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