Nurse.ICU
Real Resources for Real Nurses

Nursing Skills & Procedures

Master essential nursing skills with step-by-step procedures, competency checklists, and evidence-based techniques for safe, effective patient care.

🔧 Fundamental Nursing Skills

Vital Signs

Accurate measurement and interpretation

  • Blood pressure techniques
  • Pulse assessment sites
  • Respiratory rate monitoring
  • Temperature methods
  • Oxygen saturation

Physical Assessment

Systematic head-to-toe evaluation

  • Inspection techniques
  • Palpation methods
  • Percussion skills
  • Auscultation sites
  • Documentation standards

Infection Control

Standard and transmission-based precautions

  • Hand hygiene protocols
  • PPE selection and use
  • Isolation procedures
  • Sterile technique
  • Equipment disinfection

💉 Advanced Clinical Procedures

Master complex nursing procedures with detailed guides and safety protocols for specialized patient care.

💉 Medication Administration

Oral Medications

  1. Verify order and patient identification
  2. Check medication against MAR
  3. Assess patient's ability to swallow
  4. Provide appropriate liquid if needed
  5. Position patient upright
  6. Stay with patient until medication swallowed
  7. Document administration immediately

Intramuscular Injection

  1. Select appropriate site and needle gauge
  2. Perform hand hygiene and don gloves
  3. Clean injection site with alcohol
  4. Insert needle at 90-degree angle
  5. Aspirate to check for blood return
  6. Inject medication slowly and steadily
  7. Remove needle quickly, apply pressure

Injection Sites

  • Deltoid: 1-2 mL, avoid radial nerve
  • Vastus lateralis: Up to 3 mL, preferred for infants
  • Ventrogluteal: Up to 3 mL, safest for adults
  • Dorsogluteal: Avoid due to sciatic nerve risk

🩹 Wound Care & Dressings

Wound Assessment

  • Location: Anatomical description
  • Size: Length x width x depth in cm
  • Appearance: Color, tissue type
  • Drainage: Amount, color, consistency
  • Odor: Present or absent
  • Surrounding skin: Integrity, temperature

Sterile Dressing Change

  1. Gather supplies and explain procedure
  2. Position patient comfortably
  3. Perform hand hygiene, don clean gloves
  4. Remove old dressing carefully
  5. Assess wound and surrounding tissue
  6. Clean hands, establish sterile field
  7. Clean wound per facility protocol
  8. Apply new dressing using sterile technique
  9. Secure dressing and label with date/time
  10. Document findings and interventions

🫁 Respiratory Procedures

Oxygen Therapy

  • Nasal Cannula: 1-6 L/min (24-44% FiO2)
  • Simple Face Mask: 6-10 L/min (40-60% FiO2)
  • Non-rebreather: 10-15 L/min (80-95% FiO2)
  • High-flow nasal cannula: Up to 60 L/min

Always assess respiratory status before and after oxygen administration

Suctioning

  • Assess need for suctioning
  • Explain procedure to patient
  • Pre-oxygenate if indicated
  • Use sterile technique for trach/ET
  • Limit suction time to 10-15 seconds
  • Monitor patient throughout procedure

Incentive Spirometry

  • Position patient upright
  • Demonstrate proper technique
  • Inhale slowly and deeply
  • Hold breath 2-3 seconds
  • Exhale slowly through mouth
  • Repeat 10 times every hour while awake

🔬 Specimen Collection & Laboratory

Proper specimen collection techniques to ensure accurate laboratory results and optimal patient care.

