Dialysis Nursing Skills Checklist
  Dialysis Nursing 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) WORK SETTINGS 1 2 3 4  
Acute/Inpatient Dialysis  
Chronic/Outpatient Dialysis  
Dialysis Home Care  
Pediatric Dialysis  
Apheresis  
Plasmapheresis  
Predialysis Nursing Assessment  
Charge Experience  
Rating Stars (Click) SET UP/INITIATE DIALYSIS TREATMENT 1 2 3 4  
Bicarbonate Dialysate  
Conductivity Testing  
Priming Dialyzer  
Prep Vascular Access  
Fistula Gortex/Bovine Graft  
Anticoagulation Management  
Apheresis  
Plasmapheresis  
Cannulating Buttonholes  
Continuous Renal Replacement Therapy  
Peritoneal Dialysis  
Rating Stars (Click) ASSESSMENT DURING DIALYSIS 1 2 3 4  
Vascular Access Function  
Arterial and Venous Pressures  
Blood Flow Rate  
Management of Anticoagulation  
Conductivity  
Ultra Filtration Calculation  
Operation of Myron L. Meter  
Administration of Blood and Blood Products  
Administration of Mannitol  
Sequential Ultrafiltration/PUF  
Rating Stars (Click) PATIENT MANAGEMENT 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  
Anticoagulation Emergencies  
Rating Stars (Click) DIALYSIS EQUIPMENT 1 2 3 4  
Baxter  
Cobe  
Fresenius H/K  
Gambro  
Phoenix  
T Machine  
Other  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals  
Patient Isolation/Infection Prevention  
Management of Dialysis Equipment Alarms  
Bedside Blood Glucose Monitoring  
Pyxis Medication Admin. System  
Computerized Charting  
Proton Charting Experience  
AMI Charting Experience  
Ecube Charting Experience  
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)  
CERTIFICATIONS     Expiry Date :  
BLS  
CNRN  
ACLS  
CCRN  
  Other: