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 Of Emergency Drugs
Ambuing Technique
Calculation Of Medication Dosage
Cardiac Arrest/cpr
Defibrillator/cardioversion
Establish An Airway
Extubation
Intubation
Oxygen Administration
Respiratory Arrest
Line Management (care Of)
General
Experience 1 2 3 4
Central Lines
Groshong Catheters
Hickman/broviac Lines
Picc Lines
Portacaths/passports/lifeports
Quinton/permacath
Procedures
General
Experience 1 2 3 4
Assessment Of Wounds
Assist With Bone Marrow Biopsy
Blood Cultures
Blood Glucose Monitoring
Central Line Blood Draw
Heel Stick/finger Stick
Peak And Troughs
Sterile Dressing Changes Complex
Sterile Dressing Changes Simple
Use Of Emla Cream
Venipuncture
Equipment (use Of)
General
Experience 1 2 3 4
Apnea Monitor
Buretrol
Epidural Pump
Face Mask/shield
Infusion Pump
Isolette
Kangaroo Pump (feeding Pump)
K-pad/blanketrol
Mist Tent/croup Tent
Nasal Cannula
Ohio Warmer Bed
Overhead Warmer
Oxygen Hookup For Blowby
Oxyhood
Pca Pump
Pleurevac/thoraflex
Pulse Oximeter
Weigh Scales
Suctioning
Experience 1 2 3 4
Nasotracheal
Oral
Ph Probe
Cardiac/thoracic/vascular
General
Experience 1 2 3 4
Assessment Of Heart Sounds
Interpretation Of Rhythms
Care Of Patient With
Experience 1 2 3 4
Anaphylaxis Shock
Cardiac Surgery (pre/post)
Congenital Cardiac Deformities
Congestive Heart Failure
Sickle Cell Anemia/crisis
Transfusion Reaction
Neurology
General
Experience 1 2 3 4
Assessment Of Neuro Signs
Assist With Lumbar Puncture
Glascow Coma Scale
Seizure Precautions
Care Of Patient With
Experience 1 2 3 4
Cns Infections
Failure To Thrive
Hydrocephalus
Meningitis
Overdose/poisoning
Seizure Activity
Spina Bifida
Respiratory
General
Experience 1 2 3 4
Assessment Of Breath Sounds
Assist With Chest Tube Insertion
Management Of Chest Tube Drainage Devices
Trach Care & Suctioning
Care Of Patient With
Experience 1 2 3 4
Asthma
Croup
Cystic Fibrosis
Epiglottitis
Near Drowning
Postural Drainage
Respiratory Distress Syndrome
Reyes Syndrome
Tracheoesophageal Fistula
Gastrointestinal
General
Experience 1 2 3 4
Assessment Of Bowel Sounds
Insertion & Verification Of Feeding Tubes
Ng Insertion
Administration Of Feed Via
Experience 1 2 3 4
Bowel Obstruction
Feeding Pump (continuous)
Feeding Techniques For Cleft Palate Repair
Gravity Drainage (bolus)
Tonsilar Abscess
Care Of Patient With
Experience 1 2 3 4
Diabetes
Renal
General
Experience 1 2 3 4
Electrolyte Imbalance/replacement
Foley Catheter
Hemodialysis
Peritoneal Dialysis
Urine Specimen Collection
Care Of Patient With
Experience 1 2 3 4
Renal Trauma
Shunts & Fistula (urinary)
Vascular
Initiating Iv Access
Experience 1 2 3 4
Blood & Blood Products
Cranial
Hyperalimentations/tpn
Peripheral
Other
General
Experience 1 2 3 4
Burns
Chemotherapy
Diabetic Teaching
Isolation Techniques
Nutritional Teaching
Oncology
Patient Teaching
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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