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 Skills | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Care of Patient in Restraints |
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| Electronic Documentation |
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| Isolation Precautions |
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| Medicare Documentation |
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| Patient/Family Education |
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| Written Documentation |
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| Care of Patients With | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acute/Chronic Bronchitis |
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| ARDS |
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| Aspiration Pneumonia |
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| Asthma |
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| Atelectasis |
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| Bacterial/Viral Pneumonia |
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| Bronchiectasis |
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| Broncho-Pulmonary Dysplasia |
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| Cardiac Surgery |
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| Congestive Heart Failure |
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| Croup |
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| Cystic Fibrosis |
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| Diabetic Ketoacidosis |
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| Emphysema |
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| Epiglottitis |
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| Failure to Thrive |
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| Fem-pop Bypass |
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| Gullian Barre |
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| Hayaline Membrane Disease (HMD/IRDS) |
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| Lung Cancer |
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| Meconium Aspiration |
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| Myasthenia Gravis |
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| Myesthena Gravis |
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| Myocardial Infarction |
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| Near Drowning |
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| Neonatal Pneumonia |
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| Open Hearts |
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| Pacemakers |
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| Persistant Fetal Circulation |
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| Pulmonary Interstitial Emphysema (PIE) |
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| Pleural Effusion |
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| Pulmonary Edema |
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| Pulmonary Embolism |
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| Respiratory Failure |
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| Respiratory Syncytial Virus |
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| Respiratory Distress Syndrome |
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| Respiratory Distress Syndrome |
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| Tracheo-Esophageal Fistula |
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| Transient Tachpnea |
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| Thoracotomies |
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| Tuberculosis |
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| Therapy and Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Apnea Monitor |
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| Assessment of Breath Sounds |
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| Carbogen Delivery |
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| Diaphragmatic Breathing |
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| Disinfection and Sterilization |
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| End-Tidal CO2 Monitoring |
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| Nasal-Oral Airway Placement |
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| Oximetry |
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| Pursed Lip Breathing |
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| Transcutaneous Monitoring |
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| Oxygen Administration: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acapella |
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| Aerosol Set Up/Mask/Trach |
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| Analyze Oxygen |
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| BiPAP Nasal/Mask |
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| Bronchial Hygiene Therapy |
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| Chest Physical Therapy/Postural Drainage |
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| CPAP Nasal/Mask |
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| Continuous Medication Nebulizer |
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| Cough Assisted machine |
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| Croup Tent Set Up |
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| EzPAP Expansion Therapy |
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| Flutter Valve Therapy |
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| Hand Held Nebulizer |
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| Heated Aerosol Mask/Trach Collar |
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| Heliox Delivery |
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| Incentive Spirometry (IS) |
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| Infant Hood Set Up |
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| Intrapulmonary Percussive Ventilation (IPV) |
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| Metered Dose Inhaler |
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| Nasal Cannula |
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| Nitric Oxide Delivery |
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| Oxgen Tank Set Up/Change Tank |
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| Partial Rebreather/Non-Rebreather Mask |
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| PEP Mask/PEP Valve Therapy |
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| Positive Pressure Breathing (IPPB) |
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| Simple Mask |
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| Splint Cough |
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| Sputum Induction |
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| Venturi Mask |
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| Vest Airway Clearance |
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| Obtaining Arterial Blood Gases: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| ABG Interpretation/Analyzer |
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| Airway Pressure Release Ventilation (ARPV) |
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| Allen Test |
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| Arterial Blood Gas Analysis |
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| Arterial Line Insertion |
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| Arterial Line Maintenance |
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| Bronchoscopies/Assist |
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| Change, Clean Trach Tubes |
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| Check Intracuff Pressures |
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| Continuous Positive Airway Pressure (CPAP) |
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| Endotracheal |
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| Extubations |
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| Perform Independently |
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| Assist Only |
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| Femoral Artery |
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| Flow/Volume/Pressure Waveform Interpretation |
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| High Frequency Ventilator |
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| Independent Sychronous Lung Ventilation |
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| Inhaler Reservoirs |
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| Intra Aortic Balloon Pump (IABP) |
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| Intubations |
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| Perform Independently |
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| Assist Only |
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| Inverse Ratio Ventilation |
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| Nasotracheal |
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| Negative Inspiratory Force |
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| Peak Flow Rat Monitoring |
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| Positive End Expiratory Pressure (PEEP) |
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| Pressure Assist/Control |
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| Pressure Regulated Volume Control (PRVC) |
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| Pressure Support Ventilation (PSV) |
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| Pulmonary Function Testing |
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| Pulmonary Stress Testing |
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| Radial/Brachial Artery |
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| Ventilator Management: | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Intermittent Mandatory Ventilation (IMV) |
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| Inverse Ratio Ventilation |
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| Pressure Release Modes/Techniques |
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| Suctioning |
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| Synchronized Intermittent Mandatory Ventilation (SIMV) |
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| Ventilate Patient with Manual Resuscitator |
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| Ventilator Modes |
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| Ventilator Set Up/On Tanks |
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| Volume Assist/Control |
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| Other: |
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| Settings | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Acute Care |
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| Adult Critical Care Unit |
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| Burn ICU |
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| Emergency Room |
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| Home Care |
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| Medical/Surgical General Floor Care |
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| Neonatal ICU Level II |
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| Neonatal ICU Level III |
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| Pediatric General Floor Care |
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| Pediatric ICU |
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| Pediatric ICU Level II |
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| Pediatric ICU Level III |
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| Pulmonary Rehabilitation |
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| Pulmonary Function Lab |
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| Skilled Nursing |
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| Sleep Lab |
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| Transplant |
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| Transports |
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| Equipment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Bird/Avea |
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| Drager |
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| Puritan-Bennett |
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| Sechrist-Infant Star |
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| Servo |
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| Siemens |
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| SIMS |
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| Age | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Newborn (birth – 30 days) |
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| Infant (30 days – 1 year) |
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| Toddler (1 – 3 years) |
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| Preschooler (3 – 5 years) |
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| School Age (5 – 12 years) |
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| Adolescents (12 – 18 years) |
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| Young Adults (18 – 39 years) |
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| Middle Adults (39 – 64 years) |
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| Older Adults (64+ years) |
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