Skill Checklists

AMBULATORY

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

General Patient Care

Admit and Assess Patients

Advance Directives

Collective Appropriate Data

Discharge Teaching

Preoperative Teaching

Patient Prep

Computerized Documentation

Cardiovascular

Assess Heart Tones

Bedside Tele Monitoring

Interpretation of Coagulation Studies

Perform Pulses / Circulation Checks

Pre / Post Op Care Pacemaker

Pulmonary

Assess Breath Sounds

Apple Oxygen

Interpret ABGs

Thoracentis

Oximetry

Neurology

Assess Neurological Signs

Epidurals

Selective Nerve Root Blocks

Level of consciousness

GI

Insertion / Monitoring NG Tubes

Assessment / Patient Care Contiuned

Flexible Sigmoidoscopy

Hemorrhoid Banding

Liver Biopsy

Paracentesis

Lap Band Surgery

GU

Bladder Biopsy

Cystoscopy

Nephrostomy

Kidney Biopsy

Suprapubic Catheter

Prostate Biopsy

Endocrine

Care of Diabetic Patient

Diabetic Teaching

ENT & Mouth

Prosthondontics - Restorative Denstistry

Mouth Biopsy

Myringotomy

Maxillofacial Prosthetics

Nose Biopsy

Fibreroptic Laryngoscopy

Tonsilectomy

Rhinoplasty

Wounds / Integument

Application of Brun Dressings

Application of Dressing

Debridement of Wound

Wound Care

OB / GYN

Electrodesiccation and Curettage (ED & C)

Nipple Reconstruction

Musculoskeletal

Anthrocentesis

External Hardware and Pin Care

Arthroscopy

Open Reduction and Internal Fixation

Closed Reduction and Internal Fixation

Trigger Point Injections

Plastics

Liposuction

Plastic Surgery

Cosmetic

General Medicaltions / Therapeutic Interventions

Administer IM & SQ Meds

Administer Inhalations Medications

Administer PO Medications

Bladder Irrigation and Instillation

Needlesss Systems

Chemotheraphy

IV Therapy

Infusion Pump

Peripheral IV Insertion

Syringe Pumps

Vascular Access Devices Car / Maintenance

Administer IV Medications

Oxygen Administration

Ambu Bag

Nasal Cannula

Non Rebreather Mask

Pulse Oximetry

Venti Mask

Face Mask

Nutritional Therapy

Lipid

TPN

Procalamine

Enteral Administration

Pain Management / Anesthesia

Inplantable Narcotic Pump Re II

Moderate Sedation

Epidural

Spinal

Local

General

Axillary Block

Bier Block

Blood

Blood and Blood Products

Albumin

General Procedure / Equipment

Apply Immobilizer (Clavicle , Knee, etc)

Assist with Code Resuscitation

Assist with Lumbar puncture

Laser

Dermabrasion

Drain Removal

Incision and Drainage

NGT Insertion

Patch Test

Punch Biopsy

Procedure Set Up

Procedures/ Equipment Contiuned

Remove External Fixators with pin

Scissor Biopsy

Scrub

Screw Hardware Removal

Set Up Assist Suturing

Staple Removal

Straight / Folet Cath female

Straight / Folet Cath Male

Suture Removal

TENS (Trascutneous Elec. Nerve Stimulator)

Use of Doppler

Specimen Collections

Venipuncture

Clean Catch Urine

Sterile Urine Collection

Stool

Sputum

Butter y Stick

Central Line Draw

Clincal Settings

Surgi Center

Out Patient Clinic

Age Group Experience Continued

Physician O ce

Ambulatory Surgery Clinic

Joint Commission

National Safety Goals

" Do Not Ue" Abbreviations and terms

Age Specific Competencies

Infant (Birth to 1 year)

Pre-school (2-5 years)

Childhood (Ages 6-12 years)

Adolescent (ages 12-18 years)

Young Adult (ages 18-30 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79)

Elderly (Ages 80+ years)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.