Nursing Scales

Nursing assessment scales with calculators

Score the 23 scales nurses use most one question at a time, get the interpretation and nursing interventions at once, copy a ready-to-chart result, and download each scale as a PDF. Every item, point value and cut-off comes from the original authors or US professional bodies, with sources on each page.

All scales by category

Neurological

Glasgow Coma ScaleLevel of consciousness: eye, verbal and motor response.Score 3 to 15 · CalculatorNIH Stroke Scale (NIHSS)Stroke severity across 15 neurological items.Score 0 to 42 · CalculatorRichmond Agitation-Sedation Scale (RASS)Agitation and sedation level, mostly in the ICU.Score -5 to +4 · CalculatorMuscle Strength Scale (MRC 0-5)Manual muscle testing on the 0 to 5 MRC grades.Score 0/5 to 5/5 · Calculator Pupil Size ChartStep-by-step reference guide.Guide

Skin & pressure injury

Braden ScalePressure injury risk from six risk factors.Score 6 to 23 · CalculatorNorton ScalePressure injury risk, a shorter five-item tool.Score 5 to 20 · Calculator Pressure Injury StagesStep-by-step reference guide.Guide

Falls & function

Morse Fall ScaleFall risk in hospitalized adults.Score 0 to 125 · CalculatorBarthel IndexIndependence in 10 activities of daily living.Score 0 to 100 · Calculator

Pain

Pain Scale (0-10 Numeric Rating Scale)Pain intensity from 0 to 10, rated by the patient.Score 0 to 10 · CalculatorFLACC ScaleBehavioral pain scale for children who cannot self-report.Score 0 to 10 · CalculatorCritical-Care Pain Observation Tool (CPOT)Pain in ICU patients who cannot self-report, including on a ventilator.Score 0 to 8 · Calculator Wong-Baker FACES Pain Rating ScaleStep-by-step reference guide.Guide

Deterioration & sepsis

Modified Early Warning Score (MEWS)Early warning score from five vital signs.Score 0 to 14 · CalculatorPediatric Early Warning Score (PEWS)Early warning score for hospitalized children.Score 0 to 13 · CalculatorqSOFA ScoreBedside prompt for sepsis risk outside the ICU.Score 0 to 3 · Calculator Pediatric Vital SignsStep-by-step reference guide.Guide

Circulation & fluid

Pitting Edema ScaleEdema grade from pit depth and rebound time.Score 1+ to 4+ · Calculator Capillary Refill TimeStep-by-step reference guide.Guide

Alcohol & opioid withdrawal

CIWA-ArAlcohol withdrawal severity to guide monitoring.Score 0 to 67 · CalculatorClinical Opiate Withdrawal Scale (COWS)Opioid withdrawal severity from 11 signs.Score 0 to 48 · Calculator

Maternal & newborn

Apgar ScoreNewborn condition at 1 and 5 minutes after birth.Score 0 to 10 · CalculatorNew Ballard ScoreNewborn gestational age from physical and neuromuscular maturity.Score -12 to 50 · CalculatorBishop ScoreCervical readiness before labor induction.Score 0 to 13 · CalculatorEdinburgh Postnatal Depression Scale (EPDS)Screening for depression during pregnancy and after birth.Score 0 to 30 · Calculator

Surgery & VTE risk

Aldrete ScoreReadiness to leave the post-anesthesia care unit.Score 0 to 10 · CalculatorCaprini Risk Assessment Model (Caprini Score)Venous thromboembolism risk, mostly in surgical patients.Score 0 to 88 · Calculator

Reference guides

Capillary Refill TimeCapillary refill time explained: normal values (2 to 3 seconds), how to test it step by step, what a delayed refill means, and why age and cold skew results.GuideNormal Lab ValuesNormal lab values for nurses: adult ranges for CBC, BMP, liver panel, PT/INR, ABGs, lipids, A1C and urinalysis, with SI units and critical value examples.GuideNursing AbbreviationsCommon nursing and medical abbreviations with meanings: orders, routes, assessment, units, charting and departments, plus the Do Not Use and ISMP lists.GuidePediatric Vital SignsNormal pediatric vital signs by age: heart rate, respiratory rate, blood pressure and temperature from PALS ranges, adult values, how to measure, red flags.GuidePressure Injury StagesPressure injury (pressure ulcer) stages: NPIAP stages 1 to 4, unstageable, deep tissue, device-related and mucosal injuries, with a chart and nursing care.GuidePupil Size ChartPupil size chart in mm: normal diameters in light and dark, what 1 to 9 mm pupils mean, how to document PERRLA, anisocoria, and pupil changes in neuro checks.GuideWong-Baker FACES Pain Rating ScaleHow the Wong-Baker FACES pain scale works: six faces scored 0 to 10, ages 3 and up, how to ask, common mistakes, FLACC vs 0-10 comparison, and documentation.Guide

