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
Ventilator Management
Fresh Tracheostomy
Thoracotomy/Lobectomy/Pneumonectomy
Pneumothorax/Hemothorax
Laryngospasm
Pulmonary Embolism
COPD
ABG Interpretation
Post Craniotomy
Anterior/Posterior Spinal Fusion
Carotid Endardarectomy
Spine Surgery
CVA
Stroke Scale
Glascow Coma Scale
Spinal Precautions
Hypothermia Protocol
Hypo/Hyperthermia Blanket
Sedation Scales/Levels
Pancreas/Liver Transplant
Colon Surgery
Colostomy/Ileostomy
ERCP
G Tube/J Tube Management
T Tube Management
Renal Surgery
TURP
Arteriovenous Fistula/Shunt
Nephrostomy Tubes
Diabetes - Hypo/Hyperglycemic Crisis
IV Insulin Protocols
Laminectomy
Total Joint Replacement
Amputation
Open Reduction/Internal Fixation
General Orthopedic Surgeries
CPM/Traction
Circulation Checks
Surgical Drains
Wound Vac
Surgical Wound Assessment
Skin Assessment for Breakdown
Staging Decubitus Ulcers
Procedural Sedation
Anesthesia Medications
Anti-Arrhythmics
Anticoagulants
Anti-Hypertensives
Anti-Seizure Medications
Benzodiazepines
Emergency Medications
Insulin
Narcotics/Opioid Analgesics
Nitrates
Non-Opioid Analgesics
Reversal Agents
Steroids
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Starting Ivs
Central Line Blood Draws
Central Line/Implanted Line Care
Blood Product Administration
Malignant Hyperthermia
Dysrhythmia Interpretation
Dysrhythmia Management
12 Lead EKG
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Age Specific/Population-Based Care
Pain Assessment & Management
Charge Experience
Interpretation and Communication of Lab Values
Specialty Beds
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
PULMONARY
EMR Conversion - yes
BLS
ACLS
PALS
Certification: CAPA or CPAN
Other: Specify
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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