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Intermediate Care Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided to FILL IN THE BLANK 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) | CARDIAC | 1 | 2 | 3 | 4 | ||
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Acute Coronary Syndrome | ||||||
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Congestive Heart Failure | ||||||
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Post Open Heart (12-24 hours) | ||||||
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Carotid Endarterectomy | ||||||
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Post Vascular Surgery | ||||||
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Heart Transplant | ||||||
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Pacemaker - Temporary/Permanent | ||||||
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Pacemaker - Epicardial | ||||||
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Sheath Removal | ||||||
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Heart Sounds | ||||||
| Rating Stars (Click) | PULMONARY | 1 | 2 | 3 | 4 | ||
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Pneumonia | ||||||
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Respiratory Distress | ||||||
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COPD | ||||||
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Breath Sounds | ||||||
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Post Thoracic Surgery | ||||||
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Chest Tube Placement & Management | ||||||
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Trach Management | ||||||
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Modes of Ventilation (AC/PC/SIMV/CPAP) | ||||||
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Intubation/Extubation | ||||||
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External CPAP/BiPAP | ||||||
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Interpretation of Arterial Blood Gases | ||||||
| Rating Stars (Click) | NEUROLOGIC & PSYCHIATRIC | 1 | 2 | 3 | 4 | ||
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Stroke Scale Assessment | ||||||
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CVA | ||||||
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Brain Injury | ||||||
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Post Craniotomy | ||||||
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Spinal Cord Injury | ||||||
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Seizure Disorders | ||||||
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ETOH/Drug Withdrawal | ||||||
| Rating Stars (Click) | GASTROINTESTINAL | 1 | 2 | 3 | 4 | ||
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GI Bleeding | ||||||
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GI Surgery | ||||||
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Liver Failure | ||||||
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Pancreatitis | ||||||
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Liver Transplant | ||||||
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Pancreas Transplant | ||||||
| Rating Stars (Click) | RENAL/GENITOURINARY | 1 | 2 | 3 | 4 | ||
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Renal Failure | ||||||
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Renal Surgery | ||||||
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Renal Transplant | ||||||
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Arteriovenous Fistula/Shunt | ||||||
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Nephrostomy Tubes | ||||||
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Peritoneal Dialysis | ||||||
| Rating Stars (Click) | ENDOCRINE METABOLIC | 1 | 2 | 3 | 4 | ||
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Diabetes - Hypo/Hyperglycemic Crisis | ||||||
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Pituitary Disorders | ||||||
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IV Insulin Protocols | ||||||
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Indwelling Insulin Pumps | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
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Anti- Arrhythmics | ||||||
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Anticoagulants (IV, oral & injection) | ||||||
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Anti-Hypertensives | ||||||
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Anti-Psychotics | ||||||
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Anti-Seizure Medications | ||||||
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Benzodiazepines | ||||||
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Procedural Sedation | ||||||
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Diuretics | ||||||
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Emergency Medications | ||||||
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Inhaled Medications | ||||||
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Insulin | ||||||
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Titrate Vasoactive Drips | ||||||
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Manage Vasoactive Drips - No Titration | ||||||
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Narcotics/Opioid Analgesics (IV, oral & injection) | ||||||
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Nitrates (Oral & Topical) | ||||||
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Non-Opioid Analgesics (IV, Oral & Injection) | ||||||
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Reversal Agents | ||||||
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Steroids (IV, Oral, Inhaled) | ||||||
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Automated Medication Dispensing (i.e. Pyxis, Omnicell) | ||||||
| Rating Stars (Click) | IV THERAPY | 1 | 2 | 3 | 4 | ||
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Starting Ivs | ||||||
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Central Line Blood Draws | ||||||
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Central Line/Implanted Line Care | ||||||
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Arterial Line Management | ||||||
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TPN & Lipids | ||||||
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Blood Product Administration | ||||||
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Administration of Chemotherapy | ||||||
| Rating Stars (Click) | CARDIAC MONITORING & EMERGENCY RESPONSE | 1 | 2 | 3 | 4 | ||
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Dysrhythmia Interpretation | ||||||
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Dysrhythmia Management | ||||||
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Obtain 12 Lead EKG | ||||||
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Interpret 12 Lead EKG | ||||||
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Cardioversion | ||||||
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Defibrillation | ||||||
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Malignant Hyperthermia | ||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||
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National Patient Safety Goals/Core Measures | ||||||
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Fall Risk Assessment/Prevention | ||||||
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Pressure Ulcer Risk Assessment/Prevention | ||||||
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Restraints/Use of Least Restrictive Device | ||||||
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Patient/Family Teaching | ||||||
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Age Specific/Population-Based Care | ||||||
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Isolation Precautions | ||||||
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Infection Prevention | ||||||
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Pain Assessment & Management | ||||||
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Charge Experience | ||||||
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Interpretation and Communication of Lab Values | ||||||
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Specialty Beds | ||||||
| Rating Stars (Click) | EMR | 1 | 2 | 3 | 4 | ||
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Epic | ||||||
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Cerner | ||||||
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Eclipsys | ||||||
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McKesson | ||||||
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Meditech | ||||||
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Other Computerized System | ||||||
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Computerized Physician Order Entry | ||||||
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Bar Coding for Medication Administration | ||||||
| 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) | ||||||