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
Pediatric MedSurg
Pediatric Step Down/Telemetry
Pediatric Oncology
Pediatric Ortho
Pediatric Neuro
Congenital Heart Disease/Repair
Pre Cardiac Surgery
Post Cardiac Surgery
Heart Sounds
Reactive Airway Disease
RSV
Tuberculosis
Esophageal Atresia
Epiglottitis
Tonsillitis
Laryngotracheobronchitis (Croup)
ENT Surgery
Oxygen Delivery Systems
Tracheostomy Management
Oral Suctioning
Deep Suctioning
Management of Chest Tubes
Apnea Monitor
Home Ventilator Therapy
Brain Injury
Spinal Cord Injury
Seizure Disorders
Meningitis
Neuromuscular Disease
Extremity Fracture/Cast
Post Vertebral Surgery
Traction - General
Traction - Halo
Pin Care
VP Shunts/Internal/External
Inflammatory Bowel Disease
Cleft Lip/Palate
Colostomy/Ileostomy
Surgical Drains
Failure to Thrive
Feeding Intolerance
Gastroenteritis/Dehydration
Bowel Obstruction
Short Gut Syndrome
Breastfeeding Support/Handling of Breast Milk
Circumcision
Testicular Torsion
Glomerulonephritis
Renal Failure
Renal Transplant
Urinary Retention
Bladder Scan
Insertion/Management of Bladder Catheters
Management of Suprapubic Catheters
Diabetes - Hypo/Hyperglycemia
Diabetic Ketoacidosis
IV Insulin Pumps
Indwelling Insulin Pumps
Hyperbilirubinemia
Bili Bed
Chemotherapy Administration
Hodgkin's Disease
Hemophilia
Sickle Cell Anemia
Leukemia
Solid Tumors
Bone Marrow Transplant
Childhood Communicable Diseases
Hepatitis
HIV
Kawasaki Disease
Pediatric Dosage Calculations
Anti-Hypertensives
Anticoagulants
Anti-Seizure Medications
Benzodiazepines
Digoxin
Diurectics
Emergency Medications
Inhaled Medications
Insulin
Narcotics/Opioid Analgesics (IV/Oral/Injection)
Non-Opioid Analgesics (IV/Oral/Injection)
Procedural Sedation - Recovery
Reversal Agents
Steroids (IV/Oral/Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Starting Ivs
Central Line Blood Draw
Central Line/Implanted Line Care
TPN/Lipids
Blood Product Administration
Administration of Chemotherapy
Pediatric Early Warning Score (PEWS)/Rapid Response Team
Dysrhythmia Interpretation
Dysrhythmia Management
National Patient Safety Goals/Core Measures
Recognize/Report Signs of Abuse
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Normal Growth and Development
Age Specific/Population Based Care
Patient Family Teaching
Isolation Precautions
Infection Prevention
Reporting Communicable Diseases
Pain Assessment & Management
Charge Experience
Interpretation and Communication of Lab Values
Epic
Cerner
Eclipsys
McKesson
Meditech
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)
PALS
BLS
CPHON
Chemo Certification: Specify
PICC Certification: Specify
Other: Specify
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