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.
| Cardiac | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Defibrillation/Cardioversion |
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| Assisting with Insertion of Central Lines |
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| Pacemakers?External |
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| Permanent or Temporary Pacemaker |
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| Cardiac Arrest/CPR |
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| A?Line (Transducer setup?D/C) |
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| Swan Ganz (Transducer setup?D/C) |
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| Balloon Pump (IABP) |
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| SVO2 Monitoring |
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| Automatic Internal Cardioverter Defib |
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| Care of patient with | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Aneurysm |
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| Acute MI/Unstable Angina |
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| Cardiogenic/Hypovolemic Shock |
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| Pre/Post Cardiac Surgery |
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| Heart Transplant |
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| PTCA |
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| COPD |
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| ARDS |
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| Pulmonary Embolism |
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| Pulmonary Edema |
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| Pneumonia |
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| Inhalation Injuries |
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| CVA |
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| Seizure Disorder |
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| Overdose |
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| Neuro Injury/Trauma |
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| Pre/Post Neuro Surgery |
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| Cranial Hemorrhage |
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| Aphasia |
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| Multiple Sclerosis |
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| Pancreatitis |
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| GI Bleed |
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| Esophageal Bleeding |
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| Bowel Obstruction |
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| Liver Transplant |
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| Paralitic Ileus |
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| TURP |
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| Shunts and Fistulas |
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| Nephrectomy |
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| Renal Transplant |
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| Renal Trauma |
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| Use and Administration of the following | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Atropine |
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| Bretylol |
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| Bumex |
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| Digoxin |
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| Dopamine |
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| Dobutrex |
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| Inderal |
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| Inocor |
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| Isuprel |
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| Lidocaine |
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| Neosynephrine/Nipride |
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| NTG |
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| Pronestyl |
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| Titrate Morphine |
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| Verapamil |
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| Thrombolitic Agents |
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| Prep/Titration of Emergency Drugs |
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| Aminophylline |
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| Corticosteroids |
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| Bronkosol |
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| Ventolin |
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| Alupent |
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| Decadron |
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| Dilantin |
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| Magnesium Sulfate |
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| Phenobarbital |
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| Steroids |
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| Valium |
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| Versed |
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| Respiratory | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Lung Transplant |
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| Establishing an Airway |
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| Pulse Oximetry |
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| Interpretation of ABG |
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| Drawing ABG Blood Sample from A?Line |
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| Incentive Spirometer |
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| Neurology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assessment of Neuro Signs |
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| Use of Glascow Coma Scale |
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| Seizure Precautions |
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| Assist with Lumbar Puncture |
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| ICP Monitoring |
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| Crutchfield Tongs |
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| Halo Traction |
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| Stryker Frame |
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| Assessment of Sensory?Motor Function |
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| Cervical Traction |
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| Cranial Nerve Assessment |
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| LOC Assessment |
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| Pre/Post Neuro Surgical Care |
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| Visual Acuity Measurement |
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| Vascular | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Peripheral Pulses |
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| Fluid Overload |
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| Starting IV's |
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| Subcutaneous Central Line |
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| Hickman/Broviac/Groshong Catheters |
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| Mainenance of Heparin Lock |
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| TPN/Hyperalimentation |
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| Air Occlusive Dressing |
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| Infusion Pump |
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| Peritoneal Dialysis |
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| Hemodialysis |
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| Heparin Drip ? Precautions and Maintenance |
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| Gastrointestinal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| NG Tube Insertion |
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| Gastronomy Tube |
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| Jejunoostomy Tube |
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| Enterostomal Care |
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| Genito Urinary/Renal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Foley Catheter Insertion |
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| GU Irrigations |
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| Nephrostomy Tube |
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| Suprapubic Tube |
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| Electrolyte Imbalance/Replacement |
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| Other | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Oncology |
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| Chemotherapy |
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| Isolation Techniques |
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| Hyperbaric Oxygenation |
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| Fingerstick Blood Glucose monitoring |
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| Equipment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Bear I |
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| Bear II |
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| Bear V |
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| Bennett 7200 |
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| CPAP |
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| Emerson |
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| EMV |
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| MA?I |
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| MA?II |
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| Monihan |
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| Ohio 560 |
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| PEEP |
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| Pressure Pre?Set |
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| Servo 900b |
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| Servo 900c |
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| Servo 900e |
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| Siemens |
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| Hewlett?Packard |
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| Spacelab |
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| Marquette |
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| Mennen |
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| Lifecare |
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| Nihon?Koder |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 years) |
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| Childhood (ages 6-12 years) |
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| Adolescents (ages 13-21 years) |
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| Young Adults (ages 22-39 years) |
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| Adults (ages 40-64 years) |
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| Older Adults (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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