Medical Surgical Nurse

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

PULMONARY

NEUROLOGICAL and PSYCHIATRIC

ORTHOPEDICS

GASTROINTESTINAL

RENAL/GENITOURINARY

ENDOCRINE METABOLIC

ONCOLOGY

MEDICATIONS

IV THERAPY

CARDIAC MONITORING & EMERG. RESPONSE

PROFESSIONAL KNOWLEDGE AND SKILLS

EMR

CERTIFICATIONS

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.

Angina
Post Acute MI
Congestive Heart Failure
Post Cardiac Cath
Post Cardiac Surgery
Aneurysm
Carotid Endarterectomy
Post Vascular Surgery
Post Cardiac Transplant

Pneumonia
COPD
Tuberculosis
Pulmonary Embolism
Tracheostomy Management
CPAP/BiPAP
Interpretation of Arterial Blood Gases
Post Lung Transplant

Stroke Scale Assessment
Traumatic Brain Injury
CVA
Post Craniotomy
Seizure Disorders
Spinal Cord Injuries
Mood Disorders
Substance Withdrawal

Circulation/Skin Checks
Continuous Passive Motion Devices
Ambulation Assistive Devices
Prosthetics
Cast Care
Pin Care
Traction
Total Joint Replacement
Amputation

Bariatrics
Feeding Tubes
GI Bleeding
Bowel Obstruction
GI Surgery
Liver Disease
Pancreatitis
Post Liver Transplant
Post Pancreas Transplant

Arteriovenous Fistula/Shunt
3 Way Catheter & Bladder Irrigation
Suprapubic Catheter
Renal Failure
Peritoneal Dialysis
GU Surgery
Nephrostomy Tubes
Renal Transplant
Management Pre/Post Hemodialysis
Gyn Surgery

Diabetes Type I
Diabetes Type II
Blood Glucose Monitoring
IV Insulin Protocols
Management of Hypoglycemia
Indwelling Insulin Pumps
Pituitary Disorders

Chemotherapy Administration
Radiation Therapy
Medical Oncology
Surgical Oncology
Radiation Implants
Bone Marrow Transplant

Antiarrhythmics
Anticoagulants (IV, oral, & injection)
Anti-Depressants
Anti-Hypertensives
Anti-Psychotics
Benzodiazepines
Emergency Medications
Epidural Analgesia
Inhaled Medications
Insulin
Narcotics/Opioid Analgesics (IV, oral, & injection)
Nitrates (Oral & Topical)
Non-Opioid Analgesics (IV, Oral, & Injection)
Oral Hypoglycemics
Patient Controlled Analgesia
Procedural Sedation Administration
Reversal Agents
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)

Starting IVs
Central Line Blood Draws
Central Line/Implanted Line Care
TPN & Lipids
Blood Product Administration
Monitoring of Chemotherapy

Placement of Telemetry Leads
Rhythm Interpretation
Dysrhythmia Management
Obtain 12 Lead EKG
Use of Rapid Response Teams

National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Patient/Family Teaching
Age Specific/Population-Based Care
Isolation Precautions
Infection Prevention
Pain Assessment & Management
Charge Experience
Interpretation and Communication of Lab Values
Wound Care /Wound Vac
Specialty Beds

Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
EMR Conversion

BLS
ACLS
Telemetry Certificate
ONS Chemo/Biotherapy Certification
Other Chemo Certification
Other: Specify