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 | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Admit patient to pre-procedure holding |
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Complete assessments, obtain family history & risk factors |
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Start peripheral IV |
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Complete pre-procedure checklist |
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Transport pre-procedure patient to the Lab. |
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Transport post-procedure patient to in-hospital units |
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PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cerebral Angiogram – Prepare |
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Cerebral Angiogram – Assist |
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Lower Extremity Angiogram – Prepare |
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Lower Extremity Angiogram – Assist |
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Upper Extremity Angiogram – Prepare |
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Upper Extremity Angiogram – Assist |
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Ultrasound Guided Biopsy – Prepare |
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Ultrasound Guided Biopsy – Assist |
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CT Scan Guided Biopsy – Prepare |
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CT Scan Guided Biopsy – Assist |
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Liver Biopsy and Embolization – Prepare |
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Liver Biopsy and Embolization – Assist |
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Prepare and Assist with Line Placement – Broviac |
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Prepare and Assist with Line Placement – Groshong |
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Prepare and Assist with Line Placement – Hickman |
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Prepare and Assist with Line Placement – PICC |
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Prepare and Assist with Line Placement – PortaCath |
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Uterine Fibroid Embolization – Prepare |
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Uterine Fibroid Embolization – Assist |
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Temporary Hemodialysis Shunt Placement– Prepare |
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Temporary Hemodialysis Shunt Placement– Assist |
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Permanent Hemodialysis Shunt Placement– Prepare |
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Permanent Hemodialysis Shunt Placement– Assist |
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AV Fistula/Shunt Declotting – Prepare |
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AV Fistula/Shunt Declotting – Assist |
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Vertebroplasty – Prepare |
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Vertebroplasty – Assist |
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Lumbar Puncture – Prepare |
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Lumbar Puncture – Assist |
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Myelogram – Prepare |
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Myelogram – Assist |
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Other Procedures (please list): |
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Provide care for the post-procedure patient |
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CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assess heart sounds and peripheral pulses |
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Interpret arrhythmias |
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Perform CPR |
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Perform defibrillation |
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Participate as a team member in resuscitation |
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PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assess lung sounds |
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Set up oxygen devices |
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Obtain pulse oximetry reading |
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Interpret ABG |
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Use Ambu bag |
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Assist with intubation |
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Assist with chest tube insertion |
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Provide care for the patient with mechanical ventilation |
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MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Titrate vasoactive drugs |
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Calculate mcg/min and mcg/kg/min |
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Use IV infusion pump to calculate drug doses |
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Administer IV dopamine |
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Administer IV nitroglycerine |
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Administer IV dobutamine (Dobutrex) |
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Administer IV lidocaine |
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Administer IV diltiazem (Cardizem) |
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Administer IV epinephrine |
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Administer IV atropine |
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Administer IV heparin |
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Administer IV benzodiazepines (Valium, Versed, Ativan) |
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Administer IV propofol (Diprivan) |
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Administer IV neuromuscular blocking agents (Pavulon, Norcuron) |
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Administer IV narcotics (morphine, fentanyl) |
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PAIN/WOUND MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assess pain level/tolerance |
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Care of patient with anesthesia/analgesia |
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Care of patient with IV conscious sedation |
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Care of patient with narcotic analgesia |
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Care of patient with patient controlled analgesia (PCA pump) |
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Assess surgical wound status with/without drain(s) |
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Care of patient with sterile dressing changes |
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Care of patient with FemoStop device |
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Assessment of VasoSeal, AngioSeal, PerClose success |
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AGE SPECIFIC PRACTICE CRITERIA | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Pediatric (1-18years) |
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Adolescents (12 - 18 years) |
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Adult (19 - 65 years) |
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Older adults (Older than 65years) |
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EXPERIENCE WITH AGE GROUPS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Calculate body weight to verify correct dosing of medication |
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Assess immunization status for pediatric, and adolescent |
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Set age-appropriate short-term and long-term goals in care planning |
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Provide age-appropriate education, considering possible vision and hearing impairment for Older than 65years |
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