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 Skills | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Advanced directives |
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Patient/family teaching |
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Restrictive devices (restraints) |
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Lift/transfer devices |
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Specialty beds |
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End of life care/palliative care |
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Wound assessment & care |
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Automated Medication Dispensing System, Pyxis, Omnicell, or other |
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Bar coding for medication administration |
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Blood Glucose Monitor (BGM) |
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Cardioversion/defibrillation |
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Electronic ICU |
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National Patient Safety Goals |
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Accurate patient identification |
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Effective communication |
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Interpretation & communication of lab values |
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Medication administration |
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Medication reconciliation |
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Labeling (medications & specimens) |
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Anticoagulation therapy |
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Monitoring conscious sedation |
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Pain assessment & management |
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Infection control |
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Universal precautions |
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Isolation |
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Minimize risk for falls |
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Prevention of pressure ulcers |
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Use of rapid response teams |
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Awareness of HCAHPS |
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Cardiovascular | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assessment of heart sounds |
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Interpretation of arrhythmias |
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Performing 12 lead EKG’s |
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Interpretation of 12 lead EKG |
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Interpretation of hemodynamic monitoring |
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CVC (Central Venous Catheter) |
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Arterial line |
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Swanz Ganz catheter |
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Flow trac or Vigileo monitoring caths |
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Intra-Aortic Balloon Pump (IABP) |
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Ventricular Assist Device (LVAD, RVAD) |
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Permanent pacemakers |
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Implantable Cardioverter Defibrillator (ICD) |
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External pacemakers |
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Epicardial pacemaker wires |
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Discontinuing venous/arterial sheaths |
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Femostop/vasoseal |
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Acute myocardial infarction |
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Pre/post: cardiac catheterization |
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Congestive heart failure |
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Cardiomyopathy |
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Dysrhythmias/conduction disturbances |
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Aortic aneurysm |
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Thoracic/abdominal surgery |
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Endoluminal graft |
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Cardiogenic shock |
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Hypertensive crisis |
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Pericarditis/endocarditis |
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MAZE procedure |
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Post open heart (CABG/valve) |
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Cardiac contusion/trauma |
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Heart transplant |
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Cardiac tamponade |
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ACLS medications and protocols |
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Antidysrythmics |
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Antihypertensives |
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Vasoactive/vasopressor agents |
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Anesthetics (propofol/presedex) |
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Thrombolytics (retavase/activase) |
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Platelet inhibitors (ReoPro/Integrilin/Aggrastat) |
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Flolan for pulmonary hypertension |
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Pulmonary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assessment of breath sounds |
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Oral/NT/ET airway |
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Tracheostomy |
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Arterial blood gas analysis/interpretation |
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Obtaining ABG blood sample/arterial line |
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Pulse oximetry |
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BiPAP (Bi-level Positive Airway Pressure) |
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Oscillation/high-frequency ventilation |
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Nitric |
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Interpretation of weaning parameters |
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Maintenance & management of pleural chest tubes |
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Acute respiratory failure |
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Adult Respiratory Distress Syndrome (ARDS) |
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Sudden Inflammation Respiratory Syndrome (SIRS) |
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Inhalation injuries |
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Pneumonia |
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Pulmonary edema |
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Near drowning |
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Chronic Obstructive Pulmonary Disease (COPD) |
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Pre/post thoracic surgery |
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Pulmonary embolism |
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Pulmonary/chest trauma |
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Pulmonary hypertension |
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Status asthmaticus |
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Rapid sequence intubation drugs/protocols |
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Nebulizer treatments: Ventolin, Atrovent |
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Neurology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cranial nerve assessment |
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Glasgow coma scale |
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NIH stroke scale |
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NIH stroke certification |
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Seizure precautions |
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Skeletal traction |
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Cervical spine precautions/logroll positioning |
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Halo vest/halo traction |
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Monitoring of neuromuscular blocking agents/paralytics |
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Assist with lumbar puncture |
