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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