This checklist will be used to assess your suitability for placement.
Experience Guide
1 - Not Applicable -
minimal or no exposure to clinical aspect or care.
2 - Beginner -
sufficient knowledge to understand the contextual nature of the function, able to perform routine functions independently, requires assistance when setting priorities in complex situations, needs to gain speed and flexibility to be competent.
3 - Competent -
perceives situations and functions as a whole, has knowledge of the typical events to expect in a given situation and the appropriate responses, flexible in decision making.
4 - Proficient -
considerable background and experience, can grasp situations intuitively, mastery in performance, incorporates elements of innovation and creativity in clinical experience.
Medication Administration
General
Experience 1 2 3 4
Coumadin Therapy
Epidural Pumps
Infusion Pumps
Intradermal Injections
Intramuscular Injections
Iv Additives & Piggybacks
Iv Pushes
Pca Pumps
Subcutaneous Injections
Unit Dose
Respiratory
General
Experience 1 2 3 4
Ambuing Techniques
Assessment Of Breath Sounds
Care Of Tracheostomy
Chest Tubes (emerson/pleuravac)
Establishing An Airway
Hemovac Drains
Incentive Spirometry
Interpretation Of Abg
Nasal Cannula
Nasotracheal Suctioning
Nonrebreather Mask
Oral Suctioning
Oxygen Therapy
Pulse Oximetry
Sputum Collection
Tracheal Suctioning
Venturi Mask
Care Of Patient With
Experience 1 2 3 4
Ards
Asthma
Copd
Inhalation Injuries
Inhalation Therapies
Pneumonia
Pneumothorax
Pulmonary Edema
Pulmonary Embolism
Thoracic Surgery (pre/post)
Tuberculosis
Cardiac
General
Experience 1 2 3 4
Administration Of Emergency Drugs
Aneurysm
Angina
Assessment Of Heart Sounds
Cardiac Arrest/cpr
Congestive Heart Failure
Use Of Defibrillator/cardioversion
Care Of Patient With
Experience 1 2 3 4
Hypertensive Crisis
Mi
Neurology
General
Experience 1 2 3 4
Assist With Lumbar Puncture
Glascow Coma Scale
Neuro Assessment
Siezure Precautions
Care Of Patient With
Experience 1 2 3 4
Cva/tia
Head Injury
Multiple Sclerosis
Overdose
Paraplegia
Quadraplegia
Siezure Activity
Gastrointestinal
Care Of Patient With
Experience 1 2 3 4
Appendicitis
Bowel Obstruction
Gi Bleed (upper/lower)
Hepatitis
Liver Failure (cirrosis)
Pancreatitis
Paralitic Ileus
Administration Of Feeding With
Experience 1 2 3 4
Feeding Pump (continuous)
Gravity Drainage (bolus)
General
Experience 1 2 3 4
Assessment Of Bowel Sounds
Gastrostomy Tube Care
Insertion And Verification Of Feeding Tube
Jackson-pratt Drain
Jejunostomy Tube Care
Penrose Drain
Renal
General
Experience 1 2 3 4
Electrolyte Imbalance/replacement
Gu Irrigation (setup & Maint)
Nephrostomy Tube
Suprapubic Catheters
Care Of Patient With
Experience 1 2 3 4
Chronic/acute Renal Failure
Hemodialysis
Peritoneal Dialysis
Prostectomy
Renal Calculi
Renal Trauma
Turp
Vascular
General
Experience 1 2 3 4
Administration Of Blood & Blood Products
Assist Physician With Insertion Of Central Line
Care Of Arteriovenous Shunt
Care Of Skin Graft
Cellulitis
Deep Vein Thrombosis
Fluid Overload
Groshong Catheters
Heparin Drip (precautions & Maint)
Initiating Iv Access
Maint Of Heparin/saline Lock
Peripheral Pulses
Sickle Cell Anemia
Tpn/hypealimentation/lipids
Transfusion Reaction
Venipuncture
Care Of Patient With
Experience 1 2 3 4
Anaphylaxis
Septic Shock
Orthopedic
General
Experience 1 2 3 4
Amputation
Arthroscopic Surgery (pre/post)
Bucks Extention
Cast Care
Orthopedic Trauma
Passive Rom Exercisis
Pin Site Care
Skeletal Traction
Total Joint Replacement (pre/post)
Gynecology
General
Experience 1 2 3 4
Assist Gyn Exam/pap
Ectopic Pregnancy
Hysterectomy
Mastectomy
Removal Of Cysts
Tubal Ligation
Other
General
Experience 1 2 3 4
Accuchecks (blood Glucose)
Burn Patients
Chemotherapy
Diabetic Teaching
Isolation Techniques
Knowledge Of Normal Lab Values
Nutritional Teaching
Patient Teaching
Sterile Dressing Changes
Experience 1 2 3 4
Complex
Complex Wounds
Fall Assessment
Simple
Skin Assessment
Restraints
Experience 1 2 3 4
Informed Consent
Posey
Soft
Restraints
Experience 1 2 3 4
Aids
Antibiotic Resistant Infections
Delirium Tremens
Hiv
Age Specific Practice Criteria
Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care.
A.
New Born/Neonate
(Birth - 30 days)
B.
Infant
(30 days - 1 Year)
C.
Toddler
(1 - 3 Years)
D.
Preschooler
(3 - 5 Years)
E.
School age children
(5 - 12 Years)
F.
Adolescents
(12 - 18 Years)
G.
Young Adults
(18 - 39 Years)
H.
Middle Adults
(39 - 64 Years)
I.
Older Adults
( +64 Years)
Experience With Age Groups
Able to adapt care to incorporate normal growth and development
A
B
C
D
E
F
G
H
I
Able to adapt method and terminology of patient information to their age, comprehension and maturity level.
A
B
C
D
E
F
G
H
I
Can ensure a safe environment reflecting specific needs of varying age groups.
A
B
C
D
E
F
G
H
I
By submitting this checklist you agree to the following:
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a per diem nurse with those facilities.
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