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.
WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Acute/Inpatient Dialysis |
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Chronic/Outpatient Dialysis |
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Dialysis Home Care |
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Pediatric Dialysis |
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Apheresis |
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Plasmapheresis |
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Predialysis Nursing Assessment |
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Charge Experience |
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SET UP/INITIATE DIALYSIS TREATMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Bicarbonate Dialysate |
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Conductivity Testing |
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Priming Dialyzer |
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Prep Vascular Access |
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Fistula Gortex/Bovine Graft |
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Anticoagulation Management |
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Apheresis |
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Plasmapheresis |
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Cannulating Buttonholes |
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Continuous Renal Replacement Therapy |
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Peritoneal Dialysis |
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ASSESSMENT DURING DIALYSIS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Vascular Access Function |
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Arterial and Venous Pressures |
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Blood Flow Rate |
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Management of Anticoagulation |
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Conductivity |
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Ultra Filtration Calculation |
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Operation of Myron L. Meter |
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Administration of Blood and Blood Products |
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Administration of Mannitol |
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Sequential Ultrafiltration/PUF |
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PATIENT MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Fluid Overload |
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Hypertension |
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Hypotension |
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Disequilibrium Syndrome |
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Hyperkalemia |
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Seizures |
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Muscle Cramps |
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Clotted Access/Poor Blood Flow Rate from Catheter |
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Pyrogenic Reaction |
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Hemolysis |
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Air Embolus |
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Chest Pain |
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Anemia |
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Neuropathy |
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Pericarditis |
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Filter Blood Leak |
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Cardiopulmonary Arrest |
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Anticoagulation Emergencies |
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DIALYSIS EQUIPMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Baxter |
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Cobe |
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Fresenius H/K |
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Gambro |
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Phoenix |
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T Machine |
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Other |
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PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
National Patient Safety Goals |
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Patient Isolation/Infection Prevention |
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Management of Dialysis Equipment Alarms |
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Bedside Blood Glucose Monitoring |
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Pyxis Medication Admin. System |
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Computerized Charting |
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Proton Charting Experience |
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AMI Charting Experience |
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Ecube Charting Experience |
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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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