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Telemetry/Stepdown 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 |
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| Rating Stars (Click) | CARDIOVASCULAR Care of Patient with | 1 | 2 | 3 | 4 | ||
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Acute MI | ||||||
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CHF | ||||||
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Angina Hypertension | ||||||
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Cardiomyopathy Cardiopulmonary Arrest | ||||||
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Abdominal Aortic Aneurysm | ||||||
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Carotid Endarterectomy | ||||||
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Femoral Popliteal Bypass | ||||||
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Pre & Post Cardiac Surgery | ||||||
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Pre & Post Cardiac Cath | ||||||
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Pre & Post PTCA | ||||||
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Permanent Pacemaker Temporary PacemakerExternal Pacemaker | ||||||
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Cardiac Lab Interpretation | ||||||
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Cardiac Patient/Family Teaching | ||||||
| Rating Stars (Click) | RESPIRATORY | 1 | 2 | 3 | 4 | ||
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Respiratory assessment | ||||||
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Assess Lung sounds | ||||||
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Chest percussion | ||||||
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Establish/Protect Airway | ||||||
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Chest tubes/Pleurevac | ||||||
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Oxygen therapy | ||||||
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Drawing ABGs | ||||||
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Interpretation of ABGs | ||||||
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Incentive Spirometry | ||||||
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Suctioning: oral nasotracheal endotracheal tube tracheostomy tube | ||||||
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Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET | ||||||
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Inturbation/extubationambu bag pulse oximetry | ||||||
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Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema | ||||||
| Rating Stars (Click) | NEUROLOGY | 1 | 2 | 3 | 4 | ||
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Neurological assessment | ||||||
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Seizure precautions | ||||||
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Assessment and Management of Seizure Activity | ||||||
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Assisting with lumbar puncture | ||||||
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Signs/Symptoms of increasing ICP | ||||||
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Glascow Coma Scale | ||||||
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Crutchfield tongs | ||||||
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Circo-electric bed Halo traction | ||||||
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Stryker frame | ||||||
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Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery | ||||||
| Rating Stars (Click) | GASTROINTESTINAL | 1 | 2 | 3 | 4 | ||
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G.I. assessment | ||||||
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Bowel sounds | ||||||
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Inserting N-G tubes | ||||||
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Colostomy care | ||||||
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Measurement of I & O | ||||||
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Administration of tube feedings | ||||||
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Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction | ||||||
| Rating Stars (Click) | RENAL/GENITOURINARY | 1 | 2 | 3 | 4 | ||
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Insertion and care of: straight cath Indwelling urinary cath: male female 3-way | ||||||
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Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp | ||||||
| Rating Stars (Click) | ORTHOPEDIC | 1 | 2 | 3 | 4 | ||
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Total Knee Replacement | ||||||
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Bucks Extension | ||||||
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Cast Care | ||||||
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Crutch Walking | ||||||
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K-Wires | ||||||
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Spica Casts | ||||||
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Balanced Suspension Traction | ||||||
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Circulation Checks | ||||||
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Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty | ||||||
| Rating Stars (Click) | GENERAL | 1 | 2 | 3 | 4 | ||
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Blood Glucose Monitoring | ||||||
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Dressing Changes | ||||||
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Universal Precautions | ||||||
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Isolation | ||||||
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Discharge Planning | ||||||
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Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
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Unit Dose | ||||||
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Dosage Calculation | ||||||
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Pouring from stock medication | ||||||
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Administration of Code Cart Emergency Drugs | ||||||
| Administration of : | |||||||
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Aminophylline | ||||||
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Ativan | ||||||
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Atropine | ||||||
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Chemotherapy Agents | ||||||
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Corticosteroids | ||||||
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Decadron | ||||||
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Digoxin | ||||||
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Dilantin | ||||||
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Dobutamine | ||||||
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Dopamine | ||||||
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Heparin Inhalers | ||||||
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Lidocaine | ||||||
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Lopressor | ||||||
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Magenesium Sulfate | ||||||
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Nipride Nitroglycerin | ||||||
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Phenobarbital | ||||||
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Thrombolytic Agents | ||||||
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Valium | ||||||
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Verapamil | ||||||
| Rating Stars (Click) | IV THERAPY | 1 | 2 | 3 | 4 | ||
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Inserting IVs Mixing IV solutions | ||||||
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Heparin locks | ||||||
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TPN/Hyperalimentation | ||||||
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IV push IV drip Infusion pumps Syringe pumps | ||||||
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Continuous Subcutaneous Infusion Pumps | ||||||
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PCA Pumps | ||||||
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Ultrasonic Doppler | ||||||
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CVP lines/measurement of CVP | ||||||
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Central line dressing change | ||||||
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Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction | ||||||
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Multi-lumen central venous catheters Implanted CVC (port-a-cath) | ||||||
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Assessment of IV insertion site | ||||||
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Assist with insertion of central line | ||||||
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X-ray/assessment after insertion | ||||||
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Care of patient with Central Line | ||||||
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Charge Nurse Experience? | ||||||
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CPR certified? | ||||||
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BCLS certified? | ||||||
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ACLS certified? | ||||||
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Knowledge of normal values? | ||||||
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Have you had a dysrhythmia course? | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Elderly (ages 80+ years) | ||||||