Proﬁciency Scale:

1 – Clinicals Only

2 – 1 Year or Less Experience

3 – 2 Years’ Experience

4 – 3 Years + Experience

Pulmonary

1

2

3

4

Pneumonia

Respiratory Distress

COPD

Breath Sounds

Post Thoracic Surgery

Chest Tube Placement & Management

Trach Management

Modes of Ventilation (AC/PC/SIMV/CPAP)

Intubation/Extubation

External CPAP/BiPAP

Interpretation of Arterial Blood Gases

Gastrointestinal

1

2

3

4

GI Bleeding

GI Surgery

Liver Failure

Pancreatitis

Liver Transplant

Pancreas Transplant

Endocrine Metabolic

1

2

3

4

Diabetes - Hypo/Hyperglycemic Crisis

Pituitary Disorders

IV Insulin Protocols

Indwelling Insulin Pumps

IV Therapy

1

2

3

4

Starting IVs

Central Line Blood Draws

Central Line / Implanted Line Care

Arterial Line Management

TPN & Lipids

Blood Product Administration

Administration of Chemotherapy

EMR

1

2

3

4

Epic

Cerner

Eclipsys

McKesson

Meditech

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication Administration

Age Specific Practice Criteria

1

2

3

4

Newborn/Neonate (birth - 30 days)

Infant (30 days - 1 year)

Toddler (1 - 3 years)

Preschooler (3 - 5 years)

School age children (5 - 12 years)

Adolescents (12 - 18 years)

Young adults (18 - 39 years)

Middle adults (39 - 64 years)

Older adults (64+ years)

I certify that all the above information is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency. I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Proﬁciency Scale:

Cardiac

Pulmonary

Neurologic & Psychiatric

Gastrointestinal

Renal/Genitourinary

Endocrine Metabolic

Medications

IV Therapy

Cardiac Monitoring & Emerg Response

EMR

Professional Knowledge and Skills

Age Specific Practice Criteria