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.
| General Patient Care | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Admit and Assess Patients |
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| Advance Directives |
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| Collect Appropriate Data |
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| Discharge Teaching |
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| Preoperative Teaching |
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| Patient Prep |
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| Computerized Documentation |
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| Cardiovascular | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess Heart Tones |
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| Bedside Tele Monitoring |
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| Interpretation of Coagulation Studies |
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| Perform Pulses/Circulation Checks |
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| Pre/Post Op Care Pacemaker |
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| Pulmonary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess Breath Sounds |
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| Apply Oxygen |
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| Interpret ABGs |
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| Thoracentesis |
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| Oximetry |
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| Neurology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess Neurological Signs |
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| Epidurals |
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| Selective Nerve Root Blocks |
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| Level of Consciousness |
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| GI | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Insertion/Monitoring NG Tubes |
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| Assessment/Patient Care Continued |
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| Flexible Sigmoidoscopy |
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| Hemorrhoid Banding |
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| Liver Biopsy |
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| Paracentesis |
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| Lap Band Surgery |
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| GU | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Bladder Biopsy |
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| Cystoscopy |
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| Urethral Dilation |
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| Nephrostomy |
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| Kidney Biopsy |
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| Suprapubic Catheter |
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| Prostate Biopsy |
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| Endocrine | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Care of Diabetic Patient |
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| Diabetic Teaching |
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| ENT and Mouth | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Prosthondontics – Restorative Dentistry |
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| Mouth Biopsy |
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| Myringotomy |
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| Maxillofacial Prosthetics |
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| Nose Biopsy |
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| Thyroid Aspirate Biopsy |
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| Fiberoptic Laryngoscopy |
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| Tonsilectomy |
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| Rhinoplasty |
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| Wounds/Integument | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Application of Burn Dressings |
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| Application of Dressing |
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| Debridement of Wound |
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| Wound Care |
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| OB/GYN | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Electrodesiccation and Curettage (ED&C) |
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| Nipple Reconstruction |
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| Musculoskeletal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Arthrocentesis |
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| External Hardware and Pin Care |
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| Arthroscopy |
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| Open Reduction and Internal Fixation |
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| Closed Reduction and Internal Fixation |
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| Plastics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Liposuction |
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| Plastic Surgery |
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| Cosmetic |
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| General Medications/Therapeutic Interventions | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Administer IM and SQ Meds |
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| Administer Inhalation Medications |
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| Administer PO Medications |
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| Bladder Irrigation and Instillation |
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| Needleless Systems |
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| Chemotherapy |
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| IV Therapy | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infusion Pumps |
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| Peipheral IV Insertion |
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| Syringe Pumps |
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| Vascular Access Devices Care/Maintenance |
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| Administer IV Medications |
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| Oxygen Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Ambu-Bug |
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| Nasal Cannula |
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| Non-ReBreather Mask |
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| Pulse Oximetry |
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| Venti Mask |
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| Face Mask |
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| Nutritional Therapy | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Lipids |
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| TPN |
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| Procalamine |
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| Enteral Administration |
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| Pain Management/Anesthesia | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Inplantable Narcotic Pump Re ll |
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| Moderate Sedation |
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| Epidural |
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| Spinal |
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| Local |
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| General |
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| Axillary Block |
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| Bier Block |
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| Blood | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Blood and Blood Products |
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| Albumin |
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| General Procedures/Equipment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Apply Immobilizers (clavicle, knee, etc.) |
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| Assist with Code Resuscitation |
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| Assist with Lumbar Puncture |
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| Laser |
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| Dermabrasion |
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| Drain Removal |
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| Incision and Drainage |
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| NGT Insertion |
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| Patch Test |
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| Punch Biopsy |
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| Procedure Set Up |
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| Procedures/Equipment Continued |
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| Remove External Fixators With Pin |
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| Scissor Biopsy |
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| Scrub |
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| Screw-Hardware Removal |
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| Set-up Assist Suturing |
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| Staple Removal |
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| Straight/Foley Cath Female |
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| Straight/Foley Cath Male |
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| Suture Removal |
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| TENS (Transcutaneous Elec. Nerve Stimulator) |
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| Use of Doppler |
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| Specimen Collections | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Venipuncture |
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| Clean Catch Urine |
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| Sterile Urine Collection |
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| Stool |
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| Sputum |
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| Butter y Stick |
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| Central Line Draw |
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| Clinical Settings | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Surgi-Center |
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| Out Patient Clinic |
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| Age Group Experience Continued |
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| Physician O ce |
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| Ambulatory Surgery Clinic |
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| Joint Commission | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| National Safety Goals |
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| “Do Not Use” Abbreviations and Terms |
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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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