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.
| CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Open Heart Recovery |
 |
||||||
| AAA Repair |
|
||||||
| Vascular Surgery |
|
||||||
| Pacemaker-Permanent & Temporary |
|
||||||
| Cardioversion |
|
||||||
| AICD Insertion |
|
||||||
| Cardiac Arrest |
|
||||||
| Cardiac Tamponade |
|
||||||
| CHF/Pulmonary Edema |
|
||||||
| Abnormal Heart Sounds/Murmurs |
|
||||||
| Pulses/Circulation Checks |
|
||||||
| PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Ventilator Management |
|
||||||
| Fresh Tracheostomy |
|
||||||
| Thoracotomy/Lobectomy/Pneumonectomy |
|
||||||
| Pneumothorax/Hemothorax |
|
||||||
| Laryngospasm |
|
||||||
| Pulmonary Embolism |
|
||||||
| COPD |
|
||||||
| ABG Interpretation |
|
||||||
| NEUROLOGIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Post Craniotomy |
|
||||||
| Anterior/Posterior Spinal Fusion |
|
||||||
| Carotid Endardarectomy |
|
||||||
| Spine Surgery |
|
||||||
| CVA |
|
||||||
| Stroke Scale |
|
||||||
| Glascow Coma Scale |
|
||||||
| Spinal Precautions |
|
||||||
| Hypothermia Protocol |
|
||||||
| Hypo/Hyperthermia Blanket |
|
||||||
| Sedation Scales/Levels |
|
||||||
| GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Pancreas/Liver Transplant |
|
||||||
| Colon Surgery |
|
||||||
| Colostomy/Ileostomy |
|
||||||
| ERCP |
|
||||||
| G Tube/J Tube Management |
|
||||||
| T Tube Management |
|
||||||
| RENAL/GENITOURINARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Renal Surgery |
|
||||||
| TURP |
|
||||||
| Arteriovenous Fistula/Shunt |
|
||||||
| Nephrostomy Tubes |
|
||||||
| ENDOCRINE METABOLIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Diabetes - Hypo/Hyperglycemic Crisis |
|
||||||
| IV Insulin Protocols |
|
||||||
| ORTHOPEDIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Laminectomy |
|
||||||
| Total Joint Replacement |
|
||||||
| Amputation |
|
||||||
| Open Reduction/Internal Fixation |
|
||||||
| General Orthopedic Surgeries |
|
||||||
| CPM/Traction |
|
||||||
| Circulation Checks |
|
||||||
| WOUND MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Surgical Drains |
|
||||||
| Wound Vac |
|
||||||
| Surgical Wound Assessment |
|
||||||
| Skin Assessment for Breakdown |
|
||||||
| Staging Decubitus Ulcers |
|
||||||
| MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Procedural Sedation |
|
||||||
| Anesthesia Medications |
|
||||||
| Anti-Arrhythmics |
|
||||||
| Anticoagulants |
|
||||||
| Anti-Hypertensives |
|
||||||
| Anti-Seizure Medications |
|
||||||
| Benzodiazepines |
|
||||||
| Emergency Medications |
|
||||||
| Insulin |
|
||||||
| Narcotics/Opioid Analgesics |
|
||||||
| Nitrates |
|
||||||
| Non-Opioid Analgesics |
|
||||||
| Reversal Agents |
|
||||||
| Steroids |
|
||||||
| Automated Medication Dispensing (i.e. Pyxis, Omnicell) |
|
||||||
| IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Starting Ivs |
|
||||||
| Central Line Blood Draws |
|
||||||
| Central Line/Implanted Line Care |
|
||||||
| Blood Product Administration |
|
||||||
| CARDIAC MONITORING & EMERG. RESPONSE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Malignant Hyperthermia |
|
||||||
| Dysrhythmia Interpretation |
|
||||||
| Dysrhythmia Management |
|
||||||
| 12 Lead EKG |
|
||||||
| PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| National Patient Safety Goals/Core Measures |
|
||||||
| Fall Risk Assessment/Prevention |
|
||||||
| Pressure Ulcer Risk Assessment/Prevention |
|
||||||
| Age Specific/Population-Based Care |
|
||||||
| Pain Assessment & Management |
|
||||||
| Charge Experience |
|
||||||
| Interpretation and Communication of Lab Values |
|
||||||
| Specialty Beds |
|
||||||
| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Epic |
|
||||||
| Cerner |
|
||||||
| Eclipsys |
|
||||||
| McKesson |
|
||||||
| Meditech |
|
||||||
| Other Computerized System |
|
||||||
| Computerized Physician Order Entry |
|
||||||
| Bar Coding for Medication Administration |
|
||||||
| PULMONARY |
|
||||||
| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
|
||||||
| Preschooler (ages 2-5 years) |
|
||||||
| Childhood (ages 6-12 years) |
|
||||||
| Adolescents (ages 13-21 years) |
|
||||||
| Young Adults (ages 22-39 years) |
|
||||||
| Adults (ages 40-64 years) |
|
||||||
| Older Adults (ages 65-79 years) |
|
||||||
| Elderly (ages 80+ years) |
|
||||||