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Ventriculostomy |
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Subarachnoid screw/bolt |
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Lumbar drains |
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Cerebral aneurysm |
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Subarachnoid hemorrhage |
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Status epilepticus |
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TBI (Traumatic Brain Injury) |
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Spinal cord injury |
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CerebroVascular Accident (CVA) |
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Pre/post cranial surgery |
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Meningitis |
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Myasthenia gravis |
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Clipping and/or coilings of aneurysms |
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Pituitary Tumor |
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Steroids: Decadron, Solu-Medrol |
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Anticonvulsants: Dilantin, phenobarbital |
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Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium |
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Mannitol |
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Antipsychotics: Haldol |
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Trauma & Burns | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Mass casualty |
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Electrocution |
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Amputation |
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Gangrene |
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Multiple fractures |
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Thermoregulation: hypothermia/hyperthermia |
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Berdow Formula/ “Rule of Nines” |
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Lund and Browder chart |
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Fluid resuscitation |
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Care & management of burns |
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Gastrointestinal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Small bore feeding tube insertion (Dobhoff or Keofeed) |
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Nasogastric tube insertion |
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Post pyloric feeding tube insertion |
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Gastric lavage |
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Use of activated charcoal |
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Maintenance of gastric/jejunostomy tube |
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Stoma care |
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Maintenance & management of enteral tube feedings |
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Assisting/monitoring bedside procedures: endo/chest tubes/bronchs/trach insertion/PEG tubes |
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Abdominal trauma |
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Acute gastrointestinal hemorrhage |
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Esophageal varices |
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Balloon tamponade devices (i.e. Blakemore tube) |
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Peritonitis |
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Acute pancreatitis |
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Bowel obstruction |
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Liver/pancreas transplant |
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Antiemetics: Reglan, Zofran |
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H2 receptor antagonists |
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Renal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Foley catheter insertion |
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Suprapubic tube |
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Nephrostomy tube |
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Peritoneal dialysis |
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Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT) |
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Hemodialysis of the critically ill patient |
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Acute renal failure |
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Chronic renal failure |
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AV fistulas, shunts & dialysis catheters |
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Nephrectomy |
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Renal transplant |
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Renal/urinary tract trauma |
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Endocrine | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Diabetic Ketoacidosis (DKA) |
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Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK) |
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Diabetes Insipidus (DI) |
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) |
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Administration & monitoring of insulin infusion |
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Use of Endo tool |
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Intravenous Management | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Starting peripheral IV’s |
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Care of patient with Peripherally-Inserted Central Catheter (PICC) |
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Administration/monitoring of Total Parenteral Nutrition (TPN) |
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Administration of blood/blood products |
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Administration of narcotics/sedatives: (fentanyl, Valium, Ativan, Versed, morphine) |
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Bispectral monitoring |
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Tele-ICU (ICU-E) | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Mentoring |
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Communication |
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Video assessment |
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Utilize tele-ICU system |
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Multi-tasking |
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Troubleshoot equipment |
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Giving directions over AV system |
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Interpretation of data |
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Critical thinking |
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Diplomacy |
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Other | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Drug or chemical overdose (TCA, ethanol, ASA) |
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Poisoning (CO, cyanide) |
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Substance abuse (ETOH, stimulants, narcotics) |
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Human Immunodeficiency Virus (HIV) |
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Multisystem Organ Dysfunction Syndrome (MODS) |
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Anaphylaxis |
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Disseminated Intravascular Coagulation (DIC) |
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Septic shock |
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Cancer |
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Administration of chemotherapy |
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Monitoring of chemotherapy (does not initiate) |
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Hyperbaric oxygenation |
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Organ/tissue donation procedures |
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Suicide precautions |
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Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Adolescent (ages 13-21 years) |
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Young adult (ages 22-39 years) |
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Adult (ages 40-64 years) |
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Older adult (ages 65-79 years) |
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Elderly (ages 80+ years) |
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