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
Interpretation of Arterial Blood Gases
NEUROLOGICAL & PSYCHIATRIC
Continuous Passive Motion Devices
Ambulation Assistive Devices
Arteriovenous Fistula/Shunt
3 Way Catheter & Bladder Irrigation
Management Pre/Post Hemodialysis
Management of Hypoglycemia
Chemotherapy Administration
Anticoagulants (IV, oral, & injection)
Narcotics/Opioid Analgesics (IV, oral, & injection)
Nitrates (Oral & Topical)
Non-Opioid Analgesics (IV, Oral, & Injection)
Patient Controlled Analgesia
Procedural Sedation Administration
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Central Line/Implanted Line Care
Blood Product Administration
Monitoring of Chemotherapy
CARDIAC MONITORING & EMERG. RESPONSE
Placement of Telemetry Leads
Use of Rapid Response Teams
PROFESSIONAL KNOWLEDGE AND SKILLS
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Age Specific/Population-Based Care
Pain Assessment & Management
Interpretation and Communication of Lab Values
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration