This checklist was electronically signed on (Today’s date)
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Skin Assessment
Total Body Irradiation
Side Effect Management
External Radiotherapy
Brachytherapy
Radiation Safety Precautions
Intraoperative Radiation
Renal Failure
Fever
Pneumonia
Cardiac Arrhymias
Hypercalcemia
Hyperkalemia
Pancreatitis
Pulmonary Embolism
Bowel Obstruction
Diabetes
Pneumothorax
Stress Fractures
Respiratory Distress
Spinal Cord Compression
GI Bleed
Pleural Effusion
Infection Control techniques and Policies and Procedures
Hypokalemia
DIC
Atlelectasis
Lymphedema
Flush Catheter
Punctured Catheter
Chemo Port
Omega-Port
S.E.A. Port
Port-A-Cath
Opti-Port
PICC Lines
Obtain Blood Specimens
Line Insertion Assistance
De-Clotting Ports
Groshong Catheters
Site Care
Broviac Catheters
Patient/Teaching
Hickan Catheters
Foley Catheter Irrigations
CVP Line Insertion
Jejunostomy Tubes
Wound Care
Colostomy Care
TURP
Liver Biopsy
Platelet Precautions
Accucheck
NG Tube Insertion
Suprapubic Catheter
Ileostomy
Thoracentesis
Isolation
Bone Marrow Biopsy
Enterostomal Care
Chest Tube Care
Paracentesis
Gastrostomy Tube
Narcotic Infusion
Hemodialysis
Nephrostomy Tube
Pain Management
Pulse Oximetry
Fistulas/Shunts
Seizure Precautions
Peritoneal Dialysis
Nasotracheal Suctioning
PCA Pumps
Hyperalimentation
Peripheral Blood Stem Cells
Packed RBC’s
IV Fluid Hydration
Venoclusive Disease
Fresh Frozen Plasma
Infections
Pneumonitis
Graft Rejection
Platelets
WBC/Lukocytes
Blood /Byproducts
Antivirals
Donor Education
Allogeneic BMT
Antibiotics
GVHD Graft
Autologous BMT
Antifungals
Implantable Infusion Pumps
Medtronic
Infusaid
Ambulatory Infusion Pumps
Synchormed
Cormed
Pharmacia
Auto Syringe
Pancretec
Patency Maintenance
Patient Teaching
Palliative Care
Hospice Care
Family Support
Counseling/Death/Dying
Identifying Support Groups
Advance Directives
Identifying Resources
Health Care Proxy
Floxuridine/FUDR
Doxorubicin/Adrianycin
Heparin/Coumadin
Carmustine/BiCNU
Dopamine
Cistplatin
Mitonycin/Mutanycin
Dilantin
Fluorouracil/-FU
Usulfan/Myleran
Neupogen/Epogen
Hydroxyurea/Hydrea
Corticosteroids
Vincristine/Oncovin
Methotrexate/Amethopterin
Morphine
Etoposide/VP-6-
Decadron
Belomycin/Blenoxane
Vinblastine/Velban
Melphalan/Alkeran
IV Care/Skills
Chemotherapy Adm
IM/SQ
IVPB
IV Push/Intrathecal
Thrombocytopenia
Stomatitis
Hemorrhabe
Oncology PCU
Neuropathy
Bone Marrow Transplant
Death /Dying
Venous Access Devices
Electrolyte Imbalance
Palliative/Hospice Care
Neutropenia
Telemetry
Nutritional Needs
Immunosuppression
IV Maintenance
Septic Shock
Vomiting/Diarrhea/Nausea
Skin Care
Blood/Blood Byproducts
Normal Serum Labs Values
Radiation Therapy
Surgical Patient Care
Chemotherapy Protocols
Implantable Vascular Ports
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
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