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.
Experience In The Following Setting(s) | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Telemetry Unit (located on the unit) |
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Remote Telemetry Office |
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Patient/Equipment Preparation | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Skin prep |
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Lead Placement - 3 Lead |
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Lead Placement - 5 Lead |
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Set up MCL1 |
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Set up Lead II |
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Set up 12 Lead ECG |
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Interpret The Following Rhythms | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Normal Sinus Rhythm |
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Sinus Bradycardia/Sinus Tachycardia |
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Premature Atrial Contractions |
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Atrial Flutter |
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Atrial Fibrillation |
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Junctional Rhythms |
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PVC - Unifocal/Multifocal |
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PVC- Bigeminy/Trigeminy/Coupling |
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Ventricular Tachycardia |
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Ventricular Fibrillation |
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1st Degree Heart Block |
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2nd Degree Heart Block Type I |
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2nd Degree Heart Block Type II |
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3rd Degree Heart Block |
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Sinus Arrest |
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Asystole |
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Bundle Branch Block |
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Paced Rhythms - Atrial/Ventricular/AV |
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Pacemaker Misfire |
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Pacemaker- Failure to Capture |
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Measure Cardiac Rate |
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Measure Cardiac Intervals (PR, QRS, ST, etc.) |
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Monitoring System Used | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
GE |
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Philips |
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Spacelabs |
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Miscellaneous | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cardiac Arrest Protocol |
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Computerized Charting |
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EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
EPIC |
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Cerner |
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Eclipsys |
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McKesson |
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Meditech |
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Other Computerized System |
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Computerized Physician Order Entry |
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Bar Coding for Medication Administration |
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Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn/Neonate (birth to 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 years to 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 to 64 years) |
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Older adults (64+ years) |
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