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 MI
CHF
Angina Hypertension
Cardiomyopathy Cardiopulmonary Arrest
Abdominal Aortic Aneurysm
Carotid Endarterectomy
Femoral Popliteal Bypass
Pre & Post Cardiac Surgery
Pre & Post Cardiac Cath
Pre & Post PTCA
Permanent Pacemaker Temporary PacemakerExternal Pacemaker
Cardiac Lab Interpretation
Cardiac Patient/Family Teaching
Respiratory assessment
Assess Lung sounds
Chest percussion
Establish/Protect Airway
Chest tubes/Pleurevac
Oxygen therapy
Drawing ABGs
Interpretation of ABGs
Incentive Spirometry
Suctioning: oral nasotracheal endotracheal tube tracheostomy tube
Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET
Inturbation/extubationambu bag pulse oximetry
Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema
Neurological assessment
Seizure precautions
Assessment and Management of Seizure Activity
Assisting with lumbar puncture
Signs/Symptoms of increasing ICP
Glascow Coma Scale
Crutchfield tongs
Circo-electric bed Halo traction
Stryker frame
Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery
G.I. assessment
Bowel sounds
Inserting N-G tubes
Colostomy care
Measurement of I & O
Administration of tube feedings
Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction
Insertion and care of: straight cath Indwelling urinary cath: male female 3-way
Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp
Total Knee Replacement
Bucks Extension
Cast Care
Crutch Walking
K-Wires
Spica Casts
Balanced Suspension Traction
Circulation Checks
Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty
Blood Glucose Monitoring
Dressing Changes
Universal Precautions
Isolation
Discharge Planning
Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS
Unit Dose
Dosage Calculation
Pouring from stock medication
Administration of Code Cart Emergency Drugs
Administration of : Aminophylline
Administration of - Ativan
Administration of : Atropine
Administration of - Chemotherapy Agents
Administration of - Corticosteroids
Administration of - Decadron
Administration of : Digoxin
Administration of: Dilantin
Administration of -Dobutamine
Administration of - Dopamine
Administration of -Heparin Inhalers
Administration of - Lidocaine
Administration of - Lopressor
Administration - Magenesium Sulfate
Administration of - Nipride Nitroglycerin
Administration of - Phenobarbital
Administration of - Thrombolytic Agents
Administration of - Valium
Administration - Verapamil
Inserting IVs Mixing IV solutions
Heparin locks
TPN/Hyperalimentation
IV push IV drip Infusion pumps Syringe pumps
Continuous Subcutaneous Infusion Pumps
PCA Pumps
Ultrasonic Doppler
CVP lines/measurement of CVP
Central line dressing change
Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction
Multi-lumen central venous catheters Implanted CVC (port-a-cath)
Assessment of IV insertion site
Assist with insertion of central line
X-ray/assessment after insertion
Care of patient with Central Line
Charge Nurse Experience?
CPR certified?
BCLS certified?
ACLS certified?
Knowledge of normal values?
Have you had a dysrhythmia course?
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)
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