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
Assessment of Renal/ GU System
Insertion of foley
Turp
Nephrectomy
Ileal Conduit
Chronic Renal Failure
Hemodialysis
Peritoneal Dialysis
Acute Renal Failure
Supra-PubiC catheter
Tunneled/Non-Tunneled catheter
AV Fistual / AV Graft
Nephrostomy tube
Predialysis Nursing Assessment
Chronic/Outpatient Dialysis
Teaching the Dialysis Patlent and Family
Pediatric Dialysis
Dialysis Home Care
Acute/Inpatient Dialysis
Anticoagulation
Prep Vascular Access
Collect Blood Specimens
Dialysis
Fistula Gortex/Bovine Graft
Checks for Machine/Alarm Settings
Priming Dialyzer
Conductivity Testing
Bicarbonate Dialysate
Administration of Blood and Blood Products
Vascular Access Function
Volume Status
Documentation of Dialysis Treatment
Sequential Ultrafiltration/PUF
Administration of Mannitol
Operation of Myron L Meter
Ultrafiltration Calculation
Conductivity
Management of Anticoagulation
Subjective Response to Treatment
Blood Row Rate
Arterial and Venous Pressures
Systems Assessment of Patient
Cardropulmonary Arrest
Anemra
Seizures
Pencarditis
Muscle Cramps
Hypertension
Filter Blood Leak
Air Embolus
Hemolysis
Neuropathy
Chest Pain
Pyrogenic Reaction
Clotted Access/Poor Blood Row Rate From catheter
Hyperkalemia
Hypotension
Chest trauma
Fluid Overload
Venous Pressure Alarm
Blood Pump Alarm
Power Failure Alarm
Air/Foam Detector Alarm
High Temperature Alarm
Uttrafiltration Alarm
Conductivity Alarm
Arterial Pressure Alarm
Blood Leak Alarm
Dialysis Catheter
Sterilization Procedures
Equipment Clean Up
Post Treatment Access Care
Return of Blood
Fistula/ Vern Graft
Elderly (>60 years)
Mature Adult (30-60 years)
Young Adult ( 18-30 years)
Adolescent ( 12-18 years)
School Age (6-12 years)
Pre-school (3-6 years)
Toddler (1-3 years)
Infant (Birth to 1 year)
Copyright © Ambe Healthcare Staffing