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Nursing Skills & Procedures

Step-by-step procedures, competency checklists, and evidence-based techniques for core and advanced nursing skills — from vital signs and medication administration to specimen collection and cardiac monitoring.

By The Nurse.ICU TeamUpdated
Nursing skills and procedures — step-by-step clinical guides and competency checklists

Master essential nursing skills with step-by-step procedures, competency checklists, and evidence-based techniques for safe, effective patient care. Verify each procedure against your facility’s current policies before performing it.

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

Medication administration

Oral medications

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

Intramuscular injection

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

Injection sites

  • Deltoid: 1–2 mL; avoid the 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 × width × 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 the procedure
  2. Position the patient comfortably
  3. Perform hand hygiene and don clean gloves
  4. Remove the old dressing carefully
  5. Assess the wound and surrounding tissue
  6. Clean hands and establish a sterile field
  7. Clean the wound per facility protocol
  8. Apply a new dressing using sterile technique
  9. Secure the 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 the need for suctioning
  • Explain the procedure to the patient
  • Pre-oxygenate if indicated
  • Use sterile technique for trach/ET
  • Limit suction time to 10–15 seconds
  • Monitor the patient throughout the procedure

Incentive spirometry

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

Specimen collection & laboratory

Blood collection — venipuncture

  1. Verify patient identity and orders
  2. Assemble equipment and label tubes
  3. Position the patient’s arm comfortably
  4. Apply the tourniquet 3–4 inches above the site
  5. Select a vein using inspection and palpation
  6. Clean the site with alcohol in a circular motion
  7. Insert the needle at a 15–30 degree angle
  8. Fill tubes in the correct order
  9. Remove the tourniquet before the 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 — clean catch midstream

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

Urinalysis — catheterized specimen

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

Nutrition & elimination

  • Nasogastric tube insertion: Measure from nose to earlobe to xiphoid process. Insert with the patient’s head flexed forward. Verify placement with X-ray before use.
  • Catheter insertion: Use sterile technique. Select the appropriate size (14–16 Fr for adults). Inflate the 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 the bed, use a gait belt
  • Wheelchair to bed: lock wheels, remove footrests
  • Two-person lift: for dependent patients
  • Mechanical lift: when a manual lift is unsafe

Body mechanics

  • Keep your back straight and bend your knees
  • Get close to the object or patient
  • Use your legs for lifting, not your 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

Basic skills

  • 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

  • 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