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
Congenital Heart Disease/Repair
Post Cardiac Surgery (Directly from OR)
Post Cardiac Surgery (NOT Directly from OR)
Post Diagnostic/Interventional Cardiac Cath
Heart Failure/Cardiogenic Shock
Arrhythmia Interpretation
Pacemaker - Temporary/Permanent
Intra-Aortic Balloon Pump
Ventricular Assist Device
Respiratory Distress Syndrome/Resp. Failure
Endotracheal Tube Management
Modes of Ventilation: AC/PC/SIMV/CPAP
Modes of Ventilation: Jet/Oscillator
Management of Gastric Tubes
Breast Milk Handling/Storage
Renal Replacement Therapy
Diabetes - Hypo/Hyperglycemic Crisis
Craniofacial Reconstruction
Poison Ingestion/Overdose
Immunosuppressive Disorder
Pediatric Dosage Calculations
Anticoagulants (IV, Oral & Injection)
Procedural Sedation - Administration
Narcotics/Opioid Analgesics (IV, Oral & Injection)
Non-Opioid Analgesics (IV, Oral & Injection)
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Central Line/Implanted Line Care
Blood Product Administration
Administration of Chemotherapy
CARDIAC MONITORING & EMERG. RESPONSE
Dysrhythmia Interpretation
Management of Cardiac Arrest
Multisystem Organ Failure
PROFESSIONAL KNOWLEDGE AND SKILLS
National Patient Safety Goals/Core Measures
Recognize/Report Signs of Abuse
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Normal Growth and Development
Age Specific/Population Based Care
Reporting Communicable Diseases
Pain Assessment & Management
Interpretation and Communication of Lab Values
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)
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration