CYNET_SYSTEMS_MAIN_LOGO.gif   ONCOLOGY NURSE PRACTITIONER SKILL CHECK LIST
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group 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.  
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

  
       
Rating Stars (Click) Comprehensive Health Assessment 1 2 3 4  
Demonstrates the ability to perform initial health assessments that identify factors that will impact the patient’s cancer chemotherapy experience, this may include:  
Pre-existing health problems including allergies, medication and any previous exposure to cancer chemotherapy medications  
Age and stage of development  
Psychosocial factors  
Demonstrates the ability to perform ongoing health assessments in a timely manner:  
Before each chemotherapy cycle  
Before renewal of self-administered and non- cyclical chemotherapy and biotherapy prescriptions  
In response to patient concerns  & When health status changes (physical, emotional, mental, spiritual, cognitive, developmental, environmental)  
When side effects occur  
When evidence of an adverse event/toxicity  
Demonstrates the ability to document assessments by BCHS policy and procedure as well as CNO standards in the following applications:  
Meditech  
Opis  
Mosaiq  
Patient’s individualized paper chart  
Demonstrates the ability to formulate a place of care in collaboration with the patient, family and interprofessional care team to address issues
identified during assessments 		 
Rating Stars (Click) Supportive and Therapeutic Relationships 1 2 3 4  
Demonstrates the ability to consider the emotional, cultural, and spiritual context of patients and families
during initial and ongoing care 		 
Demonstrates the ability to work collaboratively with the patient and family to identify support services
needed to manage and initiate referrals as appropriate 		 
Demonstrates the ability to reflect on and monitor the therapeutic relationships that evolve overtime, as
needs and outcomes change 		 
Demonstrates the ability to document the patient and family perspective to enable individualized cancer chemotherapy and biotherapy care while maintaining
confidentiality 		 
Demonstrates the ability to listen and explore the
patient and family concerns 		 
Rating Stars (Click) Management of Cancer Symptoms and Treatment Side Effects 1 2 3 4  
Demonstrates the ability to maintain and apply current knowledge, judgement and skill in the management of chemotherapy and biotherapy side effects and toxicities related to the specific population in which is practiced. This includes but not limited to:  
Neutropenia  
Anemia  
Peripheral neuropathies and neurotoxicity  
Thrombocytopenia  
Hepatoxicity  
Nephrotoxicity  
Hemorrhagic cystitis  
Cutaneous changes: nail changes, rash, pigmentation alternations, hand-foot syndrome, photosensitivity  
Alopecia  
Cardiac toxicity  
Pulmonary toxicities  
Cognitive changes  
Psychosocial distress  
Chemotherapy induced nausea & vomiting  
Anorexia & cachexia  
Mucositis  
Diarrhea  
Constipation  
Sleep disorders  
Ocular toxicity  
Fatigue  
Sexuality and fertility alterations  
Infusion reactions  
Extravasation and infiltration  
the ability to communicate to members of the interdisciplinary team, the patient and family to assist in developing care plans that address chemotherapy and biotherapy side effects, toxicities, adverse events, and patient identified concerns in a
timely manner 		 
Demonstrates an understanding of the principles, indications, classifications, and mechanism of action for chemotherapies and biotherapies commonly
administered in the Cancer Clinic at BCHS 		 
Applies principles of safety and safe handling specific to the route and method of chemotherapy and
biotherapy administration and the cytotoxic profile of the drugs 		 
Applies principles of safe handling to disposal of contaminated equipment and cytotoxic agents, spill
management, and contaminated body fluids 		 
Demonstrates understanding of and utilizes principles of monitoring of patient during blood and blood product transfusion:  
PRBC  
FFP  
Platelets  
Immune globulin  
Albumin  
Identifies blood transfusion reactions and nursing responsibilities  
Demonstrates the ability to care for central venous access devices & peripherally inserted central catheters (PICC):  
Explain indication of use and sites  
States complications of CVAD’s & PICC’s  
Demonstrates the skill to access CVAD’s for
intravenous therapy 		 
Demonstrates the skill to obtain blood sampling from:  
Percutaneous CVAD  
Implanted CVAD  
Peripherally inserted central catheter (PICC)  
Rating Stars (Click) Teaching and Coaching 1 2 3 4  
Demonstrates the ability to assess the patient and family’s readiness to learn by evaluating age and developmental level, existing knowledge level, their expectations for the treatment and response to learning  
Demonstrates the ability to pace the teaching based
on the patient’s readiness to learn 		 
Provides the patient and family with information specific to their cancer treatment in relation to the following, based on best practice guidelines, protocols and standards:  
Purpose, mechanism of action, route, and schedule of the treatment and supportive medication  
Immediate, early, late and delayed side effects and toxicities of treatment and their management, differentiating between expected, non-urgent side effects and those that require immediate medical attention  
Safe use of mechanical devices and equipment  
Vascular access device assessment and care  
Safe handling of contaminated equipment and body fluids  
Requirements and rational for monitoring parameters including bloodwork, diagnostic interventions, and symptoms  
Provides patients and families with opportunities for reinforcement of the education and validation of their
understanding 		 
Evaluates the outcomes of the education provided to
patients and families 		 
Documents teaching provided  
Collaborates with the healthcare team, including the pharmacist and physician, to provide patient
education, share relevant findings and concerns 		 
Rating Stars (Click) Facilitating Continuity of Care/Navigating the System 1 2 3 4  
Demonstrates facilitation and advocacy for chemotherapy and biotherapy care to be provided in the most appropriate setting along the cancer
continuum for the patient and family, with consideration given to their needs 		 
Facilitates processes that enable patients and families to communicate with the appropriate members of the health care team leading to access to resources and assistance when needed. This process addresses who, when and how to communicate with the health care team  
Communicates with healthcare providers at points of transition for the patient and family to promote continuity of care and safety for the patient  
Demonstrates ability to assist patients and families to access comprehensive supportive care. This includes psychosocial care, spiritual care, home care/CCAC and additional care based on patient and family specific needs  
Rating Stars (Click) Decision Making and Advocacy 1 2 3 4  
Demonstrates providing information, education, and support to patients and families to facilitate their decision making and autonomy in the informed
consent processes 		 
Advocates for the patient’s wishes and decisions in relation to their cancer chemotherapy care  
Rating Stars (Click) Professional Practice and Leadership 1 2 3 4  
Recognizes the limit of my competence and will only perform cancer chemotherapy
  
Collaborates with healthcare professionals to make decisions about BCHS capacity to provide safe chemotherapy and biotherapy services based on the level of competence of involved healthcare professionals and clinical facilities available
  
Seeks out mentorship in areas where my expertise is limited
  
Provides mentorship to novice nurses in areas in which I possess expertise
  
Demonstrates use of research and evidence based knowledge to provide care to patients and families
  
Participates in professional oncology associations and professional practice groups to further the practice of cancer chemotherapy and biotherapy nursing
  
Demonstrates ability to recognize and critically analyse situations for potential ethical and legal issues and apply ethical frameworks to support patients and families decision making – accessing recourses as needed to assist in this process
  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:              
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)