Name: Date: RN/LVN Experience & Skill Checklist ER/ICU/CCU/DOU/Tele/Med-Surg

Transcription

1 Name: Date: RN/LVN Experience & Skill Checklist ER/ICU/CCU/DOU/Tele/Med-Surg Instructions: In the following sections, we ask you to rate yourself on your skill and experience level for nursing/medical procedures. The rating system is as follows: 0=No experience 1=Minimal experience; review and/or supervision required 2=Experienced; able to perform without supervision 3=Extensive experience; can assist others; well skilled TRAUMA Air Transport of Trauma Patient Major Trauma Patient Minor Trauma Patient Assisting with Diagnostic Peritoneal Lavage Assisting with Unstable Airways 1

2 BURNS First Degree Burns Second Degree Burns Third Degree Burns Electrocution Dressing Procedures Hazardous Materials Exposure Radiation Exposure RESPIRATORY Care of patient with ARDS Pulmonary Edema COPD Assisting with Chest Tube Insertion Maintenance of Chest Tubes Use of Pleurovac Water Seal and Suction Drainage Pneumothorax Hemothorax Auto-Transfusion Assisting with Intubation Assisting with Extubation Tracheotomy 2

3 Trach Tube T-Piece Pre and Post Thoracic Surgery Assessment of Lung Sounds Obtaining Arterial Blood Gases from Radial Artery Obtaining Arterial Blood Gases from Femoral Artery Obtaining Blood Gases from Arterial Lines Interpreting Arterial Blood Gases Setting up an Arterial Line Use and Complications related to Ventilators Use and Complications related to Bi Pap Ventilator Ability to use Ventilator or Bi Pap Independently without a Respiratory Therapist Oxygen Masks Oxygen Cannulas Venturi Masks Ventilating Patients with Ambu Bags Oxygen Cylinders Hand Held Nebulizer Set Up/Treatment Continuous Nebulizer Set Up/Treatment Oropharyngeal Suction Nasotracheal Suction Endotracheal Suction 3

4 Chest Physiotherapy Use of Incentive Spirometry Obtaining Sputum Specimen Obtaining Sputum Specimen with Leukens (induced specimen) Pulse Oximetry CARDIOVASCULAR Acute MI CHF Angina Abdominal or Thoracic Aortic Aneurysm/Dissecting Pre Angiogram Post Angiogram Post CABG Day 1 Post CABG Day 2 + Carotid Endarectomy Femoral Popliteal Bypass Cardiac Monitoring Assessing Heart Sounds Recognizing Arrhythmias Asystole Atrial Arrhythmias Heart Blocks Ventricular Arrhythmias Ventricular Tachycardia 4

5 Ventricular Fibrillation Pulseless Electical Activity (Electromechanical Dissociation) Junctional Arrhythmias Treatment of Arrhythmias Working with Vasoactive Drips Emergency Drug Therapy Obtaining 12 Lead EKG Interpreting 12 Lead EKG reading Cardiopulmonary Arrest/Resuscitation Cardioversion Defibrillation External Cardiac Pacing Open Chest Heart Massage/Defibrillation Cardiac Tamponade/Pericardiocentesis Assist with Insertion of Temporary Pacemaker Assist with Insertion of Permanent Pacemaker Familiarity with Temporary Pacemaker Settings/Controls Set up and use of CVP Line Interpretation of CVP Reading/Pressure Interpretation of Swan Ganz Readings Left Atrial Pressure Line Intra Aortic/Pulmonary Artery Balloon Pump 5

6 Left Ventricular/Right Ventricular Assistive Device Thrombolytic Therapy Anaphalactic Shock Cardiogenic Shock Septic Shock Neurogenic Shock Hypovolemic Shock Administration of Blood and Blood Products Use of Doppler Anti-embolic Hose Application/Use Use of Sequential Compression Device Assisting with Thoracentesis Assessing Peripheral Pulses Assessing for Fluid Overload Weighing Scale (Bed, Chair and Standing) NEUROLOGICAL Performing a Neuro Assessment Monitoring Neuro Signs Use of Glascow Coma Scale Acute Head Injury Acute TIA vs. CVA Acute Spinal Cord Injury 6

7 Seizures Precautions Post Craniotomy Observing for Increased Intracranial Pressure Intracranial Pressure Monitoring Subarachnoid Bolts Transport of Patient with Spinal Cord Injury Assisting with Spinal Immobilization Crutchfield Tongs Halo Traction Stryker Frame Halo Traction Circo Electric Bed Eggcrate Mattress Foot Cradle Assist with Lumbar Puncture Post Lumbar Puncture Procedural Care Bell s Palsy Guillian-Barre Syndrome Multiple Sclerosis Congenital Neurological Defects Knowledge and use of Dilantin Knowledge and use of Phenobarbital 7

