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.
Emergency Situations:
General
Experience 1 2 3 4
Administration & Calculation Of Emergency Drugs
Blow By
Cardiac Arrest/cpr
Defibrillator/cardioversion
Establish An Airway
Extubation
Intubation
Nrp
Oxygen Administration
Respiratory Arrest
Cardiac
General
Experience 1 2 3 4
Adenosine
Assessment Of Heart Sounds
Cardiac Tamponade
Dobutrex
Dopamine
Ekg Interpretation
Hemodynamic Monitoring
Pa Lines
Prostin Vr
Svo2 Monitoring
Care Of Patient With
Experience 1 2 3 4
Bradycardia Related To Apnea
Cardiac Surgery (pre/post)
Congenital Heart Disease
Congestive Heart Failure
Electrolyte/imbalance/replacement
Patent Ductus Arteriosis
Renal Failure
Tachycardia & Svt
Tetralogy Of Fallot
Thoracic Surgery (pre/post)
Transposition Of Great Vessels
Respiratory
General
Experience 1 2 3 4
Assessment Of Breath Sounds
Obtaining Abg's Via
Experience 1 2 3 4
A Line
Arterial Stick
Assist With Chest Tube Insertion
Interpretation Of Abgs
Management Of Chest Tube & Drainage Devices
Nasal Cpap
Care Of Patient With
Experience 1 2 3 4
Asthma
Bronco-pulmonary Dysplasia
Cystic Fibrosis
Endotracheal Tube Care & Suctioning
Epiglottitis
Meconium Aspiration
Pneumonia
Pulmonary Edema
Rds
Rsv
Trach Care & Suctioning
Tracheoesophogeal Fistula
Suctioning
Experience 1 2 3 4
Nasotracheal
Oral
Post Tracheal Surgery (cryothyroid Split)
Neurology
General
Experience 1 2 3 4
Assess Neuro Signs
Assist With Lumbar Puncture
Seizure Activity
Seizure Precaution
Care Of Patient With
Experience 1 2 3 4
Brain Death Criteria
Cns Infections
Drug Withdrawal/addiction
Hydrocephalus
Intracranial Hemorrhage
Meningitis
Neural Tube Defects
Neuromuscular Disease
Vp Shunt
Gastrointestinal
General
Experience 1 2 3 4
Assessment Of Gi Sounds
Bowel
Familiar With Formula, Fluid & Caloric Needs
Obstruction
Oj/og/nj Tubes & Feeds
Care Of Patient With
Experience 1 2 3 4
Colostomy Care
Nec
Post-op Bowel Surgery
Renal
General
Experience 1 2 3 4
Foley Catheter Insertion
Urine Collection
Vascular
Initiating Iv Access
Experience 1 2 3 4
Admin. Of Blood/blood Products
Admin. Of Tpn/hyperalimentation
Obtain Specimens From Uac &uvc
Peripheral
Scalp
Sterile Dressing Changes
Experience 1 2 3 4
Complex
Hypothermia
Simple
Other
General
Experience 1 2 3 4
Accuchecks (blood Glucose)
Blood Cultures
Central Lines
Circumcision Care
Cord Care
Heel Stick/finger Stick
Hypoglycemia
Isolation Techniques
Low Birth Weight Infants
Normal Lab Values
Venipuncture
Equipment (use Of):
General
Experience 1 2 3 4
A Line
Central Line
Picc Line
Transducer Set Up And Maint.
Uac
Uvc
Ventilators
Experience 1 2 3 4
Jet
Oscillatory
Pressure
Volume
Cardio-respiratory Montor With
Experience 1 2 3 4
Invasive Blood Pressure
Noninvasive Blood Pressure
Oxygen Saturation
Oxyhood
Experience 1 2 3 4
Apnea Monitors
Infusion Pumps
Isolette
Kangaroo Pumps (feeding Pumps)
Nasal Cannula
Nebulizer
Phototherapy
Pyxis
Radiant Warmers
Transport Monitor
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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