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This checklist was electronically signed on (Today’s date)
This checklist is designed to guide our client facilities in assessing your proficiency in your nursing specialty. Please use the scale provided to indicate your level of experience and expertise in each of the areas listed below.
Skill Level Indicator:
★ = No Experience
★★ = Requires Training
★★★ = Capable with Supervision
★★★★ = Capable Independently
Cardiac Anomalies
CHF/Pulmonary Edema
Cardiogenic Shock
Cardioversion
Heart Sounds
Reactive Airway Disease
Croup
Pneumonia
Epiglottitis
Aspiration
Airway Obstruction
Hemo/Pneumothorax
Chest Tube Placement/Management
ABG Interpretation
Meningitis/Encephalitis
Seizures-Febrile/Epileptic
Lumbar Puncture
Migraine
Fractures/Casting
Open/Complex Fractures
Nursemaid's Elbow
Apply/Manage Splints
Circulation Checks
Crutch Walking
Car Seat Instruction for Casted Patient
Abdominal Trauma/Peritoneal Lavage
Abdominal Pain
Constipation
GI Bleeding
Hepatitis/Liver Failure
Poison Ingestion
Hypoglycemia
Hyperglycemia
DKA
Acute Renal Failure
UTI/Pyelonephritis
Renal Trauma
Testicular Torsion
Menstrual Pain
Ovarian Cyst
Ectopic Pregnancy
Pelvic Inflammatory Disease/STD
Sexual Assault
Reporting Acts of Violence
Foreign Body - Eye
Foreign Body - Ear
Foreign Body - Nose
Epistaxis
Glasgow Coma/Pediatric Trauma Scale
Trauma Code
Trauma Team Member
Brain Injury
Spinal Cord Injury
Spinal Precautions
Facial/Dental Trauma
Penetrating Trauma
Blunt Trauma
Traumatic Amputation
Hypovolemic Shock
Neurogenic Shock
Anaphylactic Shock
Septic Shock
Burns - 2nd Degree
Burns - 3rd Degree
Contagious/Infectious Patients
Isolation
Reporting Communicable Disease
Neutropenia/Reverse Isolation
Drug /ETOH Overdose/Withdrawal
Psychiatric Hold
Suicidal Patient
Pediatric Dosage Calculations
Anti-Arrhythmics
Anticoagulants (IV, Oral & Injection)
Anti-Hypertensives
Anti-Psychotics
Anti-Seizure Medications
Benzodiazepines
Continuous IV Paralytics
Continuous IV Sedation
Procedural Sedation - Administration
Ketamine
Emergency Medications
Inhaled Medications
Insulin
IV Vasopressors
Narcotics/Opioid Analgesics (IV, Oral & Injection)
Reversal Agents
Steroids (IV, Oral & Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Recognizing/Reporting Abuse
Triage
Ambulance/Paramedic Radio
Charge Experience
EMTALA
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Patient Family Teaching
Car Seat Specific Standards/Teaching
Age/Developmentally Specific/Population Based Care
Pain Assessment and Management - Verbal/Non-Verbal
Interpretation and Communication of Lab Values
Epic
Cerner
Eclipsys
McKesson
Meditech
Allscripts
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
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)
BLS
5
PALS
PEARS
ACLS
TNCC
ENPC
CEN
Other: Specify
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.
