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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