🩸 Blood Collection

Venipuncture Procedure

  1. Verify patient identity and orders
  2. Assemble equipment and label tubes
  3. Position patient's arm comfortably
  4. Apply tourniquet 3-4 inches above site
  5. Select vein using inspection and palpation
  6. Clean site with alcohol in circular motion
  7. Insert needle at 15-30 degree angle
  8. Fill tubes in correct order
  9. Remove tourniquet before needle
  10. Apply pressure and bandage

Order of Draw

  1. Blood culture bottles (sterile)
  2. Light blue (coagulation studies)
  3. Red/gold (chemistry, serology)
  4. Green (heparinized plasma)
  5. Lavender/purple (hematology)
  6. Gray (glucose, lactate)

💧 Urinalysis Collection

Clean Catch Midstream

  1. Explain procedure to patient
  2. Provide sterile collection container
  3. Instruct patient to clean genital area
  4. Begin urination, stop, then collect midstream
  5. Fill container 1/2 to 3/4 full
  6. Replace lid without contaminating inside
  7. Label specimen and send to lab promptly

Catheterized Specimen

  • Use sterile technique throughout
  • Clamp tubing below sampling port
  • Clean sampling port with alcohol
  • Insert needle into port at 45-degree angle
  • Withdraw required amount of urine
  • Transfer to sterile container
  • Unclamp tubing and document

🍽️ Nutrition & Elimination

Nasogastric Tube Insertion

Measure from nose to earlobe to xiphoid process. Insert with patient's head flexed forward. Verify placement with X-ray before use.

Catheter Insertion

Use sterile technique. Select appropriate size (14-16Fr for adults). Inflate balloon with sterile water only after confirming bladder placement.

Enteral Feeding

Check tube placement before each feeding. Aspirate stomach contents and check pH (<5.5 indicates gastric placement). Monitor for residual volume.

🚶 Mobility & Safety

Fall Risk Assessment

  • History of falls
  • Cognitive impairment
  • Medications affecting balance
  • Visual or hearing deficits
  • Mobility limitations
  • Orthostatic hypotension

Transfer Techniques

  • Bed to Chair: Lower bed, use gait belt
  • Wheelchair to Bed: Lock wheels, remove footrests
  • Two-Person Lift: For dependent patients
  • Mechanical Lift: When manual lift unsafe

Body Mechanics

  • Keep back straight and bend knees
  • Get close to the object/patient
  • Use legs for lifting, not back
  • Avoid twisting motions
  • Get help when needed

❤️ Cardiac Monitoring

12-Lead ECG Placement

  • V1: 4th intercostal space, right sternal border
  • V2: 4th intercostal space, left sternal border
  • V3: Midway between V2 and V4
  • V4: 5th intercostal space, midclavicular line
  • V5: Same level as V4, anterior axillary line
  • V6: Same level as V4 and V5, midaxillary line

Basic Rhythm Interpretation

  • Rate: 60-100 bpm normal
  • Rhythm: Regular vs irregular
  • P waves: Present and consistent
  • PR interval: 0.12-0.20 seconds
  • QRS complex: <0.12 seconds

✅ Competency Checklists

Use these comprehensive checklists to validate nursing skills and ensure competency in clinical procedures.

📋 Skills Validation Checklist

Basic Skills Checklist

  • □ Hand hygiene technique
  • □ Vital signs measurement
  • □ Medication administration (PO, IM, SQ)
  • □ IV insertion and maintenance
  • □ Catheter insertion
  • □ Wound care and dressing changes
  • □ Documentation standards

Advanced Skills Checklist

  • □ Central line access and care
  • □ Ventilator management
  • □ Hemodynamic monitoring
  • □ Code blue response
  • □ Blood product administration
  • □ Tracheostomy care
  • □ Specialized equipment operation

Assessment Skills

  • □ Head-to-toe physical assessment
  • □ Neurological assessment
  • □ Pain assessment and management
  • □ Fall risk evaluation
  • □ Pressure ulcer risk assessment
  • □ Mental health screening
  • □ Family teaching and discharge planning

🎓 Continuing Education

Required Annual Training

  • BLS (Basic Life Support) certification
  • Fire safety and emergency procedures
  • Infection control updates
  • Patient safety initiatives
  • HIPAA privacy training
  • Cultural competency

Specialty Certifications

  • ACLS: Advanced Cardiac Life Support
  • PALS: Pediatric Advanced Life Support
  • TNCC: Trauma Nursing Core Course
  • ENPC: Emergency Nursing Pediatric Course
  • CCRN: Critical Care Registered Nurse
  • CEN: Certified Emergency Nurse

📚 Skill Development Resources

Online Learning Platforms

Professional Organizations