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 | ||
| PICU |
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| Pediatric CVICU |
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| Pediatric Step Down |
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| Pediatric PACU |
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| CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Congenital Heart Disease/Repair |
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| Post Cardiac Surgery (Directly from OR) |
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| Post Cardiac Surgery (NOT Directly from OR) |
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| Post Diagnostic/Interventional Cardiac Cath |
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| Heart Failure/Cardiogenic Shock |
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| Cardiac Transplant |
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| Hemodynamic Monitoring |
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| Arrhythmia Interpretation |
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| Pacemaker - Temporary/Permanent |
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| SVO2 Monitoring |
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| Intra-Aortic Balloon Pump |
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| Ventricular Assist Device |
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| ECMO |
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| PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Respiratory Distress Syndrome/Resp. Failure |
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| Reactive Airway Disease |
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| ENT Surgery |
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| Epiglottis |
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| Cystic Fibrosis |
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| Tuberculosis |
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| Intubation/Extubation |
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| Endotracheal Tube Management |
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| Tracheostomy Management |
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| Modes of Ventilation: AC/PC/SIMV/CPAP |
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| Modes of Ventilation: Jet/Oscillator |
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| Nitric Oxide |
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| Hemo/Pneumothorax |
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| NEUROLOGIC/ORTHOPEDIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Brain Injury |
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| Craniotomy |
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| Spinal Cord Injury |
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| Seizure Disorders |
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| ICP Monitoring |
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| VP Shunt |
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| Meningitis |
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| Neuromuscular Disease |
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| Post Vertebral Surgery |
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| Traction - General |
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| Traction - Halo |
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| GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acute Surgical Abdomen |
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| GI Bleeding |
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| Pancreatitis |
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| Hepatic Failure |
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| Ostomy Management |
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| Management of Gastric Tubes |
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| Breast Milk Handling/Storage |
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| RENAL/GENITOURINARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Nephrotic Syndrome |
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| Renal Transplant |
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| Renal Replacement Therapy |
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| Peritoneal Dialysis |
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| ENDOCRINE/METABOLIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Diabetes - Hypo/Hyperglycemic Crisis |
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| Diabetic Ketoacidosis |
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| IV Insulin Pumps |
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| Indwelling Insulin Pumps |
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| TRAUMA/OTHER | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Blunt/Penetrating Trauma |
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| Burns |
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| Craniofacial Reconstruction |
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| Near Drowning |
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| Poison Ingestion/Overdose |
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| Bites-Animal/Snake/Human |
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| Suicide Precautions |
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| Wound Management/VAC |
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| Specialty Beds |
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| ONCOLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Bone Marrow Transplant |
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| Immunosuppressive Disorder |
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| Hemophilia Crisis |
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| Sickle Cell Crisis |
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| MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Pediatric Dosage Calculations |
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| Anti-Arrhythmics |
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| Anticoagulants (IV, Oral & Injection) |
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| Anti-Hypertensives |
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| Anti-Seizure Medications |
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| Benzodiazepines |
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| Continuous IV Paralytics |
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| Continuous IV Sedation |
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| Procedural Sedation - Administration |
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| Diuretics |
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| Emergency Medication |
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| Inhaled Medications |
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| Insulin |
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| IV Vasopressors |
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| Narcotics/Opioid Analgesics (IV, Oral & Injection) |
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| Non-Opioid Analgesics (IV, Oral & Injection) |
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| Reversal Agents |
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| Steroids (IV, Oral, Inhaled) |
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| Automated Medication Dispensing (i.e. Pyxis, Omnicell) |
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| IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Starting Ivs |
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| Central Line Blood Draw |
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| Central Line/Implanted Line Care |
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| TPN/Lipids |
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| Blood Product Administration |
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| Administration of Chemotherapy |
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| CARDIAC MONITORING & EMERG. RESPONSE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Dysrhythmia Interpretation |
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| Dysrhythmia Management |
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| Management of Cardiac Arrest |
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| Shock Management |
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| Malignant Hyperthermia |
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| Multisystem Organ Failure |
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| PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| National Patient Safety Goals/Core Measures |
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| Recognize/Report Signs of Abuse |
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| EMTALA |
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| Fall Risk Assessment/Prevention |
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| Pressure Ulcer Risk Assessment/Prevention |
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| Restraints/Use of Least Restrictive Device |
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| Normal Growth and Development |
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| Age Specific/Population Based Care |
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| Patient Family Teaching |
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| Isolation Precautions |
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| Infection Prevention |
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| Reporting Communicable Diseases |
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| Pain Assessment & Management |
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| Charge Experience |
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| Interpretation and Communication of Lab Values |
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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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| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Epic |
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| Cerner |
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| Eclipsys |
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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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| Bar Coding for Medication Administration |
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