Priority RN Nursing Services



Name:      

Date:      

RN/LVN Experience & Skill Checklist

Emergency Department

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

|0 |1 |2 |3 | |

| | | | |Air Transport of Trauma Patient |

| | | | |Major Trauma Patient |

| | | | |Minor Trauma Patient |

| | | | |Assisting with Diagnostic Peritoneal Lavage |

| | | | |Assisting with Unstable Airways |

BURNS

|0 |1 |2 |3 |Care of Patient with… |

| | | | |First Degree Burns |

| | | | |Second Degree Burns |

| | | | |Third Degree Burns |

| | | | |Electrocution |

| | | | |Dressing Procedures |

| | | | |Hazardous Materials Exposure |

| | | | |Radiation Exposure |

RESPIRATORY

|0 |1 |2 |3 |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 |

| | | | |Trach Tube |

| | | | |T-Piece |

| | | | |Assessment of Lung Sounds |

| | | | |Obtaining Arterial Blood Gases from Radial 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 |

| | | | |Use of Incentive Spirometry |

| | | | |Obtaining Sputum Specimen |

| | | | |Obtaining Sputum Specimen with Leukens (induced specimen) |

| | | | |Pulse Oximetry |

CARDIOVASCULAR

|0 |1 |2 |3 |Care of Patient with… |

| | | | |Acute MI |

| | | | |CHF |

| | | | |Angina |

| | | | |Abdominal or Thoracic Aortic Aneurysm/Dissecting |

| | | | |Pre Angiogram |

| | | | |Cardiac Monitoring |

| | | | |Assessing Heart Sounds |

| | | | |Recognizing Arrhythmias |

| | | | |Asystole |

| | | | |Atrial Arrhythmias |

| | | | |Heart Blocks |

| | | | |Ventricular Arrhythmias |

| | | | |Ventricular Tachycardia |

| | | | |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 |

| | | | |Familiarity with Temporary Pacemaker Settings/Controls |

| | | | |Set up and use of CVP Line |

| | | | |Interpretation of CVP Reading/Pressure |

| | | | |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 |

| | | | |Assisting with Thoracentesis |

| | | | |Assessing Peripheral Pulses |

| | | | |Assessing for Fluid Overload |

| | | | |Weighing Scale (Pediatric and/or Adult) |

NEUROLOGICAL

|0 |1 |2 |3 |Care of Patient with… |

| | | | |Performing a Neuro Assessment |

| | | | |Monitoring Neuro Signs |

| | | | |Use of Glascow Coma Scale |

| | | | |Acute Head Injury |

| | | | |Acute TIA vs. CVA |

| | | | |Acute Spinal Cord Injury |

| | | | |Seizures Precautions |

| | | | |Observing for Increased Intracranial Pressure |

| | | | |Transport of Patient with Spinal Cord Injury |

| | | | |Assisting with Spinal Immobilization |

| | | | |Eggcrate Mattress |

| | | | |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 |

| | | | |Knowledge and use of Decadron |

| | | | |Knowledge and use of Mannitol |

| | | | |Knowledge and use of High doses of Solu Medrol |

| | | | |Conscious Sedation |

GASTROINTESTINAL

|0 |1 |2 |3 |Care of Patient with… |

| | | | |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 |

| | | | |Assessment of Abdomen |

| | | | |Assessment of Bowel Sounds |

| | | | |Collection of Stool Specimen |

| | | | |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

|0 |1 |2 |3 |Care of Patient with… |

| | | | |Acute Renal Failure |

| | | | |Chronic Renal Failure |

| | | | |Hemodialysis |

| | | | |Peritoneal Dialysis |

| | | | |Renal Colic |

| | | | |Insertion of Foley Catheter |

| | | | |Insertion of Straight Catheter |

| | | | |Insertion of Coude Catheter |

| | | | |Insertion of Supra Pubic Catheter |

| | | | |Bladder Irrigation |

| | | | |Nephrostomy Tube |

| | | | |Electrolyte Imbalance/Replacement |

| | | | |T.U.R.P. |

| | | | |Shunts and Fistulas |

| | | | |Obtaining Sterile Urine Specimen |

| | | | |Collecting Mid Stream Urine Specimen |

| | | | |Straining Urine Specimen |

| | | | |Obtaining 24 hour Urine Specimen |

| | | | |Calculating and Documenting Intake and Output |

ORTHOPEDIC

|0 |1 |2 |3 | |

| | | | |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 |

| | | | |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) |

EENT DISORDERS

|0 |1 |2 |3 |Care of Patient with… |

| | | | |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 |

| | | | |Use of Morgan Lens Irrigation |

| | | | |Ear Irrigation |

| | | | |Eye Patch Application |

| | | | |Removal of Contact Lens |

| | | | |Obtaining Visual Acuity |

| | | | |Obtaining Throat Culture |

INTEGUMENTARY

|0 |1 |2 |3 | |

| | | | |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 |

PEDIATRIC

|0 |1 |2 |3 |Care of Patient with… |

| | | | |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

|0 |1 |2 |3 |Care of Patient with… |

| | | | |Spontaneous Abortion |

| | | | |Vaginal Hemorrhage |

| | | | |Placenta Previa |

| | | | |Abruptio Placenta |

| | | | |Pre-Eclampsia/Eclampsia |

| | | | |Emergency Delivery |

| | | | |Mother/Infant Identification Procedures |

| | | | |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

|0 |1 |2 |3 |Care of Patient with… |

| | | | |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 |

ENDOCRINE

|0 |1 |2 |3 |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

|0 |1 |2 |3 |Care of Patient with… |

| | | | |Hypothermia |

| | | | |Hyperthermia |

| | | | |Use of Hypothermia/Hyperthermia Blanket |

| | | | |Heat Stroke |

| | | | |Heat Exhaustion |

| | | | |Snake Bite |

| | | | |Administration of Anti-Venom |

| | | | |Animal Bite |

| | | | |Poison Index/Contacting Poison Control |

SEXUAL ASSAULT/ABUSE CASES

|0 |1 |2 |3 |Care of Patient with… |

| | | | |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

|0 |1 |2 |3 |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 |

| | | | |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 |

| | | | |Narcotic Wasting Policy/2 Nurse Witnessed Waste |

| | | | |2 RN Check on All Insulin Administration |

| | | | |Post Blood and Body Fluids Exposure Prophylaxis |

INTRAVENOUS ACCESS LINES

|0 |1 |2 |3 | |

| | | | |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

|0 |1 |2 |3 |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 |

NURSING INTERVENTION/NUTRITION

|0 |1 |2 |3 | |

| | | | |Performing a Nutritional Assessment |

| | | | |Calorie Count |

NURSING INTERVENTION/DISCHARGE PLANNING

|0 |1 |2 |3 | |

| | | | |Admission Assessment of Discharge Needs |

| | | | |Interdisciplinary Documentation/Collaboration |

| | | | |Patient Teaching |

| | | | |Transfer/Discharge Procedures |

| | | | |EMTALA Regulations |

| | | | |COBRA Regulations |

MISCELLANEOUS SKILLS/PROCEDURES

|0 |1 |2 |3 | |

| | | | |Isolation Procedures |

| | | | |Reverse Isolation Procedures |

| | | | |Taking care of Patients with Radiation Implants |

| | | | |Triage Procedures |

| | | | |Triage Categorization |

| | | | |Identifying Emergent Patients |

| | | | |Identifying Urgent Patients |

| | | | |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 |

OTHER SKILLS/PROCEDURES/SPECIAL TRAINING/SEMINARS:

     

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)       |

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