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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 |
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| Rating Stars (Click) | WORK SETTINGS | 1 | 2 | 3 | 4 | ||
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Acute/Inpatient Dialysis | ||||||
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Chronic/Outpatient Dialysis | ||||||
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Dialysis Home Care | ||||||
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Pediatric Dialysis | ||||||
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Apheresis | ||||||
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Plasmapheresis | ||||||
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Predialysis Nursing Assessment | ||||||
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Charge Experience | ||||||
| Rating Stars (Click) | SET UP/INITIATE DIALYSIS TREATMENT | 1 | 2 | 3 | 4 | ||
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Bicarbonate Dialysate | ||||||
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Conductivity Testing | ||||||
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Priming Dialyzer | ||||||
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Prep Vascular Access | ||||||
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Fistula Gortex/Bovine Graft | ||||||
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Anticoagulation Management | ||||||
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Apheresis | ||||||
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Plasmapheresis | ||||||
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Cannulating Buttonholes | ||||||
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Continuous Renal Replacement Therapy | ||||||
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Peritoneal Dialysis | ||||||
| Rating Stars (Click) | ASSESSMENT DURING DIALYSIS | 1 | 2 | 3 | 4 | ||
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Vascular Access Function | ||||||
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Arterial and Venous Pressures | ||||||
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Blood Flow Rate | ||||||
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Management of Anticoagulation | ||||||
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Conductivity | ||||||
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Ultra Filtration Calculation | ||||||
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Operation of Myron L. Meter | ||||||
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Administration of Blood and Blood Products | ||||||
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Administration of Mannitol | ||||||
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Sequential Ultrafiltration/PUF | ||||||
| Rating Stars (Click) | PATIENT MANAGEMENT | 1 | 2 | 3 | 4 | ||
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Fluid Overload | ||||||
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Hypertension | ||||||
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Hypotension | ||||||
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Disequilibrium Syndrome | ||||||
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Hyperkalemia | ||||||
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Seizures | ||||||
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Muscle Cramps | ||||||
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Clotted Access/Poor Blood Flow Rate from Catheter | ||||||
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Pyrogenic Reaction | ||||||
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Hemolysis | ||||||
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Air Embolus | ||||||
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Chest Pain | ||||||
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Anemia | ||||||
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Neuropathy | ||||||
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Pericarditis | ||||||
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Filter Blood Leak | ||||||
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Cardiopulmonary Arrest | ||||||
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Anticoagulation Emergencies | ||||||
| Rating Stars (Click) | DIALYSIS EQUIPMENT | 1 | 2 | 3 | 4 | ||
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Baxter | ||||||
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Cobe | ||||||
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Fresenius H/K | ||||||
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Gambro | ||||||
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Phoenix | ||||||
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T Machine | ||||||
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Other | ||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||
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National Patient Safety Goals | ||||||
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Patient Isolation/Infection Prevention | ||||||
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Management of Dialysis Equipment Alarms | ||||||
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Bedside Blood Glucose Monitoring | ||||||
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Pyxis Medication Admin. System | ||||||
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Computerized Charting | ||||||
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Proton Charting Experience | ||||||
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AMI Charting Experience | ||||||
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Ecube Charting Experience | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Elderly (ages 80+ years) | ||||||
| CERTIFICATIONS | Expiry Date : | ||||||
| BLS | |||||||
| CNRN | |||||||
| ACLS | |||||||
| CCRN | |||||||
| Other: | |||||||