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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