Yearly Competency and Required Courses for PACU CNA

FY 2014/2015

Name: _____________________________________ Unit: __AIP PACU________________ Date completed: ________________________
This form should be completed by the employee and includes a list of skills, competencies and on-line courses that you must complete each year.
Record the date for each item completed in the appropriate box. Provide a copy of this document demonstrating competency progress to your
manager at the time for your annual evaluation and a completed copy by the end of the year.






Mandatory
Skills Checklist
Assessment content/Verification
method
Rating Comment (Required
for does not meet)
Date assessed/
initials
Regulatory Requirements

ULearn
Completes ULearn assigned
courses
Meets
Does Not
Meet
N/A

Glucometer Completes glucometer
competency by November, 2015
Meets
Does Not
Meet
N/A




Rating:
M Meets
DNM Does not meet
N/A Not applicable
2

For each of the competency statements listed below, the employee may select which method of assessment and verification he/she would like to
use for validation of this content.

Competency
Checklist
Assessment content/Verification method Rating Comment (Required for does
not meet
Date assessed/
Initials

Service Excellence

Must choose and complete 1 of the following
activities:

Observed interactions: 2 Peer Audits
Exemplar
Attend committee meeting: Reflective
paragraph
Read article: Identify 3 concepts for practice
Attend in-service or educational offering: CEU
record
Shadow FCC: Exemplar


Meets
DNM
N/A


Roles/Jobs During
Emergencies

Must choose and complete 1 of the following
activities:
Exemplar
Mock event: Evaluation
Case study: Evaluation
Presentation: Attendance record
Meets
DNM
N/A


Joint Commission
Compliance
Competency


Must choose and complete 1 of the following
activities:
Review PowerPoint: Posttest
Outcomes board: Peer review
Mock event: Participation form
Assist management: Form verified
Synopsis
Meets
DNM
N/A

CNA Participation
in Vital
Signs/Monitors
Must choose and complete 1 of the following
activities:
Direct observation: 2 Peer audits
Meets
DNM

3

Competency
Checklist
Assessment content/Verification method Rating Comment (Required for does
not meet
Date assessed/
Initials
Written test: Posttest
Exemplar
Return demonstration: 2 Evaluations
N/A

Validator Signature Initials Validator Signature Initials Validator Signature Initials



Signature of Employee
(upon full completion)
Date
Completed
Nurse Manager/Designee Reviewer Date Reviewed