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.
| WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Adult Acute Care |
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| ED/ICU |
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| Adult Outpatient |
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| Pediatric Acute Care |
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| Pediatric Outpatient |
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| ADULT ECHO | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Routine |
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| 3-D Echo |
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| Pedoff Probe |
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| Transesophageal Echo |
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| Stress Echo |
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| Pharmacologic Stress Echo |
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| Post-Cath Echo |
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| Post-Surgical Echo |
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| Imaging with Contrast Agents |
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| Sterilization Procedures |
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| SPECIAL VIEWS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Pulmonary Veins |
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| Hepatic Veins |
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| Suprasternal Notch |
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| CALCULATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Simpson's Rule |
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| Proximal Isovelocity Surface Area |
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| Distology with TDI |
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| LV Strain/LV Volume |
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| PEDIATRIC ECHO | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Routine |
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| 3-D Echo |
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| Pedoff Probe |
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| Transesophageal Echo |
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| PEDIATRIC ANOMALIES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Aortic Arch Abnormalities/Vascular Ring |
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| Arch Sidedness |
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| Coarctation of the Aorta |
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| Coronary Artery Anomalies |
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| Double Outlet Ventricle |
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| Hypoplastic Heart Syndrome |
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| Pulmonary Venous Return Anomalies |
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| Tetralogy of Fallot |
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| Transposition of the Great Vessels |
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| Triscupid and Pulmonary Atresia |
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| Truncus Arteriosis |
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| Univentricular Heart Anomalies |
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| PEDIATRIC POST-SURGICAL SCANS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Arterial Switch |
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| Blalock - Taussig |
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| Damus-Kaye-Stansel |
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| Fontan |
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| Glenn |
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| Konno |
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| Mustard |
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| Norwood |
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| Rastelli |
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| Sano |
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| Sennig |
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| EQUIPMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Phillips/ATL (List Types) |
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| GE (List Types) |
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| Siemens (List Types) |
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| Toshiba (List Types) |
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| Hitachi (List Types) |
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| SonoSite (List Types) |
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| Other: List |
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| TECHNOLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| McKesson |
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| Epic |
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| Horizon |
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| SCI- Imaging |
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| Online Reporting |
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| EMR Conversion |
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| MISCELLANEOUS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 12 Lead ECG |
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| Stress Testing |
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| Holter Monitor |
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| PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| National Patient Safety Goals |
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| Supervisory /Management Experience |
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| Isolation/Infection Prevention |
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| Procedures for Patients on Ventilators |
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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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