Personal Information

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Self-Assessed experience rating scale

0 – No Experience

1 – Minimal experience, need review and supervision, have performed at least once

2 – Comfortable performing with resource available

3 – Competent to perform independently and safely

4 – Expert, able to act as resource to others

PATIENT RIGHTS

Communicates and obtains information while respecting the rights and privacy and confidentiality of information

Involves the patient and family and respects their role in determining the nature of care to be provided, including Advanced Directives

Complies with nursing staff responsibility included in the hospital policy related to Organ Donation

Meets patient and families needs regarding communication, including interpreter services

Provides accurate information to patient and families in a timely manner

NEUROLOGY

Neuro Assessment/Neuro Vitals

Glasgow Coma Scale

Seizure Precautions

Spinal Precautions

Immobilization Techniques

NEUROLOGY Care of Patient with:

Spinal Cord Injury

Pre/Post Neurological Surgery

CNS Infections

Degenerative Diseases of the Nervous System

Drug Overdose

Acute Head Injury

Cerebral Aneurysm

Acute/Chronic C.V.A/T.I.A.

Meningococcal Illness

CARDIOVASCULAR

Use of Cardiac Monitors

Recognizing Arrhythmias

Obtaining 12 Lead EKG

Interpreting 12 Lead EKG

Cardiopulmonary Arrests

Cardioversion/Defibrillation

Interpreting Chest Pain

Care of Acute MI

Angina (Acute and Chronic)

Percutaneous Transluminal Coronary Angioplasty

Sheath Removal

Post-Op Vascular Surgery Patient (i.e. aneurysms)

Pre/Post Cardiac Catheterization

CARDIOVASCULAR Care of patient with:

Valvular Disease

Cardiogenic/Hypovolemic Shock

Requiring Trauma Resuscitation

CARDIOVASCULAR Care of patient with pacemaker including

Assisting with Insertion

Management of External/Transcutaneous

Management of Temporary (Single and Dual Chamber/AV Sequential)

Management of Permanent

CARDIOVASCULAR Use and administration of following

Amioderone

Atropine

Dilitiazem

Dobutamine

Dopamine

Epinephrine

Fibrinolytics

Heparin

Ibutilide

Insulin

Lidocaine

Metropolol

Narcan

Nitroglycerin

Procainamide

Sodium Bicarbonate

Sodium Nitroprusside

Verapamil

PULMONARY

Assessment of Breath Sounds

Assist with Set-Up/Maintenance of Chest Tubes

Use of Chest Drainage Systems

Assist with Intubation/Extubation

Ambulation Technique

Administer Oxygen (Nasal Cannula, Mask, Endotracheal)

Bronchoscopy

ABG Analysis

Oxygen Saturation Monitor

Venous Blood Gas Analysis

Oxygen Saturation Monitor

PULMONARY Care of patient with

Pulmonary Emboli

Tracheostomy

Sterile Suctioning (E.T., N.T.)

Asthma

ARDS

CHF

Anaphylactic Shock

Epiglottitis

GASTROINTESTINAL

Assessment of Bowel Sounds

Identification of Abnormalities

Stool Tests

Insert/Maintain Feeding Tubes/NG Tubes

Gastric Lavage

Care of O.D./Code Blue Lavage Kits

Care of Acute GI Bleed

Abdominal Wounds or Infections

Pre/Post-Op GI Surgery

Dehiscence

Care of Patient on Total Parenteral Nutrition

GENTOURINARY/RENAL

Ability to Insert/Maintain Urinary Drainage Tubes

GENTOURINARY/RENAL Care of patient with

Acute Renal Failure

Chronic Renal Failure

Post Renal/Genitourinary Surgery

Care of Patient Receiving Dialysis

Assessment of Fluid and Electrolyte Problems

Knowledge of UA Values

ENDOCRINE

Hormone Therapy

ENDOCRINE Care of diabetic patient

Administration of IV Insulin Drip

Capillary Blood Glucose Checks

Care of Patient in Diabetic Ketoacidosis

MUSCULOSKELETAL

Traction

Braces

Applying Plaster Splints/Casts

Fiberglass Splints and Casts

Collars

Slings

Splints

Skeletal Traction

Skin Traction

Beds (i.e., Clinitron, Roto Rest)

Crutch Walking/Walkers

MUSCULOSKELETAL Care of patient with:

Joint Disorders

Bone Disorders

Amputation

IMMUNOCOMPROMISED

Care of Tuberculosis Patients

Negative Pressure Rooms

HIV, AIDS Patients

Hepatitis Patients

Oncology Patients

PEDIATRICS

Fever

Febrile Seizures

Abuse/Rape/Protective Care

COBRA/EMTALA REQUIREMENTS

Medical Screening Exams

Triage

Transfer to Another Facility

Psychiatric

MISCELLANEOUS

Pain Management

Burn Patients

Use of Hypothermia Blanket

Inserting IVs/IV Therapy

Set-Up for Suturing

Set-Up for Cut Down

Dressing Application

Administration of Blood and Blood Products

Laceration Site Prep

Solcutrans/Blood Warmer

Obtaining peripheral venous blood

Obtaining Blood from Arterial Line

Obtaining Blood from Central Venous Line

Knowledge of Serum Lab Values: CK, Troponin, Myoglobin

Knowledge of Serum Lab Values: Chem 7, Chem 10

Knowledge of Serum Lab Values: CBC

Serum Drug Levels

Specimen Collections

Care of Drains/Tubes (i.e. Hemovac, etc.)

Report to Floor Staff

Transport and Set-Up

EXPERIENCE AREAS	YEARS	MONTHS
CCU
Telemetry/Stepdown
ICU
ER Level 1 (Trauma)
ER Level 2
ER Level 3
Peds ER
OR/PACU

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.