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
Defibrillation/Cardioversion
Assisting with Insertion of Central Lines
Permanent or Temporary Pacemaker
A‐Line (Transducer setup‐D/C)
Swan Ganz (Transducer setup‐D/C)
Automatic Internal Cardioverter Defib
Cardiogenic/Hypovolemic Shock
Use and Administration of the following
Prep/Titration of Emergency Drugs
Drawing ABG Blood Sample from A‐Line
Assessment of Neuro Signs
Use of Glascow Coma Scale
Assist with Lumbar Puncture
Assessment of Sensory‐Motor Function
Pre/Post Neuro Surgical Care
Visual Acuity Measurement
Subcutaneous Central Line
Hickman/Broviac/Groshong Catheters
Mainenance of Heparin Lock
Heparin Drip ‐ Precautions and Maintenance
Electrolyte Imbalance/Replacement
Fingerstick Blood Glucose monitoring
Age Specific Competencies
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)