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
Advanced directives
Patient/family teaching
Restrictive devices (restraints)
Lift/transfer devices
Specialty beds
End of life care/palliative care
Wound assessment & care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
Blood Glucose Monitor (BGM)
Cardioversion/defibrillation
Electronic ICU
National Patient Safety Goals
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Medication reconciliation
Labeling (medications & specimens)
Anticoagulation therapy
Monitoring conscious sedation
Pain assessment & management
Infection control
Universal precautions
Isolation
Use of rapid response teams
Awareness of HCAHPS
Assessment of heart sounds
Interpretation of arrhythmias
Performing 12 lead EKG’s
Interpretation of 12 lead EKG
Interpretation of hemodynamic monitoring
CVC (Central Venous Catheter)
Arterial line
Swanz Ganz catheter
Flow trac or Vigileo monitoring caths
Intra-Aortic Balloon Pump (IABP)
Ventricular Assist Device (LVAD, RVAD)
Permanent pacemakers
Implantable Cardioverter Defibrillator (ICD)
External pacemakers
Epicardial pacemaker wires
Discontinuing venous/arterial sheaths
Femostop/vasoseal
Acute myocardial infarction
Pre/post: cardiac catheterization
Congestive heart failure
Cardiomyopathy
Dysrhythmias/conduction disturbances
Aortic aneurysm
Thoracic/abdominal surgery
Endoluminal graft
Cardiogenic shock
Hypertensive crisis
Pericarditis/endocarditis
MAZE procedure
Post open heart (CABG/valve)
Cardiac contusion/trauma
Heart transplant
Cardiac tamponade
ACLS medications and protocols
Antidysrythmics
Antihypertensives
Vasoactive/vasopressor agents
Anesthetics (propofol/presedex)
Thrombolytics (retavase/activase)
Platelet inhibitors (ReoPro/Integrilin/Aggrastat)
Flolan for pulmonary hypertension
Assessment of breath sounds
Oral/NT/ET airway
Tracheostomy
Arterial blood gas analysis/interpretation
Obtaining ABG blood sample/arterial line
Pulse oximetry
BiPAP (Bi-level Positive Airway Pressure)
Oscillation/high-frequency ventilation
Nitric
Interpretation of weaning parameters
Maintenance & management of pleural chest tubes
Acute respiratory failure
Adult Respiratory Distress Syndrome (ARDS)
Sudden Inflammation Respiratory Syndrome (SIRS)
Inhalation injuries
Pneumonia
Pulmonary edema
Near drowning
Chronic Obstructive Pulmonary Disease (COPD)
Pre/post thoracic surgery
Pulmonary embolism
Pulmonary/chest trauma
Pulmonary hypertension
Status asthmaticus
Rapid sequence intubation drugs/protocols
Nebulizer treatments: Ventolin, Atrovent
Cranial nerve assessment
Glasgow coma scale
NIH stroke scale
NIH stroke certification
Seizure precautions
Skeletal traction
Cervical spine precautions/logroll positioning
Halo vest/halo traction
Monitoring of neuromuscular blocking agents/paralytics
Assist with lumbar puncture
Ventriculostomy
Subarachnoid screw/bolt
Lumbar drains
Cerebral aneurysm
Subarachnoid hemorrhage
Status epilepticus
TBI (Traumatic Brain Injury)
Spinal cord injury
CerebroVascular Accident (CVA)
Pre/post cranial surgery
Meningitis
Myasthenia gravis
Clipping and/or coilings of aneurysms
Pituitary Tumor
Steroids: Decadron, Solu-Medrol
Anticonvulsants: Dilantin, phenobarbital
Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium
Mannitol
Antipsychotics: Haldol
Mass casualty
Electrocution
Amputation
Gangrene
Multiple fractures
Thermoregulation: hypothermia/hyperthermia
Berdow Formula/ “Rule of Nines”
Lund and Browder chart
Fluid resuscitation
Care & management of burns
Small bore feeding tube insertion (Dobhoff or Keofeed)
Nasogastric tube insertion
Post pyloric feeding tube insertion
Gastric lavage
Use of activated charcoal
Maintenance of gastric/jejunostomy tube
Stoma care
Maintenance & management of enteral tube feedings
Assisting/monitoring bedside procedures: endo/chest tubes/bronchs/trach insertion/PEG tubes
Abdominal trauma
Acute gastrointestinal hemorrhage
Esophageal varices
Balloon tamponade devices (i.e. Blakemore tube)
Peritonitis
Acute pancreatitis
Bowel obstruction
Liver/pancreas transplant
Antiemetics: Reglan, Zofran
H2 receptor antagonists
Foley catheter insertion
Suprapubic tube
Nephrostomy tube
Peritoneal dialysis
Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT)
Hemodialysis of the critically ill patient
Acute renal failure
Chronic renal failure
AV fistulas, shunts & dialysis catheters
Nephrectomy
Renal transplant
Renal/urinary tract trauma
Diabetes Insipidus (DI)
Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)
Diabetic Ketoacidosis (DKA)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Administration & monitoring of insulin infusion
Use of Endo tool
Starting peripheral IV’s
Care of patient with Peripherally-Inserted Central Catheter (PICC)
Administration/monitoring of Total Parenteral Nutrition (TPN)
Administration of blood/blood products
Administration of narcotics/sedatives: (fentanyl, Valium, Ativan, Versed, morphine)
Bispectral monitoring
Mentoring
Communication
Video assessment
Utilize tele-ICU system
Multi-tasking
Troubleshoot equipment
Giving directions over AV system
Interpretation of data
Critical thinking
Diplomacy
Drug or chemical overdose (TCA, ethanol, ASA)
Poisoning (CO, cyanide)
Substance abuse (ETOH, stimulants, narcotics)
Human Immunodeficiency Virus (HIV)
Multisystem Organ Dysfunction Syndrome (MODS)
Anaphylaxis
Disseminated Intravascular Coagulation (DIC)
Septic shock
Cancer
Administration of chemotherapy
Monitoring of chemotherapy (does not initiate)
Hyperbaric oxygenation
Organ/tissue donation procedures
Suicide precautions
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)
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