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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