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