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 LABORATORY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Centrifuge Operation and Maintenance |
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| Refractometer Operation and Maintenance |
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| Cytospin Operation and Maintenance |
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| Hood Operation and Maintenance |
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| Proper Storage of Specimens for Later Testing |
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| Departmental Record Completion |
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| Departmental Sample Preparation |
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| Referral Testing – Sample Requirements, Packaging, Reporting |
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| Patient and Sample Identification |
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| Collection of Samples |
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| Specimen Labeling |
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| General Venipuncture |
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| Heel Stick |
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| Finger Stick |
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| Whole Blood Bedside Glucose Testing |
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| Preparation of Peripheral Blood Smears |
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| Collection of Specimens for Microbiology |
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| Emergency Identification Procedure |
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| Specimen Collection for Drug Testing |
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| Handling of Biohazardous Materials/Waste |
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| Guidelines for Specimen Rejection/Acceptance |
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| Standard Precautions |
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| Isolation Precautions |
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| Electronic Documentation |
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| TESTING | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Daily Startup Procedure |
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| Run and Review Q.C. |
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| Follow Policy/Procedure Corrective Action for Out-of-Range Q.C. |
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| Perform CBC Testing |
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| Perform PT and APTT Testing |
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| Perform Urinalysis Dipstick Procedures |
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| Perform Urinalysis Microscopic Procedures |
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| Perform Confirmation Testing for Positive Results |
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| Kit Testing (RPR, H. Influenza, Monotest UPT, RSV, Strep A Screen, Rotavirus, etc.) |
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| Culture Routine, Collection, and Setup |
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| Culture Collection Procedure |
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| Set Up Culture According to Protocols |
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| Proper Planting Techniques |
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| Seek Assistance for Critical or Absurd Results |
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| Report Acceptable Results |
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| Save/Archive/File Patient Results Per Policy |
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| Perform Preventative Maintenance |
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| Ability to Troubleshoot Instruments per Policy |
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| CYTOLOGY SPECIFIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assist with Collection of Bronchoscopy |
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| Assist with Fine Needle Aspiration |
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| Assist with Cyst Aspiration |
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| Assist with Buccal Smears |
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| Assist with Renal Biopsies |
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| Assist with Effusions |
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| Assist with Pleural Biopsies |
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| Assist with Cytogenetics Prep |
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| Logging and Accessioning of Specimens |
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| Fixation of Specimens |
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| Staining and Coverslipping |
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| Processing of Specimens by Centrifuge Method |
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| Processing by Cytocentrifuge Method |
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| Filing Slides, Requisitions, and Reports |
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| Carbowax Preparation |
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| Cresyl Violet Preparation |
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| 3% Amphyl Preparation |
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| 10% Bleach Preparation |
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| Scott’s Tap Water Preparation |
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| Saponin Preparation |
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| Centrifuge Operation and Maintenance |
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| Fume/Biological Hood Operation and Maintenance |
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