Nursing tools

SBAR template & generatorBuild a clear SBAR handoff with examples.Tool IV drip rate calculatorDrops per minute and mL/hr, with the formula.Tool Dosage calculationFormulas, a calculator and practice problems.Tool

Which scale should you use?

Start from the clinical question. The first tool answers it; the second one adds context or covers the patients the first one does not.

Your questionUseAlso useful
Does an ICU patient who cannot talk have pain?CPOTRASS
Is a hospitalized child deteriorating?PEWSPediatric vital signs
Is the cervix ready for induction?Bishop scoreApgar score (after birth)
Is a new mother at risk of depression?Edinburgh (EPDS)Pain scale
What is this surgical patient's clot risk?Caprini scoreMorse Fall Scale
Is the patient's level of consciousness changing?Glasgow Coma ScalePupil size chart
Could this be a stroke, and how severe is it?NIH Stroke ScaleGlasgow Coma Scale
Is a sedated or agitated patient at the right target?RASSPain scale
Will this patient develop a pressure injury?Braden ScalePressure injury stages
How likely is a fall?Morse Fall ScaleBarthel Index
How much pain, and can the patient tell you?0-10 pain scaleFLACC (if they cannot self-report)
Is a ward patient getting worse?MEWSqSOFA (if infection is suspected)
Alcohol or opioid withdrawal?CIWA-ArCOWS
How did the newborn transition?Apgar scorePediatric vital signs
Can the patient leave the PACU?Aldrete scorePain scale

Scales by unit

Med-surg

BradenMorsePain 0-10MEWSPitting edema

ICU

RASSCPOTGCSqSOFABradenMuscle strength

Emergency department

GCSNIHSSqSOFACIWA-ArCOWS

Pediatrics

FLACCPEWSWong-Baker FACESVital signs by ageCapillary refillPain 0-10

Labor & delivery / nursery

BishopApgarBallardEPDSNewborn vital signs

PACU & surgery

AldreteCapriniPain 0-10RASSMorse

Rehab & long-term care

BarthelNortonBradenMorse

How to use a scale well

Frequently asked questions

What are nursing assessment scales?

They are standardized tools that turn what you observe at the bedside into a number. The number makes findings easier to compare over time and between nurses, and it often triggers a protocol, such as fall precautions at a set Morse score or a pressure injury plan at a set Braden score.

Which scales do nurses use most?

On most adult units: the 0-10 pain scale, the Braden Scale for pressure injury risk, the Morse Fall Scale, and the Glasgow Coma Scale for neuro checks. Critical care adds RASS and often CIWA-Ar or COWS. Pediatrics relies on FLACC and age-based vital signs, and the nursery on the Apgar score.

Are these calculators accurate?

Each calculator uses the items, points and cut-offs published by the scale's authors or by US professional bodies, and every page lists its sources. Where sources disagree on cut-offs, the page shows the most cited US version and explains the others. Always follow the version your facility uses.

Can a score replace clinical judgment?

No. A score summarizes an assessment; it does not make the decision. If the patient looks worse than the number suggests, act on what you see and escalate according to your facility's policy.

Can I print a scale or download it as a PDF?

Yes. Every scale page has a free PDF download and a Print button. The sheet lists all items, points and the interpretation, with space to write the total, date and your name.

How do I document a score?

After you finish a calculator, use Copy for charting. It copies a line such as "GCS 10/15 (E3 V2 M5): Moderate" with the date and time, ready to paste into your notes. Check it against your facility's documentation rules.

Content reviewed September 30, 2026 by the Nursing Scales editorial team. Educational use only; not medical advice.