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
Cardiac Anomalies
CHF/Pulmonary Edema
Cardiogenic Shock
Cardioversion
Heart Sounds
Reactive Airway Disease
Croup
Pneumonia
Epiglottitis
Aspiration
Airway Obstruction
Hemo/Pneumothorax
Chest Tube Placement/Management
ABG Interpretation
Meningitis/Encephalitis
Seizures-Febrile/Epileptic
Lumbar Puncture
Fractures/Casting
Open/Complex Fractures
Nursemaid's Elbow
Apply/Manage Splints
Circulation Checks
Crutch Walking
Car Seat Instruction for Casted Patient
Abdominal Trauma/Peritoneal Lavage
Abdominal Pain
Constipation
GI Bleeding
Hepatitis/Liver Failure
Poison Ingestion
Hypoglycemia
Hyperglycemia
DKA
Acute Renal Failure
UTI/Pyelonephritis
Renal Trauma
Testicular Torsion
Menstrual Pain
Ovarian Cyst
Ectopic Pregnancy
Pelvic Inflammatory Disease/STD
Sexual Assault
Reporting Acts of Violence
Foreign Body - Eye
Foreign Body - Ear
Foreign Body - Nose
Epistaxis
Glasgow Coma/Pediatric Trauma Scale
Trauma Code
Trauma Team Member
Brain Injury
Spinal Cord Injury
Spinal Precautions
Facial/Dental Trauma
Penetrating Trauma
Blunt Trauma
Traumatic Amputation
Hypovolemic Shock
Neurogenic Shock
Anaphylactic Shock
Septic Shock
Burns - 2nd Degree
Burns - 3rd Degree
Contagious/Infectious Patients
Isolation
Reporting Communicable Disease
Neutropenia/Reverse Isolation
Drug /ETOH Overdose/Withdrawal
Psychiatric Hold
Suicidal Patient
Pediatric Dosage Calculations
Anti-Arrhythmics
Anticoagulants (IV, Oral & Injection)
Anti-Hypertensives
Anti-Psychotics
Anti-Seizure Medications
Benzodiazepines
Continuous IV Paralytics
Continuous IV Sedation
Procedural Sedation - Administration
Ketamine
Emergency Medications
Inhaled Medications
Insulin
IV Vasopressors
Narcotics/Opioid Analgesics (IV, Oral & Injection)
Reversal Agents
Steroids (IV, Oral & Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Recognizing/Reporting Abuse
Triage
Ambulance/Paramedic Radio
Charge Experience
EMTALA
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Patient Family Teaching
Car Seat Specific Standards/Teaching
Age/Developmentally Specific/Population Based Care
Pain Assessment and Management - Verbal/Non-Verbal
Interpretation and Communication of Lab Values
Epic
Cerner
Eclipsys
McKesson
Meditech
Allscripts
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
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)
