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
CARDIOVASCULAR Care of Patient with
Cardiomyopathy Cardiopulmonary Arrest
Abdominal Aortic Aneurysm
Pre & Post Cardiac Surgery
Permanent Pacemaker Temporary Pacemaker External Pacemaker
Cardiac Lab Interpretation
Cardiac Patient/Family Teaching
Suctioning: oral nasotracheal endotracheal tube tracheostomy tube
Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET
Inturbation/extubationambu bag pulse oximetry
Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema
Assessment and Management of Seizure Activity
Assisting with lumbar puncture
Signs/Symptoms of increasing ICP
Circo-electric bed Halo traction
Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery
Administration of tube feedings
Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction
Insertion and care of: straight cath Indwelling urinary cath: male female 3-way
Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp
Balanced Suspension Traction
Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty
Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS
Pouring from stock medication
Administration of Code Cart Emergency Drugs
Inserting IVs Mixing IV solutions
IV push IV drip Infusion pumps Syringe pumps
Continuous Subcutaneous Infusion Pumps
CVP lines/measurement of CVP
Central line dressing change
Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction
Multi-lumen central venous catheters Implanted CVC (port-a-cath)
Assessment of IV insertion site
Assist with insertion of central line
X-ray/assessment after insertion
Care of patient with Central Line
Knowledge of normal values?
Have you had a dysrhythmia course?
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)