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.
SETTING | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Adult Inpatient |
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ER/Trauma |
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Adult Outpatient |
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Pediatric Inpatient |
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Pediatric Outpatient |
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Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Chest Studies |
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Abdominal Studies |
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Foreign Body/Soft Tissue Studies |
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Specimen Radiography |
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Extremities | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Upper |
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Lower |
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Pelvis Obls/Judet Views |
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Pelvis SI Joints |
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Pelvis Sacrum/Coccyx |
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Spine | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cervical Spine-Obls/Flexion/Extension |
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Thoracic Spine-Swimmer’s View |
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Lumbar Spine-Obls/Flexion. Extension |
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Head | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Facial Bones |
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Mandible |
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Head (cont.) | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Mastoids |
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Orbits |
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Sinus Series |
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TMJ |
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Skull Series |
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Tomography | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Renal |
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TMJ |
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Spine |
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Flouroscopy/Contrast Studies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Barium Swallow/Esophagram |
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Modified Barium Swallow/Protocol Swallow |
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Swallow Studies with Videotaping |
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Upper GI Series-Single Contrast |
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Upper GI Series-Air Contrast |
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Small Bowel Follow Through |
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Enema Studies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Barium Enema-Single Contrast |
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Water Soluble Contrast Enema (e.g. Hypaque) |
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Barium Enema-Air Contrast |
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Lower GI Studies thru Colostomy |
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Cystography | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cystogram |
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Voiding Cystogram |
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Cystography (cont.) | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Urethrography |
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Contrast Injection Studies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
IVP |
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IVP with Tomograms |
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Myelograms | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cervical Spine |
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Thoracic Spine |
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Lumbar Spine |
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Mobile C-Arm Flouroscopy | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Broncoscopy with Fluoro Guidance |
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Bedside Line and Tube Placement |
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OR Cases | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Sterile Procedures in OR |
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Spine Work |
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Operative Cholangiography |
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Hip Studies |
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Extremity Studies |
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Cystography |
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Retrograde Urography |
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Patient Safety | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
National Patient Safety Goals |
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Computerized Charting |
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Age Specific Practice Criteria | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn/neonate (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 children (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+) |
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