ICU RN

This checklist was electronically signed on (Today’s date)

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 below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 . No Experience

2 . Need Training

3 . Able to perform with supervision

4 . Able to perform independently

CARDIAC

CARE OF PATIENT WITH

USE AND ADMINISTRATION OF THE FOLLOWING

RESPIRATORY

NEUROLOGY

VASCULAR

GASTROINTESTINAL

GENITO URINARY/RENAL

OTHER

EQUIPMENT

AGE SPECIFIC COMPETENCIES

CERTIFICATIONS

BLS	Yes	No
CNRN	Yes	No
ACLS	Yes	No
CCRN	Yes	No
Other:

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Defibrillation/Cardioversion
Assisting with Insertion of Central Lines
Pacemakers‐External
Permanent or Temporary Pacemaker
Cardiac Arrest/CPR
A‐Line (Transducer setup‐D/C)
Swan Ganz (Transducer setup‐D/C)
Balloon Pump (IABP)
SVO2 Monitoring
Automatic Internal Cardioverter Defib

Aneurysm
Acute MI/Unstable Angina
Cardiogenic/Hypovolemic Shock
Pre/Post Cardiac Surgery
Heart Transplant
PTCA
COPD
ARDS
Pulmonary Embolism
Pulmonary Edema
Pneumonia
Inhalation Injuries
CVA
Seizure Disorder
Overdose
Neuro Injury/Trauma
Pre/Post Neuro Surgery
Cranial Hemorrhage
Aphasia
Multiple Sclerosis
Pancreatitis
GI Bleed
Esophageal Bleeding
Bowel Obstruction
Liver Transplant
Paralitic Ileus
TURP
Shunts and Fistulas
Nephrectomy
Renal Transplant
Renal Trauma

Atropine
Bretylol
Bumex
Digoxin
Dopamine
Dobutrex
Inderal
Inocor
Isuprel
Lidocaine
Neosynephrine/Nipride
NTG
Pronestyl
Titrate Morphine
Verapamil
Valium
Steroids
Thrombolitic Agents
Prep/Titration of Emergency Drugs
Aminophylline
Corticosteroids
Bronkosol
Ventolin
Alupent
Decadron
Dilantin
Magnesium Sulfate
Phenobarbital
Versed

Lung Transplant
Establishing an Airway
Pulse Oximetry
Interpretation of ABG
Drawing ABG Blood Sample from A‐Line
Incentive Spirometer

Assessment of Neuro Signs
Use of Glascow Coma Scale
Seizure Precautions
Assist with Lumbar Puncture
ICP Monitoring
Crutchfield Tongs
Halo Traction
Stryker Frame
Assessment of Sensory‐Motor Function
Cervical Traction
Cranial Nerve Assessment
LOC Assessment
Pre/Post Neuro Surgical Care
Visual Acuity Measurement

Peripheral Pulses
Fluid Overload
Starting IV's
Subcutaneous Central Line
Hickman/Broviac/Groshong Catheters
Mainenance of Heparin Lock
TPN/Hyperalimentation
Air Occlusive Dressing
Infusion Pump
Peritoneal Dialysis
Hemodialysis
Heparin Drip ‐ Precautions and Maintenance

NG Tube Insertion
Gastronomy Tube
Jejunoostomy Tube
Enterostomal Care

Foley Catheter Insertion
GU Irrigations
Nephrostomy Tube
Suprapubic Tube
Electrolyte Imbalance/Replacement

Oncology
Chemotherapy
Isolation Techniques
Hyperbaric Oxygenation
Fingerstick Blood Glucose monitoring

Bear I
Bear II
Bear V
Bennett 7200
CPAP
Emerson
EMV
MA-I
MA-II
Monihan
Ohio 560
PEEP
Pressure Pre‐Set
Servo 900b
Servo 900c
Servo 900e
Siemens
Hewlett‐Packard
Spacelab
Marquette
Mennen
Lifecare
Nihon‐Koder

Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)