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.
AGE OF PATIENTS CARED FOR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn/Neonate (birth to 30 days) |
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Infant (1 month to 1 year) |
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Toddler (1 year to 3 years) |
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Preschooler (3 years to 5 years) |
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School Age Child (5 years to 12 years) |
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Adolescents (12 years to 18 years) |
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Young Adults (18 years to 39 years) |
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Middle Adults (39 years to 64 years) |
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Older Adults (64 years to 79 years) |
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Elderly Adults (over 79+ years) |
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GENERAL SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Care of Patient in Restraints |
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Automated Med Dispensing Systems |
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Electronic Documentation |
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Access/Management of Implanted Ports |
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Access/Management of Central Lines |
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Titration of Drips |
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Administration of Blood/Blood Products |
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Knowledge of Current IV Therapy Guidelines |
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Knowledge of Anatomy |
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Moderate Conscious Sedation |
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Sedation Reversal Agents |
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INSERTION OF | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Peripheral IV – Adult |
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Peripheral IV – Child |
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Peripheral IV – Neonate |
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Vein Selection – Peripheral IVs |
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Interosseous Needles |
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MIDLINE/PICC LINES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Midline Catheter Insertion – Adult |
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Midline Catheter Insertion – Child |
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Indications for Midline/PICC Placement |
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Contraindications for Midline/PICC Placement |
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Vein Selection |
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Measuring Technique |
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Catheter and Introducer Device Selection |
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Correct Tip Placement |
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Insertion Technique – Basic (Vein) |
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Insertion Technique – Seldinger |
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Insertion Technique – Ultrasound |
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Assist with Insertion in Interventional Radiology |
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Insertion Site Preparation |
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Maintaining Sterile Field |
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Securing Insertion Site Post Placement |
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X-Ray Assessment for Tip Location |
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Repositioning After X-Ray |
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CARE AND MAINTENANCE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Peripheral IV |
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Scalp IV |
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Heparin/Saline Lock |
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Groshong PICC |
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Groshong CVL |
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Hickman/Broviac |
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Port-a-Cath |
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Vascath |
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Multilumen Catheters |
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Subclavian Line |
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IJ Line |
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Femoral Line |
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Power PICC |
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Power Port |
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Dressing Changes |
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Cap Changes |
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Flushing Lines (Frequency/Solution) |
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MEDICATION ADMINISTRATION | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Chemotherapy |
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Heparin |
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Streptokinase |
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TPA (Alteplase) |
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Lidocaine |
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TPN/Lipids |
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Ativan |
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Valium |
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Versed |
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Fentanyl |
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EQUIPMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
IV Pumps |
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Needleless Systems |
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Blood Warmer |
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PCA Pumps |
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Pressure Lines |
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TROUBLESHOOTING/ COMPLICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Repair PICC |
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Repair Midline |
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Air Embolism |
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Bleeding |
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Brachial Plexus Injury |
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Cardiac Arrhythmia |
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Cardiac Tamponade |
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Catheter Erosion |
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Catheter Embolism |
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Catheter Occlusion |
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Catheter-Related Sepsis |
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Endocarditis |
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Exit Site Infection |
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Exit Site Necrosis |
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Extravasation |
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Hematoma |
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Laceration of Vessels or Viscus |
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Myocardial Erosion |
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Perforation of Vessels or Viscus |
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Phlebitis |
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Catheter Tip Malposition or Retraction |
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Thromboembolism |
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Venous Thrombosis |
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Ventricular Thrombosis |
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Vessel Erosion |
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Declotting Peripheral Site |
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Complications from Sedation |
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DISCONTINUING IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Peripheral IVs |
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PICC/Midline |
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Central Lines |
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