes Yes Bi-Polar Disorder Yes Yes Yes Yes Schizophrenia Yes Yes Yes Yes Rehabilitation Yes Yes Yes Yes Drug and Alcohol Yes Yes Yes Yes Mother and Baby Yes Yes Yes Yes Elderly Mental Health Yes Yes Yes Yes Depression Yes Yes Yes Yes Personality Disorder Yes Yes Yes Yes Safeguarding (SOVA & SOCA) Yes Yes Yes Yes PICU Yes Yes Yes Yes Autistic Spectrum Disorder Yes Yes Yes Yes Asperger's Syndrome Yes Yes Yes Yes HMP's Yes Yes Yes Yes Forensic Psychiatry Yes Yes Yes Yes Learning Disorder Yes Yes Yes Yes Family Therapy Yes Yes Yes Yes Low/Medium Secure Yes Yes Yes Yes Child & Adolescent psychiatric disorder and Treatment Yes Yes Yes Yes DRUG ADMINISTRATION PRACTISE AND PROCEDURES SKILL No Experience Limited Experience Competent Comment IM Injection Yes Yes Yes Yes Methadone Clinics/Admin Yes Yes Yes Yes Oral Administration Yes Yes Yes Yes Calculations Yes Yes Yes Yes Depot Injections Yes Yes Yes Yes SC Injection Yes Yes Yes Yes Clozapine Clinics/Admin Yes Yes Yes Yes SKILLS AND PHYSICAL OBSERVATIONS SKILL No Experience Limited Experience Competent Comment Supervising/teaching junior staff Yes Yes Yes Yes Ability to delegate Yes Yes Yes Yes Risk Assessment Yes Yes Yes Yes Universal Precautions Yes Yes Yes Yes Epilepsy / Seizure Management Yes Yes Yes Yes Response to Critical incidents Yes Yes Yes Yes Emergency Procedures Yes Yes Yes Yes Occupational Hazards Yes Yes Yes Yes Ability to manage a ward/team Yes Yes Yes Yes Physical Intervention Techniques Yes Yes Yes Yes Wound & Skin Care Yes Yes Yes Yes Specimen Collection Yes Yes Yes Yes TPR & BP Yes Yes Yes Yes Diabetes Yes Yes Yes Yes Nutritional Requirements Yes Yes Yes Yes DOLS Yes Yes Yes Yes HONOS PBR Yes Yes Yes Yes KNOWLEDGE AND UNDERSTANDING SKILL No Experience Limited Experience Competent Comment Child Protection Yes Yes Yes Yes Health Promotion Yes Yes Yes Yes NHS Community Care Act 1990 Yes Yes Yes Yes Equal Opportunities Yes Yes Yes Yes Ability to work within a multidisciplinary team Yes Yes Yes Yes Primary Nursing Yes Yes Yes Yes Mental Health act 1983 Yes Yes Yes Yes Health and Safety Yes Yes Yes Yes Clinical Governance Yes Yes Yes Yes NMC Code of Conduct Yes Yes Yes Yes Ensure actions contribute to equality Yes Yes Yes Yes Physical Intervention (last resort) Yes Yes Yes Yes Care programme approach to patient Yes Yes Yes Yes TMVA Therapeutic Management/PPI Yes Yes Yes Yes DOCUMENTATION SKILL No Experience Limited Experience Competent Comment Prioritise Care Yes Yes Yes Yes Meet Deadlines Yes Yes Yes Yes Observations and Care Pathways Yes Yes Yes Yes Referral Documentation Yes Yes Yes Yes Incident Reports Yes Yes Yes Yes Assess, Plan and Implement Care Yes Yes Yes Yes PART 2 - CLINICAL MATH QUESTIONS PLEASE MAKE SURE ALL CALCULATIONS (WORKINGS OUT) ARE WRITTEN ALONGSIDE YOUR ANSWERS Q1. You prescribe a patient 0.5 g of paracetamol. How many milligrams is this? Q2. Covert 1.5 litres to mL Q3. A patient is prescribed Budesonide 1000 micrograms by nebulizer. The medication is available as 500 micrograms / 1mL ampoules. How many ampoules are required? Q4. A patient has cardiac failure and has a daily fluid allowance of 1500 ml. He has taken 900 ml. What percentage of his allowance is left? Q.5 A patient is prescribed 80 mg of Tramadol Hydrochloride injection. The stock dose is 100mg / 2 mL. What volume will you require? Q6. Prescription for IV doxapram: 0.1mg/kg/minute. You have a 90kg patient and a bag of 500mg in 250ml. To be completed by Nurse applicant: Name* Email* Position* Phone* Date* Δ
