Dialysis RN Clinical Skills Checklist
  Dialysis RN Clinical Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
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.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
       
Rating Stars (Click) RENAL/GENITOURINARY: 1 2 3 4  
Assessment of Renal/GU System  
Insertion of Foley  
  Care of Patient with:    
Nephrostomy Tube  
AV Fistula / AV Graft  
Tunneled/Non-Tunneled Catheter  
Ileal Conduit  
Supra-Pubic Catheter  
Chronic Renal Failure  
Acute Renal Failure  
Nephrectomy  
Turp  
Peritoneal Dialysis  
Hemodialysis  
Rating Stars (Click) HEMODIALYSIS / PROCEDURES 1 2 3 4  
Acute/Inpatient Dialysis  
Chronic/Outpatient Dialysis  
Dialysis Home Care  
Pediatric Dialysis  
Predialysis Nursing Assessment  
Teaching the Dialysis Patient and Family  
Rating Stars (Click) SET-UP / STARTING DIALYSIS TREATMENT 1 2 3 4  
Collect Blood Specimens  
Anticoagulation  
Dialysis  
Fistula Gortex / Bovine Graft  
Prep Vascular Access  
Checking Alarm Settings/Machine  
Priming Dialyzer  
Conductivity Testing  
Bicarbonate Dialysis  
Rating Stars (Click) ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS: 1 2 3 4  
Systems Assessment of Patient  
Volume Status  
Vascular Access Function  
Arterial and Venous Pressures  
Blood Flow Rate  
Subjective Response to Treatment  
Management of Anticoagulation  
Conductivity  
Ultrafiltration Calculation  
Operation of Myron L Meter  
Administration of Blood/Blood Products  
Administration of Mannitol  
Sequential Ultrafiltration / PUF  
Documentation of Treatment  
Rating Stars (Click) CARE OF PATIENT WITH: 1 2 3 4  
Fluid Overload  
Hypertension  
Hypotension  
Disequilibrium Syndrome  
Hyperkalemia  
Seizures  
Muscle Cramps  
Clotted Access/Poor Blood Flow Rate From Catheter  
Pyrogenic Reaction          
Hemolysis          
Air Embolus          
Chest Pain          
Anemia          
Neuropathy          
Pericarditis          
Filter Blood Leak          
Cardiopulmonary Arrest          
Rating Stars (Click) DISCONTINUE DIALYSIS: 1 2 3 4  
Dialysis Catheter          
Fistula / Vein Graft          
Return of Blood          
Post Treatment Access Care          
Equipment Clean Up          
Sterilization Procedures          
Rating Stars (Click) MISCELLANEOUS: 1 2 3 4  
Care of Immunosupressed Patient  
Care of Patient with AIDS  
Isolation Techniques  
Assessment of Wound Healing  
Sterile Dressing Changes  
Phlebotomy / Venous Blood Draw  
Discussing Organ & Tissue Donation  
Rating Stars (Click) Age Specific Competencies 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)