8 Knowledge and use of Decadron Knowledge and use of Mannitol Knowledge and use of High doses of Solu Medrol Conscious Sedation GASTROINTESTINAL Gastrointestinal Bleed Pancreatitis Esophageal Varices Bowel Obstruction Whipple Procedure Paralytic Ileus E.R.C.P. Abdominal Wounds Gastrointestinal Tubes (Gastrostomy Tubes and Jejunostomy Tubes) Acute Abdominal Disorders Insertion and Maintenance of Nasogastric Tubes Gastric Lavage for GI Bleeds Gastric Lavage for Overdose patients Insertion, Maintenance of Discontinuation of Feeding Tubes Assessment of Abdomen Assessment of Bowel Sounds Collection of Stool Specimen 8

9 Gastrocult Procedure Hemocult Procedure Insertion of Rectal Tube Administration of Soap Suds Enema Administration of Fleets Enema Administration of Oil Retention Enema Administration of Return Flow Enema (Harris Flush) Enterostomal/Colostomy Care Assisting with Pericentesis RENAL Acute Renal Failure Chronic Renal Failure Hemodialysis Peritoneal Dialysis CVVHD-Continuous Dialysis Renal Colic Insertion of Foley Catheter Insertion of Straight Catheter Insertion of Coude Catheter Insertion of Supra Pubic Catheter Bladder Irrigation Nephrostomy Tube 9

10 Electrolyte Imbalance/Replacement T.U.R.P. Shunts and Fistulas Nephrectomy Obtaining Sterile Urine Specimen Collecting Mid Stream Urine Specimen Straining Urine Specimen Obtaining 24 hour Urine Specimen Calculating and Documenting Intake and Output TRANSPLANTS Heart Transplant acute Post-OP Lung Transplant acute Post-OP Renal Transplant acute Post-OP Liver Transplant acute Post-OP ORTHOPEDIC Set up for Cast Appication Set up for OCL Splinting Cast and Splint Care Patient Teaching related to Cast and Splint Care Checking CMST distal to injury (Capillary Refill, Movement, Sensation and Temperature, Pulses) Patient Teaching related to Crutch Walking 10

11 Set up for Insertion of Steinman Pin/K-Wire Insertion Assistance with Closed Fracture/Dislocation Reduction Conscious Sedation Monitoring/Procedures and Protocols-Adults Conscious Sedation Monitoring/Procedures and Protocols-Peds Application of External Traction Devices: Bucks Traction Sager Traction Hare Traction Body Mechanics Use of Assistive Devices: Walkers, Canes, Wheelchairs ROM Exercises Care of patient with Amputation (Digit or Extremity) Care of patient with Total Joint Replacement Care of ACL reconstruction Post OP EENT DISORDERS Foreign Body in Eye Foreign Body in Ear Foreign Body in Nose Foreign Body in Throat Epistaxis and Anterior Nasal Packing Epistaxis and Posterior Nasal Packing Set up for Flourescein/Woods Lamp Exam 11

12 Use of Morgan Lens Irrigation Ear Irrigation Eye Patch Application Removal of Contact Lens Obtaining Visual Acuity Obtaining Throat Culture INTEGUMENTARY Setting up Suture Tray Assist with Suturing Assist with Stapling Suture Removal Staple Removal Steri Strip Application Wound Drainage Systems Hemovac Drainage System Jackson Pratt Drainage System Dressing Application Dressing Changes Wet to Dry Dressings Packing of Wounds/Iodoform Guaze Decubitus Ulcers 12

13 PEDIATRIC Pediatric Arrest/Resuscitation Assisting with Insertion of Intra Osseous Needles Use of Intra Osseous Needles Use of Braslow Tape Epiglottitis Overdose/Poison Ingestion Near Drowning Child Abuse Reporting Suspected Abuse Knowledge of Necessity of Reporting Suspected Abuse Calculating Emergency Medication Doses Knowledge of Normal Serum Lab Values OBSTETRICS/GYNECOLOGY Spontaneous Abortion Vaginal Hemorrhage Placenta Previa Abruptio Placenta Pre-Eclampsia/Eclampsia Emergency Delivery Mother/Infant Identification Procedures 13

14 Baby Warmer Communicable Diseases Obtaining Cultures from cervix, vagina, or penis Assisting with Culdocentesis Obtaining Fetal Heart Tones Breast Feeding Education New Mother Education Infant Abduction Policy and Procedure Infant Abdandonment Policy and Procedure PSYCHIATRIC Suicidal/Homicidal Ideations Auditory/Visual Hallucinations Altered Mental Status Related to Chemical Impairment Overdose Chemical Restraints Physical Restraints Documentation of Patient in Seclusion/Restraints 5150 Holds Crisis Intervention Upholding Patient s Rights 14

