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
Acute Coronary Syndrome
Congestive Heart Failure
Post Open Heart (12-24 hours)
Carotid Endarterectomy
Post Vascular Surgery
Heart Transplant
Pacemaker - Temporary/Permanent
Pacemaker - Epicardial
Sheath Removal
Heart Sounds
Pneumonia
Respiratory Distress
COPD
Breath Sounds
Post Thoracic Surgery
Chest Tube Placement & Management
Trach Management
Intubation/Extubation
External CPAP/BiPAP
Interpretation of Arterial Blood Gases
Stroke Scale Assessment
CVA
Brain Injury
Post Craniotomy
Spinal Cord Injury
Seizure Disorders
ETOH/Drug Withdrawal
GI Bleeding
GI Surgery
Liver Failure
Pancreatitis
Liver Transplant
Pancreas Transplant
Renal Failure
Renal Surgery
Renal Transplant
Arteriovenous Fistula/Shunt
Nephrostomy Tubes
Peritoneal Dialysis
Endocrine / Metabolic
Pituitary Disorders
Indwelling Insulin Pumps
Anti-Arrhythmics
Anticoagulants (IV, oral, & injection)
Anti-Hypertensives
Anti-Psychotics
Anti-Seizure Medications
Benzodiazepines
Procedural Sedation
Diuretics
Emergency Medications
Inhaled Medications
Insulin
Titrate Vasoactive Drips
Manage Vasoactive Drips - No Titration
Narcotics/Opioid Analgesics (IV, oral, & injection)
Nitrates (Oral & Topical)
Non-Opioid Analgesics (IV, Oral, & Injection)
Reversal Agents
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Starting Ivs
Central Line Blood Draws
Central Line/Implanted Line Care
Arterial Line Management
TPN & Lipids
Blood Product Administration
Administration of Chemotherapy
Dysrhythmia Interpretation
Dysrhythmia Management
Obtain 12 Lead EKG
Interpret 12 Lead EKG
Cardioversion
Defibrillation
Malignant Hyperthermia
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Patient/Family Teaching
Age Specific/Population-Based Care
Isolation Precautions
Infection Prevention
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
EMR Conversion - yes
BLS
ACLS
PALS
PCCN
CCRN
Critical Care Course
Telemetry Certificate/Course
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