Urgent Care & Clinic Skills Checklist
  Urgent Care & Clinic 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) CARDIOVASCULAR 1 2 3 4  
  Assessment  
Auscultation/Irregular Heart Sounds  
Peripheral Edema  
PQRST Assessment  
  Interpretation of Labs/Tests  
EKG  
Lab Tests (Cardiac Enzymes, Troponin, BNP)  
  Equipment & Procedures  
Arrhythmia Interpretation  
12-Lead Set Up  
12-Lead Basic Interpretation  
Defibrillation  
External Pacer  
  Care of the Patient with  
Chest Pain/ACS  
Arrhythmias  
CHF  
AED  
Cardiac Arrest/CPR  
  Medications  
Nitroglycerin  
Morphine  
Heparin  
ALS (Epinephrine, Atropine, Anti-Arrhythmics)  
Rating Stars (Click) PULMONARY 1 2 3 4  
  Assessment  
Abnormal Breath Sounds (Wheezing, Stridor, Crackles)  
Abnormal Breathing Pattern (Rapid, Labored, Slow)  
  Interpretation of Lab/Tests  
Pulse Oximetry  
ABGs  
  Equipment & Procedures  
Oxygen Therapy (Nasal Cannula, Face Mask)  
Manual Resuscitation Bag (MRB, Ambu Bag)  
Metered-Dose Inhaler (MDI)  
Nebulizers  
  Care of the Patient with  
Aspiration  
Asthma/Reactive Airway Disease  
COPD  
Pneumonia  
Pulmonary Edema  
Pulmonary Embolism  
  Medications  
Bronchodilators  
Steroids  
Diuretics  
Rating Stars (Click) NEUROLOGICAL 1 2 3 4  
  Assessment  
Signs & Symptoms of Stroke  
Altered LOC  
  Equipment & Procedures  
Assist with Lumbar Puncture  
Cervical Collar  
Spinal Immobilization  
  Care of the Patient with  
Head Injury  
Meningitis  
Migraine  
Seizures  
TIA/Stroke  
  Medications  
Imitrex (Sumatriptan Succinate)  
Phenobarbitol  
Dilantin (Phenytoin)  
Depakote  
Analgesics  
Rating Stars (Click) ORTHOPEDICS 1 2 3 4  
  Assessment  
Range of Motion  
Color, Warmth, Movement, Sensation  
Fracture/Dislocation  
  Equipment & Procedures  
Apply Splints  
Assist with Casting  
Assist with Reduction of Dislocation  
Spinal Immobilization  
Transfer Boards  
  Care of the Patient with  
Cast/Splint  
Dislocation  
External Appliance  
Sprain/Fracture  
  Medications  
Analgesia/Sedation  
Rating Stars (Click) GASTROINTESTINAL 1 2 3 4  
  Assessment  
Bowel Sounds  
Distention  
Fluid Balance  
Nutritional Status  
  Equipment & Procedures  
Enemas  
Gastric Lavage  
G-Tubes  
NG Tubes  
  Care of the Patient with  
Colostomy  
Constipation/Impaction  
Diarrhea  
G-Tube (Reinsertion/Replacement)  
Nausea/Vomiting  
  Medications  
Ipecac  
Charcoal  
Antiemetics  
Antispasmodics  
Rating Stars (Click) RENAL/GENITOURINARY 1 2 3 4  
  Assessment  
Fluid Status  
Shunt/Fistula (Thrill/Bruit)  
  Interpretation of Labs  
BUN/Creatinine/Electrolytes  
  Equipment & Procedures  
Urine Dipstick/C&S  
Placement & Management of Bladder Catheters  
  Care of the Patient with  
Pyelonephritis/UTI  
Obstruction  
Renal Calculi  
Renal Trauma  
Testicular Torsion  
Priapism  
  Medications  
Antibiotics  
Rating Stars (Click) ENDOCRINE/METABOLIC 1 2 3 4  
  Assessment  
Hypo/Hyperglycemia  
  Interpretation of Labs  
Blood Glucose  
Urine Ketones  
  Equipment & Procedures  
Bedside Blood Glucose Monitoring  
  Care of the Patient with  
Hypoglycemia/Insulin Shock  
Hyperglycemia/DKA  
  Medications  
Dextrose  
Insulin  
Oral Hypoglycemics  
Rating Stars (Click) EENT 1 2 3 4  
  Assessment  
Visual Acuity  
Foreign Body  
Enlarged Tonsils  
  Equipment & Procedures  
Ear Irrigation/Removal Foreign Body  
Eye Injury/Foreign Body/Detached Retina  
Assist with Removal of Nasal Foreign Body  
Epistaxis  
Set Up/Assist Cautery  
Set Up Slit Lamp  
  Medications  
Silver Nitrate  
Liquid Cocaine  
Anti-Hypertensives  
Rating Stars (Click) INFECTIOUS DISEASE 1 2 3 4  
  Assessment  
Communicable Disease  
Interpret Culture Results  
  Equipment & Procedures  
Obtain Cultures  
Fever Management  
Isolation  
Reverse Isolation/Hepa Filter  
Use of Personal Protective Equipment  
  Care of the Patient with  
Communicable Disease  
Infectious Disease  
Immunosuppression/Neutropenia  
  Medications  
Antibiotics  
Antivirals  
Rating Stars (Click) WOUND MANAGEMENT 1 2 3 4  
Burn Care  
Dressing Change  
Ostomy Care  
Wound Repair (Staples/Sutures, etc.)  