15 ENDOCRINE Care of patient with Diabetes Diabetes Diet Education Diabetes Wound Care Education Administration of Insulin Mixing Insulin Drips Blood Glucose Monitoring Use of Accu check Machine Thyroid Storm Hypoglycemia Hyperglycemia Diabetic Ketoacidosis ENVIRONMENTAL Hypothermia Hyperthermia Use of Hypothermia/Hyperthermia Blanket Heat Stroke Heat Exhaustion Snake Bite Administration of Anti-Venom Animal Bite Poison Index/Contacting Poison Control 15

16 SEXUAL ASSAULT/ABUSE CASES Alledged Sexual Assault Rape Kit/Performing Sexual Exam/Evidence Collection Reporting Procedures for Acts of Violence Reporting Procedures of Acts of Abuse: Child or Elder Necessity of Reporting suspected Violence or Abuse PHARMACOLOGY Preparation, Calculation, Administration of Following Drugs Lidocaine Bretylium Nipride Dopamine Isuprel Digoxin Sodium Bicarbonate Rapid Sequence Induction Heparin Bolus Heparin Drip (Precautions and Maintenance) TPA Integrillin Inocor Morphine 16

17 Lopressor IV Antibiotics Magnesium Sulfate Reglan Theophylline Octreotide Vasopressin Amiodarone Pronestyl Verapamil Adenosine Atropine Epinephrine Dobutamine Tridil-Nitroglycerine Levophed Tylenol dosing for febrile pediatric patients Advil dosing for febrile pediatric patients Administering Chemotherapy Medications Narcotic Wasting Policy/2 Nurse Witnessed Waste 2 RN Check on All Insulin Administration Post Blood and Body Fluids Exposure Prophylaxis 17

18 INTRAVENOUS ACCESS LINES Initiating Peripheral IV Access on Adults Initiating Peripheral IV Access on Peds Initiating External Jugular IV Access Heparin/Saline Lock Inserting PICC line Accessing Mediport/Port-a-Cath Line Assistance with Insertion of Central Lines Care of Central Lines (including Cortis s and TLC s) Discontinuing Central Lines Discontinuing Peripheral IV Lines Use of Infusion Control Devices/Pumps PCA Pumps Performing and Assisting with IV Cut downs NURSING INTERVENTION Accurate administration of Therapeutic Agents: Therapeutic PT/PTT/INR Levels Blood and Blood Products Transfusion Procedures Medication Administration Procedures-5 Rights Heparin Protocol Potassium Protocol Pain Management Procedures and Documentation Hypertonic Saline Administration 18

19 NURSING INTERVENTION/NUTRITION Performing a Nutritional Assessment Calorie Count Administering TPN (Total Parental Nutrition) Administering Hyperalimentation NURSING INTERVENTION/DISCHARGE PLANNING Admission Assessment of Discharge Needs Interdisciplinary Documentation/Collaboration Patient Teaching Transfer/Discharge Procedures EMTALA Regulations COBRA Regulations MISCELLANEOUS SKILLS/PROCEDURES Isolation Procedures Reverse Isolation Procedures Taking care of Patients with Radiation Implants Triage Procedures Triage Categorization Identifying Emergent Patients Identifying Urgent Patients 19

20 Identifying Non-Urgent Patients Knowledge of Hospital Policy regarding Pregnant Females who present to Triage (i.e. Over 20 weeks gestation to OB etc.) Reporting Critical Lab Values Understanding Lab Values Emergency Dept-Necessity of Medical Screening Exam (MSE) Procedure for Patient Leaving Hospital AMA Procedure for Patient Leaving Hospital Without Being Seen Consent for Treatment of a Minor Multi-Victim Casuality Incidents Knowledge of Triage Categories for Multi-Victim Casuality Incidents HEICS (Hospital Emergency Incident Command System) Use of Universal Precautions Care of Patients with AIDS, Hepatitis or any other Communicable Disease Organ Donation/Procurement Documentation Related to Policy/Law Designated Requestor for Organ and Tissue Donation Post Mortem Care Policy and Procedure for Deceased Patient s Belongings Hyperbaric Oxygenation Techniques Signature of Nurse Printed Name of Nurse Date of Self Assessment 20

21 OTHER SKILLS/PROCEDURES: CERTIFICATIONS: SPECIAL TRAINING COURSES/CEU SEMINARS: NAMES OF COMPUTER CHARTING PROGRAMS: OTHER: 21

22 EXPERIENCE: Total number of years as a RN Total number of years as a LVN Please indicate the number of years of experience for the following areas of expertise: Administration Supervision Teaching Emergency Department Urgent Care ER Observation Area Trauma ICU SICU MICU PICU NICU CCU DOU Telemetry Medical Floor Surgical Floor Recovery Room Operating Room Circulating Nurse OR Open Heart Operating Room Neurology Chemical Dependency Geriatrics Psychiatic Oncology Orthopedics Critical Care Transport RN MICN Rehabilitation Pediatrics Labor and Delivery Mother/Baby/Post-partum Home Health Public Health Research Medical Sales Clinic/Urgent Care Nurses Aide/Tech Paramedic EMT Other (specify) 22