Medical Surgical RN Skills Checklist
    Medical Surgical RN 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) CARDIAC 1 2 3 4  
 
Angina  
 
Post Acute MI  
 
Congestive Heart Failure  
 
Post Cardiac Cath  
 
Post Cardiac Surgery  
 
Aneurysm  
 
Carotid Endarterectomy  
 
Post Vascular Surgery  
 
Post Cardiac Transplant  
  Rating Stars (Click) PULMONARY 1 2 3 4  
 
Pneumonia  
 
COPD  
 
Tuberculosis  
 
Pulmonary Embolism  
 
Tracheostomy Management  
 
CPAP/BiPAP  
 
Interpretation of Arterial Blood Gases  
 
Post Lung Transplant  
  Rating Stars (Click) NEUROLOGICAL & PSYCHIATRIC 1 2 3 4  
 
Stroke Scale Assessment  
 
Traumatic Brain Injury  
 
CVA  
 
Post Craniotomy  
 
Seizure Disorders  
 
Spinal Cord Injuries  
 
Mood Disorders  
 
Substance Withdrawal  
  Rating Stars (Click) ORTHOPEDICS 1 2 3 4  
 
Circulation/Skin Checks  
 
Continuous Passive Motion Devices  
 
Ambulation Assistive Devices  
 
Prosthetics  
 
Cast Care  
 
Pin Care  
 
Traction  
 
Total Joint Replacement  
 
Amputation  
  Rating Stars (Click) GASTROINTESTINAL 1 2 3 4  
 
Bariatrics  
 
Feeding Tubes  
 
GI Bleeding  
 
Bowel Obstruction  
 
GI Surgery  
 
Liver Disease  
 
Pancreatitis  
 
Post Liver Transplant  
 
Post Pancreas Transplant  
  Rating Stars (Click) RENAL/GENITOURINARY 1 2 3 4  
 
Arteriovenous Fistula/Shunt  
 
3 Way Catheter & Bladder Irrigation  
 
Suprapubic Catheter  
 
Renal Failure  
 
Peritoneal Dialysis  
 
GU Surgery  
 
Nephrostomy Tubes  
 
Renal Transplant  
 
Management Pre/Post Hemodialysis  
 
Gyn Surgery  
  Rating Stars (Click) ENDOCRINE METABOLIC 1 2 3 4  
 
Diabetes Type I  
 
Diabetes Type II  
 
Blood Glucose Monitoring  
 
IV Insulin Protocols  
 
Management of Hypoglycemia  
 
Indwelling Insulin Pumps  
 
Pituitary Disorders  
  Rating Stars (Click) ONCOLOGY 1 2 3 4  
 
Chemotherapy Administration  
 
Radiation Therapy  
 
Medical Oncology  
 
Surgical Oncology  
 
Radiation Implants  
 
Bone Marrow Transplant  
  Rating Stars (Click) MEDICATIONS 1 2 3 4  
 
Antiarrhythmics  
 
Anticoagulants (IV, oral, & injection)  
 
Anti-Depressants  
 
Anti-Hypertensives  
 
Anti-Psychotics  
 
Benzodiazepines  
 
Emergency Medications  
 
Epidural Analgesia  
 
Inhaled Medications  
 
Insulin  
 
Narcotics/Opioid Analgesics (IV, oral, & injection)  
 
Nitrates (Oral & Topical)  
 
Non-Opioid Analgesics (IV, Oral, & Injection)  
 
Oral Hypoglycemics  
 
Patient Controlled Analgesia  
 
Procedural Sedation Administration  
 
Reversal Agents  
 
Steroids (IV, Oral, Inhaled)  
 
Automated Medication Dispensing (i.e. Pyxis, Omnicell)  
  Rating Stars (Click) IV THERAPY 1 2 3 4  
 
Starting IVs  
 
Central Line Blood Draws  
 
Central Line/Implanted Line Care  
 
TPN & Lipids  
 
Blood Product Administration  
 
Monitoring of Chemotherapy  
  Rating Stars (Click) CARDIAC MONITORING & EMERG. RESPONSE 1 2 3 4  
 
Placement of Telemetry Leads  
 
Rhythm Interpretation  
 
Dysrhythmia Management  
 
Obtain 12 Lead EKG  
 
Use of Rapid Response Teams  
  Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
 
National Patient Safety Goals/Core Measures  
 
Fall Risk Assessment/Prevention  
 
Pressure Ulcer Risk Assessment/Prevention  
 
Restraints/Use of Least Restrictive Device  
 
Patient/Family Teaching  
 
Age Specific/Population-Based Care  
 
Isolation Precautions  
 
Infection Prevention  
 
Pain Assessment & Management  
 
Charge Experience  
 
Interpretation and Communication of Lab Values  
 
Wound Care /Wound Vac  
 
Specialty Beds  
  Rating Stars (Click) EMR 1 2 3 4  
 
Epic  
 
Cerner  
 
Eclipsys  
 
McKesson  
 
Meditech  
 
Other Computerized System  
 
Computerized Physician Order Entry  
 
Bar Coding for Medication Administration  
    EMR Conversion
   
  CERTIFICATIONS   Expiry Date :  
  BLS  
  ACLS  
  Telemetry Certificate  
  ONS Chemo/Biotherapy Certification  
  Other Chemo Certification  
    Other: Specify  
    Other: Specify