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
Care of Patient in Restraints
Electronic Documentation
Isolation Precautions
Medicare Documentation
Patient/Family Education
Written Documentation
Acute/Chronic Bronchitis
ARDS
Aspiration Pneumonia
Asthma
Atelectasis
Bacterial/Viral Pneumonia
Bronchiectasis
Broncho-Pulmonary Dysplasia
Cardiac Surgery
Congestive Heart Failure
Croup
Cystic Fibrosis
Diabetic Ketoacidosis
Emphysema
Epiglottitis
Failure to Thrive
Fem-pop Bypass
Gullian Barre
Hayaline Membrane Disease (HMD/IRDS)
Lung Cancer
Meconium Aspiration
Myasthenia Gravis
Myesthena Gravis
Myocardial Infarction
Near Drowning
Neonatal Pneumonia
Open Hearts
Pacemakers
Persistant Fetal Circulation
Pulmonary Interstitial Emphysema (PIE)
Pleural Effusion
Pulmonary Edema
Pulmonary Embolism
Respiratory Failure
Respiratory Syncytial Virus
Respiratory Distress Syndrome
Tracheo-Esophageal Fistula
Transient Tachpnea
Thoracotomies
Tuberculosis
Apnea Monitor
Assessment of Breath Sounds
Carbogen Delivery
Diaphragmatic Breathing
Disinfection and Sterilization
End-Tidal CO2 Monitoring
Nasal-Oral Airway Placement
Oximetry
Pursed Lip Breathing
Transcutaneous Monitoring
Acapella
Aerosol Set Up/Mask/Trach
Analyze Oxygen
BiPAP Nasal/Mask
Bronchial Hygiene Therapy
Chest Physical Therapy/Postural Drainage
CPAP Nasal/Mask
Continuous Medication Nebulizer
Cough Assisted machine
Croup Tent Set Up
EzPAP Expansion Therapy
Flutter Valve Therapy
Hand Held Nebulizer
Heated Aerosol Mask/Trach Collar
Heliox Delivery
Incentive Spirometry (IS)
Infant Hood Set Up
Intrapulmonary Percussive Ventilation (IPV)
Metered Dose Inhaler
Nasal Cannula
Nitric Oxide Delivery
Oxgen Tank Set Up/Change Tank
Partial Rebreather/Non-Rebreather Mask
PEP Mask/PEP Valve Therapy
Positive Pressure Breathing (IPPB)
Simple Mask
Splint Cough
Sputum Induction
Venturi Mask
Vest Airway Clearance
ABG Interpretation/Analyzer
Airway Pressure Release Ventilation (ARPV)
Allen Test
Arterial Blood Gas Analysis
Arterial Line Insertion
Arterial Line Maintenance
Bronchoscopies/Assist
Change, Clean Trach Tubes
Check Intracuff Pressures
Continuous Positive Airway Pressure (CPAP)
Endotracheal
Extubations
Perform Independently
Assist Only
Femoral Artery
Flow/Volume/Pressure Waveform Interpretation
High Frequency Ventilator
Independent Sychronous Lung Ventilation
Inhaler Reservoirs
Intra Aortic Balloon Pump (IABP)
Intubations
Inverse Ratio Ventilation
Nasotracheal
Negative Inspiratory Force
Peak Flow Rat Monitoring
Positive End Expiratory Pressure (PEEP)
Pressure Assist/Control
Pressure Regulated Volume Control (PRVC)
Pressure Support Ventilation (PSV)
Pulmonary Function Testing
Pulmonary Stress Testing
Radial/Brachial Artery
Intermittent Mandatory Ventilation (IMV)
Pressure Release Modes/Techniques
Suctioning
Synchronized Intermittent Mandatory Ventilation (SIMV)
Ventilate Patient with Manual Resuscitator
Ventilator Modes
Ventilator Set Up/On Tanks
Volume Assist/Control
Acute Care
Adult Critical Care Unit
Burn ICU
Emergency Room
Home Care
Medical/Surgical General Floor Care
Neonatal ICU Level II
Neonatal ICU Level III
Pediatric General Floor Care
Pediatric ICU
Pediatric ICU Level II
Pediatric ICU Level III
Pulmonary Rehabilitation
Pulmonary Function Lab
Skilled Nursing
Sleep Lab
Transplant
Transports
Bird/Avea
Drager
Puritan-Bennett
Sechrist-Infant Star
Servo
Siemens
SIMS
Newborn (birth – 30 days)
Infant (30 days – 1 year)
Toddler (1 – 3 years)
Preschooler (3 – 5 years)
School Age (5 – 12 years)
Adolescents (12 – 18 years)
Young Adults (18 – 39 years)
Middle Adults (39 – 64 years)
Older Adults (64+ years)
Copyright © Ambe Healthcare Staffing
