Clinical Competency Guide | GCC Nursing Skills Assessment

IV Cannulation — Peripheral

Cannula Gauge Quick Reference

Gauge	Colour	Flow Rate	Indication
14G	Orange	~270 mL/min	Rapid fluid resuscitation / major trauma
16G	Grey	~180 mL/min	Surgery, blood transfusion, fast fluids
18G	Green	~96 mL/min	Standard IV fluids, blood products
20G	Pink	~54 mL/min	IV medications, routine access
22G	Blue	~31 mL/min	Paediatrics, fragile veins, elderly
24G	Yellow	~13 mL/min	Neonates, very small/fragile veins

Venepuncture

Procedure Steps & Order of Draw

Confirm clinical indication, check patient ID (2 identifiers), review request form for correct tubes.
Position patient comfortably. Apply tourniquet to distend veins. Identify suitable antecubital or forearm vein.
Clean with chlorhexidine 2%/alcohol. Allow to dry. Insert needle bevel-up at 20–30° angle.
Attach vacuum tube. Fill to line. Release tourniquet BEFORE withdrawing needle to prevent haematoma.
Withdraw needle, apply pressure with gauze, label tubes at bedside before leaving patient.
Document procedure, transport to laboratory promptly (within recommended stability windows).

VACUETTE Order of Draw

Order	Cap Colour	Additive	Use
1st	Blood Culture Bottles	SPS	Microbiology — aerobic first, then anaerobic
2nd	Blue	Sodium Citrate (3.2%)	Coagulation (PT, APTT, INR)
3rd	Gold / Red	Clot activator/gel	Biochemistry (LFTs, TFTs, U&E, lipids)
4th	Green	Lithium Heparin	U&E, stat chemistry
5th	Lavender / EDTA	EDTA	FBC, HbA1c, blood film
6th	Grey	Fluoride Oxalate	Glucose, lactate
7th	Black	Sodium Citrate (3.8%)	ESR

Blood Cultures

Blood Culture Collection Checklist

Strict aseptic non-touch technique (ANTT) is mandatory. Contamination rates should be <3%. Always collect TWO sets from TWO separate sites.

Confirm clinical indication (temp >38°C or <36°C, rigors, clinical suspicion of bacteraemia/sepsis).
Gather two sets of bottles (aerobic + anaerobic per set = 4 bottles total). Check expiry dates.
Perform hand hygiene. Clean each bottle top with 70% alcohol wipe for 60 seconds, allow to dry.
Clean venepuncture site with chlorhexidine 2% in alcohol. Allow to dry fully — do NOT fan dry.
Collect minimum 10 mL per bottle (8–10 mL for adults). Inoculate anaerobic bottle first (or simultaneously).
Repeat at second separate site (contralateral arm preferred) for second set.
Label each bottle with patient ID, date, time, site of collection. Dispatch to lab within 30 minutes.
Do NOT refrigerate bottles. Incubate at 37°C or send immediately.

Oral Medication Safety Checklist

The 10 Rights of Medication Administration

Right PatientRight Drug Right DoseRight Route Right TimeRight Documentation Right ReasonRight Response Right to RefuseRight Education

Verify prescriber's order — legible, signed, dated. Query incomplete or unclear orders before proceeding.
Check patient ID using at least 2 identifiers (name + DOB, or name + MRN). Match against wristband.
Review allergies — check wristband AND medication chart. If allergy present, do NOT administer and notify prescriber.
Perform medication calculation independently or with qualified witness for high-alert medications.
Administer medication. Remain present to confirm ingestion. Do not pre-pour medications.
Document immediately after administration — never before. Record time, dose, route, your signature.
Monitor for therapeutic effect and adverse reactions per drug profile.

NG Tube Medication Administration

Position Confirmation & Administration Steps

Tube position MUST be confirmed before EVERY medication administration. Gold standard = chest/abdominal X-ray. Bedside = gastric aspirate pH <5.5.

Stop enteral feed 30 minutes before administration (check per drug guidelines). Flush tube with 30 mL sterile water.
Confirm tube position: aspirate gastric contents, test with CE-marked pH paper. Record pH. If pH ≥5.5 — do NOT give medication, escalate.
Prepare medications individually. Crush only immediate-release (IR) solid-dose tablets. Disperse in 10–15 mL water.
Administer each drug separately, flushing with 10 mL water between drugs.
Flush with final 30 mL sterile water after all medications given. Re-attach feed if prescribed.
Document time, drugs given, tube position check result, flush volumes.

