Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
  • Age of Patients Cared For/General Skills
    Newborn/Neonate (birth to 30 days)
    Infant (31 days to 12 months)
    Toddler/Preschool (13 months to 5 years)
    School Age Child/adolescent (6 years to 18 years)
    Young Adults/Middle Adult (19 years to 64 years)
    Older Adults/Elderly (65+ years)
    GENERAL SKILLS
    Automated Med Dispensing Systems
    Other Automated Med Dispensing Systems:
    Electronic Documentation
    Other Electronic Documentation:
    IV Pumps
    Other IV Pumps:
    Peripheral IV Insertion, Care and Maintenance
    Access/Management of Implanted Ports
    Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
    Administration of Blood and Blood Products
    Fluid Resuscitation
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores
    ADMISSION TO PACU
    Initial Assessment/Vital Signs
    Airway Management
    Proper Positioning
    Skin Color, Temp, Turgor
    Neurological Status
    MONITOR RECOVERY OF PATIENT FROM
    General Anesthesia
    Regional Anesthesia
    Local Anesthesia
    NEURO SKILLS
    Neuro Assessment
    Glasgow Coma Scale
    NEURO-Care of the Post Operative Patient With:
    Spinal Fusion
    Spinal Cord Injury
    Ventriculostomy
    Craniotomy
    ICP Monitor
    CARDIAC SKILLS
    Cardiac Assessment (Auscultation)
    Knowledge of Labs and Normal Values
    12 Lead Interpretation
    Arrhythmia Analysis
    Assist with Insertion of Temporary Pacemaker
    Permanent Pacemaker
    Use of Doppler
    Intravascular Hemodynamic Monitoring:
    Pulmonary Artery Catheters
    Arterial Catheters
    Swan-Ganz Catheters
    Cardiac Output
    CARE OF THE PATIENT WITH
    AAA Repair
    CARDIAC-CARE OF THE POST OPERATIVE PATIENT WITH
    Open Heart Surgery (CABG)
    Off Pump Heart Surgery
    Valve Repair
    Congestive Heart Failure
    Heart Transplant
    Cardiogenic Shock
    Hyper/Hypothermia
    Malignant Hyperthermic Crisis
    RESPIRATORY SKILLS
    Airway Insertion/Management (Nasal, Oral)
    Recognize Abnormal Breath Sounds (e.g. rales, rhonchi) & Implement Interventions
    Laryngospasm
    Bronchospasm
    Hemothorax
    Pneumothorax
    Upper Airway Obstruction
    Aspiration
    Airway Maintenance - Jaw Thrust/Chin Lift
    Obtain ABGs
    Knowledge of ABGs and normal values
    Set-up Chest Tube Drainage System
    Recognize Air Leak, Assess for SQ Emphysema
    Perform Suctioning (oral, nasal, endotracheal)
    Assist with Intubation
    End Tidal CO2 Monitor
    ETT Extubation
    Non Rebreather Mask
    Nasal Cannula
    T-Piece
    FaceMask (With/without Mist)
    RESPIRATORY-Care of the Post Operative Patient With:
    Chest Tube
    Lung Transplant
    Thoracotomy
    Lobectomy
    GASTROINTESTINAL SKILLS
    Bowel Sounds/Abdominal Assessment
    G or J Tube
    NG Tubes
    Ostomy Care and Assessment
    Wound Drains
    Abdominal Wounds
    Assessment of GI Distress/Bleeding
    GASTROINTESTINAL-Care of the Post Operative Patient With:
    Colostomy/Ileostomy
    Post -OP GI/Abdominal Surgery
    Liver/Pancreatic Transplant
    Small Bowel Transplant
    Appendectomy
    Gastric Bypass
    Hysterectomy
    GENITOURINARY SKILLS
    Urethral Catheter
    Suprapubic Catheter
    Bladder Irrigation
    Nephrostomy Tube
    GU/RENAL SKILLS-Care of the Post Operative Patient With:
    TURP/TURB
    Nephrectomy
    Kidney Transplant
    Bladder Repair
    Shunts and Fistulas
    ORTHOPEDIC SKILLS
    Circulation/Movement/Sensation Checks
    Cold Systems
    Braces/Cast Care
    ORTHOPEDIC-Care of Post Operative Patient With:
    Amputation
    Total Joint
    Fractures
    Arthroscopy/Arthrotomy
    Skeletal Traction
    Total Hip Replacement
    Total Knee Replacement
    Fractures
    PAIN MANAGEMENT
    Assessment and Documentation of Pain and Follow Up After Intervention
    PCA Systems
    Epidural Pain Systems
    IV Sedation
    Assessment of Epidural Anesthesia Level
    Assessment of Spinal Anesthesia Level
    Assist with Epidural Catheter Insertion
    MEDICATIONS/ANESTHESIC AGENTS,TREATMENT AND COMPLICATIONS
    Narcotic Analgesic
    Non-narcotic Analgesics
    Muscle Relaxants
    Anesthesia
    Spinal Anesthesia
    Local Anesthesia
    Inhalants
    Regional Anesthesia
    General Anesthesia
    Reversal Agents
    GENERAL NURSING SKILLS
    Admit and Discharge Patients
    Advance Directives
    Blood Glucose Monitoring
    Urine Dipstick
    Restraints
    Positioning/Transferring
    Multiple Trauma Patient
    Care of the HIV Patient
    Isolation Techniques
    Postmortem Care