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
Foreign Body/Soft Tissue Studies
Cervical Spine-Obls/Flexion/Extension
Thoracic Spine-Swimmer’s View
Lumbar Spine-Obls/Flexion. Extension
Fluoroscopy/Contrast Studies
Barium Swallow/Esophagram
Modified Barium Swallow/Protocol Swallow
Swallow Studies with Videotaping
Upper GI Series-Single Contrast
Upper GI Series-Air Contrast
Small Bowel Follow Through
Barium Enema-Single Contrast
Water Soluble Contrast Enema (e.g. Hypaque)
Barium Enema-Air Contrast
Lower GI Studies thru Colostomy
Contrast Injection Studies
Broncoscopy with Fluoro Guidance
Bedside Line and Tube Placement
Operative Cholangiography
National Patient Safety Goals
Age Specific Practice Criteria
Newborn/neonate (birth-30 days)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)