NEVER crush: Modified-release (MR/XL/LA/SR), enteric-coated (EC), buccal, sublingual, cytotoxic, or hormone-containing tablets. Contact pharmacist for liquid alternatives or alternative routes.

Subcutaneous Insulin Injection

Technique & Rotation Guide

Recommended Sites

Abdomen, thighs, upper arms, buttocks

Needle Angle

90° (most adults); 45° if thin/child

Needle Length

4 mm (standard), 6 mm, 8 mm

Pen Priming

Prime 2 units before EACH injection

Hold After Injection

10 seconds before withdrawing

Insulin Temperature

Inject at room temperature (not fridge-cold)

      Rotation: Rotate within and between sites to prevent lipohypertrophy. Never inject into lumpy or hard areas.
      
Air bubbles: Remove air bubbles by tapping pen/syringe upright before injection.

Intramuscular (IM) Injection

Sites, Volumes & Z-Track Technique

Site	Max Volume	Landmark	Notes
Ventrogluteal	4 mL	Greater trochanter + ASIS triangle	Preferred site — fewest major blood vessels/nerves
Vastus Lateralis	5 mL	Middle third of lateral thigh	Preferred for infants; good for self-injection
Deltoid	1 mL	3 finger-widths below acromion process	Vaccines, small volumes only
Dorsogluteal	4 mL	Upper outer quadrant	Not recommended — risk of sciatic nerve injury

      Z-Track Technique: Pull skin laterally 2.5–3.5 cm with non-dominant hand. Insert needle at 90°, inject medication slowly, hold 10 seconds, withdraw while releasing skin. Prevents tracking of irritant medications into subcutaneous tissue.
      
Aspiration: Not recommended for vaccines (WHO/ACIP guidance). May be appropriate for specific drugs per local protocol — follow your facility policy.

IV Drug Administration

Reconstitution, Dilution & Infusion Rate

Check drug, dose, diluent and concentration against BNF/facility formulary. Use manufacturer's SmPC for reconstitution details.
Reconstitute powder vials with correct diluent volume. Swirl (do not shake) until fully dissolved.
Further dilute to prescribed concentration in appropriate bag (NS 0.9%, D5W, etc.). Label bag with drug, concentration, date, time, prepared by.
Program infusion pump. Double-check rate calculation: Rate (mL/hr) = Volume (mL) ÷ Time (hr).
Prime IV line, remove air bubbles. Connect to patient's IV access and commence infusion.
Monitor patient during infusion — check for extravasation, allergic reaction, haemodynamic changes.

Infusion Rate Formula

mL/hr = Volume (mL) ÷ Time (hours)  |  Drops/min = Volume × Drop factor ÷ (Time in min)

Vital Signs — Normal Ranges & Technique

Temperature

Route	Normal Range	Notes
Oral	36.1–37.2°C	Place probe under tongue. Avoid hot/cold drinks 15 min prior.
Axillary	35.9–36.7°C	Less accurate; add ~0.5°C for core estimate.
Rectal	36.6–37.9°C	Gold standard (0.5°C above oral). Use only if clinically indicated.
Tympanic	36.1–37.5°C	Pull pinna back and up (adults); straight back (children <3yrs). Correct probe position is critical.

Blood Pressure & Pulse

      BP Correct Technique: Patient seated, arm at heart level, feet flat, back supported, no talking. Cuff covers 80% arm circumference. Take 2 readings 1–2 min apart. First visit: measure both arms — use higher reading arm subsequently.
    

Normal BP

90–139 / 60–89 mmHg

Normal HR (adult)

60–100 bpm

Radial Pulse — count

60 seconds (irregular); 30s ×2 (regular)

Pulse Character

Rate · Rhythm · Volume · Character

      SpO2: Probe on clean, warm finger (not nail-varnished). Normal 95–100%. Limitations: nail varnish, cold peripheries, dark skin, movement artefact, CO poisoning (falsely elevated — requires co-oximetry). Confirm with clinical assessment.
    

      Respirations: Observe chest rise covertly for 60 seconds immediately after checking pulse (patient unaware). Normal adult: 12–20 breaths/min. Document rate, depth, and pattern.
    

NEWS2 — National Early Warning Score 2

Interactive NEWS2 Calculator

Resp. Rate (breaths/min)

SpO2 (%)

SpO2 Scale

Supplemental O2

Systolic BP (mmHg)

Heart Rate (bpm)

Consciousness

Temperature (°C)

Score	Risk	Response
0–4	Low	Routine monitoring. Minimum 12-hourly NEWS2.
5–6 or any single 3	Medium	Urgent review by registered nurse + consider medical review. Continuous monitoring.
7+	High	Emergency response. Immediate medical review. Consider HDU/ICU transfer.

Pain Assessment Tools

FLACC Scale (non-verbal / paediatric)

Face

Legs

Activity

Cry

Consolability

Other Pain Scales — Reference

Scale	Population	Range	Notes
NRS (Numeric)	Adults, verbal	0–10	0=no pain, 10=worst imaginable. Simple, widely used.
VAS (Visual Analogue)	Adults, literate	0–100 mm	Patient marks 10 cm line. Measure with ruler.
Wong-Baker FACES	Children ≥3 yrs	0–10	6 face images from happy to crying. Child points to face.
CPOT	ICU non-verbal	0–8	4 domains: facial expression, body movements, muscle tension, ventilator compliance.
FLACC	Children & non-verbal adults	0–10	0–3 mild, 4–6 moderate, 7–10 severe pain.

Blood Glucose Monitoring

Finger-Prick Technique

Wash patient's hands with soap and water, dry thoroughly. Warm if peripherally cool.
Use automated lancet device. Select lateral pad of fingertip (avoid central pulp — more painful). Rotate sites.
Discard first drop of blood (may be diluted with interstitial fluid). Use second drop.
Apply blood to test strip edge — fill completely. Read result per meter display. Note meter calibration status.
Apply pressure. Record result, time, and clinical context in patient notes and medication chart.

BGL (mmol/L)	Status	Action
<4.0	Hypoglycaemia	Treat per hypoglycaemia protocol. 15g fast-acting carbs if conscious. Recheck 15 min.
4.0–7.8	Target (fasting)	Routine monitoring.
7.9–11.0	Above target	Review insulin/diet. Notify diabetes team if persistent.
>11.0 (or HI)	Hyperglycaemia	Confirm with lab if symptomatic. Assess for DKA/HHS. Medical review.

Weight, BMI & Nutritional Assessment

BMI Calculator

Weight (kg)

Height (cm)

      Scales technique: Calibrate scales before use. Patient wears minimal clothing, no shoes. Document to nearest 0.1 kg. For serial monitoring — same time of day, same scale, same conditions.
    

ANTT — Aseptic Non-Touch Technique

Core Principles

Key Parts

Sterile components that must never be touched or contaminated (e.g. needle tip, catheter tip, wound bed)

Key Sites

Entry points into the body — insertion sites, open wounds, IV access ports

Aseptic Field

Critical (dressing pack inner surface) — keep sterile. General (outer dressing pack) — keep clean.

Two ANTT Types

Standard ANTT (bedside/community) vs Surgical ANTT (theatre, central lines, complex wounds)

      The Golden Rule: Never touch — and never allow anything non-sterile to touch — key parts or key sites. If in doubt, change the item.
    

Wound Dressing — ANTT Checklist

Dressing Change Step-by-Step

Perform hand hygiene (WHO 6-step). Prepare clean workspace. Gather all equipment before starting.
Open sterile dressing pack onto clean field using outer corners only. Open additional supplies without contaminating sterile field.
Apply non-sterile gloves. Remove old dressing carefully. Observe dressing for exudate colour, volume, odour.
Discard old dressing and gloves. Perform hand hygiene. Don sterile gloves (Surgical ANTT) or maintain ANTT (Standard).
Assess wound using MEASURE: Measure (size/depth), Exudate, Appearance, Suffering, Undermining, Re-evaluate, Edge.
Irrigate wound with 0.9% NaCl or appropriate cleanser. Swab from cleanest to dirtiest area (wound bed outward).
Apply appropriate dressing based on wound type (dry, moist, infected, sloughy, granulating — see dressing selection guide).
Secure dressing without tension. Ensure patient comfort. Dispose of clinical waste appropriately.
Remove gloves, perform hand hygiene. Document: wound assessment findings, dressing applied, next change date, any concerns.