Rating Stars (Click) PAIN MANAGEMENT 1 2 3 4  
Assessment of Pain Level/Use of Pain Scale  
Assessment of Response to Pain Management Interventions  
Monitoring of Patients after Pain Medication  
Comfort Care  
Moderate Sedation  
Rating Stars (Click) PSYCHIATRIC 1 2 3 4  
  Assessment  
Behavior  
Drug/ETOH  
Risk for Violence  
  Equipment & Procedures  
Managing Threatening/Violent Behavior  
Psychiatric Hold  
  Care of the Patient with  
Drug OD  
ETOH OD  
Depression/Anxiety  
Restraints  
Suicide Risk  
  Medications  
Antipsychotics/Antidepressants  
Reversal Agents  
Rating Stars (Click) WOMEN'S HEALTH 1 2 3 4  
  Assessment  
Vaginal Bleeding  
Doppler/Fetal Heart Tones  
Ectopic Pregnancy  
  Equipment & Procedures  
Obtain Cultures  
Pelvic Tray  
  Care of the Patient with  
Ectopic Pregnancy  
Hemorrhage  
Pelvic Inflammatory Disease  
Placenta Abruptio/Previa  
Precipitous Delivery  
Pregnancy-Induced Hypertension  
Spontaneous Abortion  
Rating Stars (Click) PEDIATRICS 1 2 3 4  
Child Abuse Recognition/Reporting  
Shaken Baby Syndrome  
Obtaining Consent to Treat  
  Assessment  
Normal VS for age groups  
Use of Dynamap/Doppler Leg Cuffs for B/P  
Failure to Thrive  
  Equipment & Procedures  
Assist with Fracture Stabilization  
Cooling/Warming Measures  
Draw Labs (Venous/Butterfly)  
Ear Care-Assist with Cleaning/Wash, Insert Ear Drops  
IM/SQ Medications in Pediatric Patients  
Obtain RSV Culture  
Obtain Urine Culture (Cath/Bag)  
Lumbar Puncture  
Papoose Board/Therapeutic Hold  
Start IV in Pediatric Patient  
  Care of the Pediatric Patient with  
Abdominal Pain  
Aspiration  
Asthma/Reactive Airway Disease  
Burns  
Dehydration  
Epiglottitis  
Fever  
Foreign Object  
Fracture  
Head Injury  
Hypo/Hyperglycemia  
Hypo/Hyperthermia  
Lacerations  
Near Drowning  
Nursemaid's Elbow  
  Medications (Others in System Specific Areas)  
Ipecac/Charcoal  
Bronchodilators/Nebulizers  
Fluid Replacement  
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)  
Rating Stars (Click) MISCELLANEOUS 1 2 3 4  
Intake and Triage  
National Patient Safety Goals  
AMA procedures  
Disaster Management  
Computerized Charting  
  Care of the Patient with  
Bites  
Hazardous Materials Exposure  
Victims of Acts of Violence  
  My experience is primarily in the following settings  
  Adults Year/No of Days  
  Physician's Office  
  Clinic  
  Urgent Care  
  Emergency Dept - Yrs:  
  Pediatrics Year/No of Days  
  Physician's Office  
  Clinic  
  Urgent Care  
  Emergency Dept - Yrs:  
CERTIFICATIONS   Expiry Date :  
BLS  
ACLS  
PALS  
  Other: Specify