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 Care of Patient with | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acute MI |
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| CHF |
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| Angina Hypertension |
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| Cardiomyopathy Cardiopulmonary Arrest |
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| Abdominal Aortic Aneurysm |
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| Carotid Endarterectomy |
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| Femoral Popliteal Bypass |
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| Pre & Post Cardiac Surgery |
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| Pre & Post Cardiac Cath |
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| Pre & Post PTCA |
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| Permanent Pacemaker Temporary PacemakerExternal Pacemaker |
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| Cardiac Lab Interpretation |
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| Cardiac Patient/Family Teaching |
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| RESPIRATORY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Respiratory assessment |
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| Assess Lung sounds |
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| Chest percussion |
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| Establish/Protect Airway |
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| Chest tubes/Pleurevac |
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| Oxygen therapy |
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| Drawing ABGs |
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| Interpretation of ABGs |
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| Incentive Spirometry |
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| Suctioning: oral nasotracheal endotracheal tube tracheostomy tube |
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| Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET |
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| Inturbation/extubationambu bag pulse oximetry |
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| Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema |
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| NEUROLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Neurological assessment |
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| Seizure precautions |
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| Assessment and Management of Seizure Activity |
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| Assisting with lumbar puncture |
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| Signs/Symptoms of increasing ICP |
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| Glascow Coma Scale |
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| Crutchfield tongs |
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| Circo-electric bed Halo traction |
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| Stryker frame |
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| Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery |
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| GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| G.I. assessment |
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| Bowel sounds |
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| Inserting N-G tubes |
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| Colostomy care |
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| Measurement of I & O |
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| Administration of tube feedings |
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| Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction |
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| RENAL/GENITOURINARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Insertion and care of: straight cath Indwelling urinary cath: male female 3-way |
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| Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp |
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| ORTHOPEDIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Total Knee Replacement |
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| Bucks Extension |
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| Cast Care |
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| Crutch Walking |
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| K-Wires |
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| Spica Casts |
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| Balanced Suspension Traction |
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| Circulation Checks |
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| Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty |
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| GENERAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Blood Glucose Monitoring |
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| Dressing Changes |
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| Universal Precautions |
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| Isolation |
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| Discharge Planning |
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| Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS |
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| MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Unit Dose |
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| Dosage Calculation |
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| Pouring from stock medication |
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| Administration of Code Cart Emergency Drugs |
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| Aminophylline |
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| Ativan |
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| Atropine |
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| Chemotherapy Agents |
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| Corticosteroids |
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| Decadron |
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| Digoxin |
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| Dilantin |
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| Dobutamine |
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| Dopamine |
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| Heparin Inhalers |
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| Lidocaine |
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| Lopressor |
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| Magenesium Sulfate |
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| Nipride Nitroglycerin |
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| Phenobarbital |
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| Thrombolytic Agents |
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| Valium |
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| Verapamil |
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| IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Inserting IVs Mixing IV solutions |
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| Heparin locks |
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| TPN/Hyperalimentation |
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| IV push IV drip Infusion pumps Syringe pumps |
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| Continuous Subcutaneous Infusion Pumps |
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| PCA Pumps |
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| Ultrasonic Doppler |
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| CVP lines/measurement of CVP |
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| Central line dressing change |
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| Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction |
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| Multi-lumen central venous catheters Implanted CVC (port-a-cath) |
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| Assessment of IV insertion site |
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| Assist with insertion of central line |
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| X-ray/assessment after insertion |
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| Care of patient with Central Line |
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| Charge Nurse Experience? |
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| CPR certified? |
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| BCLS certified? |
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| ACLS certified? |
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| Knowledge of normal values? |
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| Have you had a dysrhythmia course? |
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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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