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 SETTING | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Procedural Cath Lab |
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lnterventional Cath Lab |
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EP Lab |
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Interventional Radiology |
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Pre/Post Procedural Setting |
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Charge Experience |
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Other Setting (List) |
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EQUIPMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Automatic Implantable Cardiac Defibrillator |
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Cardioversion |
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Cardioversion |
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Intra Aortic Balloon Pump (IABP) |
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SV02 Recording |
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Ventilator Management |
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CARDIAC CATH LAB PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
AICD Placement |
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Aortography |
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Cardiac Biopsy |
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Cardiac Implant Closure Device |
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Cardiac Stent Placement |
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Diagnostic Cardiac Catheterization Adult |
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Diagnostic Cardiac Catheterization-Pediatric/Neonatal |
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Directional Coronary Atherectomy |
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IABP Placement/Removal |
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Internal Mammary Angiography |
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Laser Assisted Procedures |
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Percutaneous Transluminal Coronary Angioplasty |
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Pericardiocentesis |
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Permanent Pacemaker Placement |
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Pulmonary Angiography |
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Rotational Coronary Atherectomy |
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Saphenous Vein Graft Angiography |
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Transluminal Extraction Catheter |
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Valvuloplasty |
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Ventricular Assist Device Insertion |
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ELECTROPHYSIOLOGY PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Electrophysiology Evaluation |
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Baseline Measurements |
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Cardiac Ablation |
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Cardiac Mapping |
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Cardioversion |
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Conduction Study |
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Internal Cardioverter Defibrillator Implant |
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Tilt Table Study |
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IR-GASTROINTESTINAL STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Angioplasty |
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Chemoembolization |
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Cholecystostomy |
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Embolization |
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ERCP |
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Esophageal Stent Placement |
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Gastrojejunostomy |
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Gastrostomy Tube Placement |
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Liver Ablation |
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Pericentesis |
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Percutaneous Hepatic Angiography |
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TIPS |
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IR-GENITOURINARY STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Adrenal Angiography |
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Angiography of Female GU System |
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Angiography of Male GU System |
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Cystostomy |
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Embolization |
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Nephrostomy |
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Percutaneous Stone Extraction |
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Renal Angiography |
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Renal Artery Angioplasty |
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Renal Artery Stent Placement |
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Ureteral Stent |
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IR-NEUROLOGIC STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cerebral Angiography |
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Carotid Angiography |
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Neurologic Angioplasty |
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Neurologic Thrombolysis |
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Vertebroplasty |
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IR-PERIPHERAL VASCULAR STUDIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
IR-PERIPHERAL VASCULAR STUDIES |
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Angioplasty |
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Central Venous Access/Port Placement |
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Dialysis Graft Creation/Revision |
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Dialysis Graft lnterventional |
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Peripheral Vascular Embolization |
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Stent Graft Placement |
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SVC/IVC Venograph |
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Thoracic Aortography |
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Upper and Lower Extremity Angiography |
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IR-PULMONARY PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Chest Tube Placement |
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Pulmonary Embolization |
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Pulmonary Angiography |
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Thoracentesis |
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PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Conscious/Procedural Sedation |
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Assist w/Central Line/Venous Line Insertion |
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Venous Sampling |
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Topical Hemostasis (D-Stat, Chito-Seal, Syvek Patch, etc.) |
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Vascular Closure Systems (Perclose, StarClose, etc.) |
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External Compression Devices (C-Clamp, Sandbags,etc.) |
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Physiologic Monitoring/Recording |
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Sheath Removal and Monitoring |
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National Patient Safety Goals/Core Measures |
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Universal Protocol Procedures |
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Isolation Precautions |
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Infection Prevention |
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Age Specific/Population-Based Care |
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Fall Risk Assessment/Prevention |
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EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cerner |
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Eclipsys |
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Epic |
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GE |
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McKesson |
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Meditech |
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Other Computerized System |
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Computerized Physician Order Entry |
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Medication Administration using Bar Coding Technology |
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EMR Conversion | |||||||
EMR Conversion |
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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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