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
Care of Patient in Restraints
Bacterial/Viral Pneumonia
Broncho-Pulmonary Dysplasia
Hayaline Membrane Disease (HMD/IRDS)
Persistant Fetal Circulation
Pulmonary Interstitial Emphysema (PIE)
Respiratory Syncytial Virus
Respiratory Distress Syndrome
Tracheo-Esophageal Fistula
Assessment of Breath Sounds
Disinfection and Sterilization
Nasal-Oral Airway Placement
Transcutaneous Monitoring
Aerosol Set Up/Mask/Trach
Bronchial Hygiene Therapy
Chest Physical Therapy/Postural Drainage
Continuous Medication Nebulizer
Heated Aerosol Mask/Trach Collar
Incentive Spirometry (IS)
Intrapulmonary Percussive Ventilation (IPV)
Oxgen Tank Set Up/Change Tank
Partial Rebreather/Non-Rebreather Mask
PEP Mask/PEP Valve Therapy
Positive Pressure Breathing (IPPB)
Obtaining Arterial Blood Gases:
ABG Interpretation/Analyzer
Airway Pressure Release Ventilation (ARPV)
Arterial Blood Gas Analysis
Arterial Line Maintenance
Change, Clean Trach Tubes
Check Intracuff Pressures
Continuous Positive Airway Pressure (CPAP)
Flow/Volume/Pressure Waveform Interpretation
High Frequency Ventilator
Independent Sychronous Lung Ventilation
Intra Aortic Balloon Pump (IABP)
Inverse Ratio Ventilation
Negative Inspiratory Force
Positive End Expiratory Pressure (PEEP)
Pressure Regulated Volume Control (PRVC)
Pressure Support Ventilation (PSV)
Pulmonary Function Testing
Intermittent Mandatory Ventilation (IMV)
Inverse Ratio Ventilation
Pressure Release Modes/Techniques
Synchronized Intermittent Mandatory Ventilation (SIMV)
Ventilate Patient with Manual Resuscitator
Ventilator Set Up/On Tanks
Medical/Surgical General Floor Care
Pediatric General Floor Care
Newborn (birth – 30 days)
Infant (30 days – 1 year)
Preschooler (3 – 5 years)
School Age (5 – 12 years)
Adolescents (12 – 18 years)
Young Adults (18 – 39 years)
Middle Adults (39 – 64 years)