Telemetry/Stepdown Skills Checklist
   LAST 4 OF SSN      
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 Care of Patient with 1 2 3 4  
Acute MI  
Angina Hypertension  
Cardiomyopathy Cardiopulmonary Arrest  
Abdominal Aortic Aneurysm  
Carotid Endarterectomy  
Femoral Popliteal Bypass  
Pre & Post Cardiac Surgery  
Pre & Post Cardiac Cath  
Pre & Post PTCA  
Permanent Pacemaker Temporary PacemakerExternal Pacemaker  
Cardiac Lab Interpretation  
Cardiac Patient/Family Teaching  
Rating Stars (Click) RESPIRATORY 1 2 3 4  
Respiratory assessment  
Assess Lung sounds  
Chest percussion  
Establish/Protect Airway  
Chest tubes/Pleurevac  
Oxygen therapy  
Drawing ABGs  
Interpretation of ABGs  
Incentive Spirometry  
Suctioning: oral nasotracheal endotracheal tube tracheostomy tube  
Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET  
Inturbation/extubationambu bag pulse oximetry  
Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema  
Rating Stars (Click) NEUROLOGY 1 2 3 4  
Neurological assessment  
Seizure precautions  
Assessment and Management of Seizure Activity  
Assisting with lumbar puncture  
Signs/Symptoms of increasing ICP  
Glascow Coma Scale  
Crutchfield tongs  
Circo-electric bed Halo traction  
Stryker frame  
Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery  
Rating Stars (Click) GASTROINTESTINAL 1 2 3 4  
G.I. assessment  
Bowel sounds  
Inserting N-G tubes  
Colostomy care  
Measurement of I & O  
Administration of tube feedings  
Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction  
Rating Stars (Click) RENAL/GENITOURINARY 1 2 3 4  
Insertion and care of: straight cath Indwelling urinary cath: male female 3-way  
Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp  
Rating Stars (Click) ORTHOPEDIC 1 2 3 4  
Total Knee Replacement  
Bucks Extension  
Cast Care  
Crutch Walking  
Spica Casts  
Balanced Suspension Traction  
Circulation Checks  
Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty  
Rating Stars (Click) GENERAL 1 2 3 4  
Blood Glucose Monitoring  
Dressing Changes  
Universal Precautions  
Discharge Planning  
Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Unit Dose  
Dosage Calculation  
Pouring from stock medication  
Administration of Code Cart Emergency Drugs  
  Administration of :    
Chemotherapy Agents  
Heparin Inhalers  
Magenesium Sulfate  
Nipride Nitroglycerin  
Thrombolytic Agents  
Rating Stars (Click) IV THERAPY 1 2 3 4  
Inserting IVs Mixing IV solutions  
Heparin locks  
IV push IV drip Infusion pumps Syringe pumps  
Continuous Subcutaneous Infusion Pumps  
PCA Pumps  
Ultrasonic Doppler  
CVP lines/measurement of CVP  
Central line dressing change  
Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction  
Multi-lumen central venous catheters Implanted CVC (port-a-cath)  
Assessment of IV insertion site  
Assist with insertion of central line  
X-ray/assessment after insertion  
Care of patient with Central Line  
Charge Nurse Experience?  
CPR certified?  
BCLS certified?  
ACLS certified?  
Knowledge of normal values?  
Have you had a dysrhythmia course?  
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)