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
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Restrictive devices (restraints)
End of life care/palliative care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
Blood Glucose Monitor (BGM)
Cardioversion/defibrillation
National Patient Safety Goals
Accurate patient identification
Interpretation & communication of lab values
Medication administration
Medication reconciliation
Labeling (medications & specimens)
Monitoring conscious sedation
Pain assessment & management
Prevention of pressure ulcers
Use of rapid response teams
Assessment of heart sounds
Interpretation of arrhythmias
Interpretation of 12 lead EKG
Interpretation of hemodynamic monitoring
CVC (Central Venous Catheter)
Flow trac or Vigileo monitoring caths
Intra-Aortic Balloon Pump (IABP)
Ventricular Assist Device (LVAD, RVAD)
Implantable Cardioverter Defibrillator (ICD)
Epicardial pacemaker wires
Discontinuing venous/arterial sheaths
Acute myocardial infarction
Pre/post: cardiac catheterization
Dysrhythmias/conduction disturbances
Thoracic/abdominal surgery
Pericarditis/endocarditis
Post open heart (CABG/valve)
ACLS medications and protocols
Vasoactive/vasopressor agents
Anesthetics (propofol/presedex)
Thrombolytics (retavase/activase)
Platelet inhibitors (ReoPro/Integrilin/Aggrastat)
Flolan for pulmonary hypertension
Assessment of breath sounds
Arterial blood gas analysis/interpretation
Obtaining ABG blood sample/arterial line
BiPAP (Bi-level Positive Airway Pressure)
Oscillation/high-frequency ventilation
Interpretation of weaning parameters
Maintenance & management of pleural chest tubes
Acute respiratory failure
Adult Respiratory Distress Syndrome (ARDS)
Sudden Inflammation Respiratory Syndrome (SIRS)
Chronic Obstructive Pulmonary Disease (COPD)
Pre/post thoracic surgery
Rapid sequence intubation drugs/protocols
Nebulizer treatments: Ventolin, Atrovent
Cervical spine precautions/logroll positioning
Monitoring of neuromuscular blocking agents/paralytics
Assist with lumbar puncture
TBI (Traumatic Brain Injury)
CerebroVascular Accident (CVA)
Clipping and/or coilings of aneurysms
Steroids: Decadron, Solu-Medrol
Anticonvulsants: Dilantin, phenobarbital
Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium
Thermoregulation: hypothermia/hyperthermia
Berdow Formula/ “Rule of Nines”
Care & management of burns
Small bore feeding tube insertion (Dobhoff or Keofeed)
Nasogastric tube insertion
Post pyloric feeding tube insertion
Use of activated charcoal
Maintenance of gastric/jejunostomy tube
Maintenance & management of enteral tube feedings
Assisting/monitoring bedside procedures: endo/chest tubes/bronchs/trach insertion/PEG tubes
Acute gastrointestinal hemorrhage
Balloon tamponade devices (i.e. Blakemore tube)
Liver/pancreas transplant
Antiemetics: Reglan, Zofran
Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT)
Hemodialysis of the critically ill patient
AV fistulas, shunts & dialysis catheters
Renal/urinary tract trauma
Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Administration & monitoring of insulin infusion
Care of patient with Peripherally-Inserted Central Catheter (PICC)
Administration/monitoring of Total Parenteral Nutrition (TPN)
Administration of blood/blood products
Administration of narcotics/sedatives: (fentanyl, Valium, Ativan, Versed, morphine)
Giving directions over AV system
Drug or chemical overdose (TCA, ethanol, ASA)
Substance abuse (ETOH, stimulants, narcotics)
Human Immunodeficiency Virus (HIV)
Multisystem Organ Dysfunction Syndrome (MODS)
Disseminated Intravascular Coagulation (DIC)
Administration of chemotherapy
Monitoring of chemotherapy (does not initiate)
Organ/tissue donation procedures
Age Specific Competencies
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Older adult (ages 65-79 years)