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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