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.
| CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cardiac Anomalies |
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| CHF/Pulmonary Edema |
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| Cardiogenic Shock |
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| Cardioversion |
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| Heart Sounds |
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| PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Reactive Airway Disease |
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| Croup |
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| Pneumonia |
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| Epiglottitis |
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| Aspiration |
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| Airway Obstruction |
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| Hemo/Pneumothorax |
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| Chest Tube Placement/Management |
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| ABG Interpretation |
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| NEUROLOGICAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Meningitis/Encephalitis |
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| Seizures-Febrile/Epileptic |
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| Lumbar Puncture |
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| Migraine |
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| ORTHOPEDIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Fractures/Casting |
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| Open/Complex Fractures |
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| Nursemaid's Elbow |
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| Apply/Manage Splints |
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| Circulation Checks |
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| Crutch Walking |
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| Car Seat Instruction for Casted Patient |
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| GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Abdominal Trauma/Peritoneal Lavage |
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| Abdominal Pain |
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| Constipation |
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| GI Bleeding |
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| Hepatitis/Liver Failure |
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| Poison Ingestion |
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| ENDOCRINE/METABOLIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Hypoglycemia |
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| Hyperglycemia |
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| DKA |
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| GENITOURINARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acute Renal Failure |
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| UTI/Pyelonephritis |
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| Renal Trauma |
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| Testicular Torsion |
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| OB/GYN | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Menstrual Pain |
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| Ovarian Cyst |
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| Ectopic Pregnancy |
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| Pelvic Inflammatory Disease/STD |
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| Sexual Assault |
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| Reporting Acts of Violence |
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| EENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Foreign Body - Eye |
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| Foreign Body - Ear |
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| Foreign Body - Nose |
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| Epistaxis |
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| TRAUMA | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Glasgow Coma/Pediatric Trauma Scale |
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| Trauma Code |
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| Trauma Team Member |
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| Brain Injury |
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| Spinal Cord Injury |
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| Spinal Precautions |
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| Facial/Dental Trauma |
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| Penetrating Trauma |
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| Blunt Trauma |
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| Traumatic Amputation |
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| Hypovolemic Shock |
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| Neurogenic Shock |
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| Anaphylactic Shock |
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| Septic Shock |
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| Burns - 2nd Degree |
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| Burns - 3rd Degree |
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| INFECTIOUS DISEASE/IMMUNOSUPPRESSION | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Contagious/Infectious Patients |
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| Isolation |
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| Reporting Communicable Disease |
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| Neutropenia/Reverse Isolation |
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| PSYCHIATRIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Drug /ETOH Overdose/Withdrawal |
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| Psychiatric Hold |
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| Suicidal Patient |
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| MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Pediatric Dosage Calculations |
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| Anti-Arrhythmics |
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| Anticoagulants (IV, Oral & Injection) |
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| Anti-Hypertensives |
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| Anti-Psychotics |
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| Anti-Seizure Medications |
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| Benzodiazepines |
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| Continuous IV Paralytics |
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| Continuous IV Sedation |
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| Procedural Sedation - Administration |
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| Ketamine |
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| Emergency Medications |
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| Inhaled Medications |
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| Insulin |
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| IV Vasopressors |
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| Narcotics/Opioid Analgesics (IV, Oral & Injection) |
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| Reversal Agents |
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| Steroids (IV, Oral & Inhaled) |
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| Automated Medication Dispensing (i.e. Pyxis, Omnicell) |
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| PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Recognizing/Reporting Abuse |
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| Triage |
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| Ambulance/Paramedic Radio |
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| Charge Experience |
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| EMTALA |
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| National Patient Safety Goals/Core Measures |
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| Fall Risk Assessment/Prevention |
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| Pressure Ulcer Risk Assessment/Prevention |
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| Restraints/Use of Least Restrictive Device |
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| Patient Family Teaching |
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| Car Seat Specific Standards/Teaching |
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| Age/Developmentally Specific/Population Based Care |
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| Pain Assessment and Management - Verbal/Non-Verbal |
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| Interpretation and Communication of Lab Values |
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| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Epic |
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| Cerner |
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| Eclipsys |
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| McKesson |
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| Meditech |
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| Allscripts |
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| Other Computerized System |
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| Computerized Physician Order Entry |
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| Bar Coding for Medication Administration |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 years) |
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| Childhood (ages 6-12 years) |
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| Adolescents (ages 13-21 years) |
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| Young Adults (ages 22-39 years) |
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| Adults (ages 40-64 years) |
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| Older Adults (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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