Wound Dressing Selection Guide

Wound Type	Dressing Choice	Notes
Clean, dry, healing	Low-adherent / vapour-permeable film	Promote moist healing environment
Heavily exuding	Foam / Alginate	High-absorbency; change when saturated
Sloughy / necrotic	Hydrogel / Hydrocolloid	Rehydrate and facilitate autolytic debridement
Infected wound	Silver-impregnated / Iodine cadexomer	Anti-microbial; culture before applying
Granulating wound	Non-adherent foam or soft silicone	Protect fragile granulation tissue
Cavity wound	Alginate rope / Foam cavity	Light packing — do NOT over-pack

Urinary Catheter Care — CAUTI Prevention Bundle

Daily CAUTI Bundle Review

Daily need review Hand hygiene before access Meatal hygiene x2 daily Closed drainage system Bag below bladder level Never kink tubing Remove ASAP when no longer needed

      Meatal hygiene: Clean with soap and water during daily wash. Wipe from meatus outward using single swipe per area. Avoid antiseptic solutions routinely — evidence shows no benefit over soap and water.
    

Hand Hygiene — WHO 6-Step Technique

When & How

Before patient contact Before aseptic procedure After body fluid exposure After patient contact After contact with surroundings

Step	Action
1	Palm to palm — rub together
2	Right over left, interlaced fingers (back of hands)
3	Palm to palm, fingers interlaced
4	Backs of fingers to opposing palms (interlocked)
5	Rotational rubbing of right thumb in left palm; repeat opposite
6	Rotational rubbing of clasped fingers in right palm; repeat opposite

ABHR (Handrub)

15–30 seconds minimum

Soap & Water

40–60 seconds minimum

Use soap & water when:

Hands visibly soiled, C. diff exposure, norovirus outbreak

GCC Nursing Competency Frameworks

DHA — Dubai Health Authority

Entry Level RN: Direct supervision required. Core clinical skills, medication safety, documentation.
Intermediate RN: Independent practice. Evidence-based care, patient education, team collaboration.
Advanced RN: Leadership, preceptorship, clinical decision-making, quality improvement participation.

SCHS — Saudi Commission for Health Specialties

Clinical Care Communication Leadership Education Research

Annual competency verification required for license renewal. Portfolio-based evidence. Minimum CPD hours per licensing cycle.

QCHP — Qatar Council for Healthcare Practitioners

Nursing scope of practice defined by registration level (RN, Senior RN, Clinical Nurse Specialist). Competency assessed at registration and for renewals.

Domain	Description
Professional & Ethical Practice	Accountability, confidentiality, scope of practice, professional conduct
Patient-Centred Care	Assessment, planning, intervention, evaluation, patient safety
Communication & Collaboration	Handover (ISBAR), teamwork, escalation, documentation standards
Leadership & Management	Delegation, resource management, change management, supervision
Education & Development	CPD, clinical teaching, evidence-based practice, competency maintenance

Annual Competency Verification — GCC Hospitals

Commonly Assessed Clinical Skills

IV Cannulation Venepuncture NG tube insertion Medication administration BLS / AED ABG sampling Blood cultures Urinary catheterisation Wound assessment & dressing NEWS2 & escalation

Supervision Levels & Clinical Portfolio

Progression Framework

Level	Description	Portfolio Evidence
Supervised Practice	Assessor present, directly observing every attempt	Assessor signature, date, comments on each attempt
Supported Practice	Assessor available but not directly observing every step	Dated entries, reflective accounts, spot checks
Unsupervised Practice	Competent to practise independently per scope	Completed competency sign-off, annual review date
Teaching Others	Assessed to teach and supervise others in this skill	Teaching records, trainee evaluations, NMC/assessor record

      Portfolio Entries Must Include: Date of procedure, patient/case context (anonymised), assessor name and PIN, supervision level, your reflection (what went well, what to improve), assessor counter-signature.
    

Quick Reference — Clinical Mnemonics

ISBAR — Escalation Handover

I — Identity (who are you, who is the patient)
S — Situation (what is the problem right now)
B — Background (history, diagnosis, current treatment)
A — Assessment (your clinical assessment of the situation)
R — Recommendation (what action do you want/need)

MEASURE — Wound Assessment

M — Measure (length × width × depth in cm)
E — Exudate (colour, volume, consistency)
A — Appearance (tissue type — granulation, slough, necrotic)
S — Suffering (pain score)
U — Undermining (palpate wound edges)
R — Re-evaluate (response to treatment)
E — Edge (attached vs. non-attached, EPT)

Clinical Knowledge Quiz — 10 MCQs