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REGISTERED NURSE
CLINIC AND URGENT CARE CHECKLIST
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NAME
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LAST 4 OF SSN
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DATE
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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.
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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.
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Proficiency Scale:
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1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
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Rating Stars (Click)
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CARDIOVASCULAR
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1
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2
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3
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4
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Auscultation/Irregular
Heart Sounds
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Peripheral Edema
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PQRST Assessment
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Rating Stars
(Click)
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Interpretation of
Labs/Tests
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1
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2
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3
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4
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EKG
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Lab Tests (Cardiac
Enzymes, Troponin, BNP)
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Arrhythmia Interpretation
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12-Lead Set Up
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12-Lead Basic
Interpretation
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Defibrillation
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External Pacer
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Chest Pain/ACS
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Arrhythmias
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CHF
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AED
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Cardiac Arrest/CPR
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Morphine
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Heparin
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ALS (Epinephrine,
Atropine, Anti-Arrhythmics)
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Rating Stars
(Click)
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PULMONARY
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1
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2
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3
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4
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Abnormal Breath Sounds
(Wheezing, Stridor, Crackles)
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Abnormal Breathing Pattern
(Rapid, Labored, Slow)
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Rating Stars
(Click)
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Interpretation of
Lab/Tests
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1
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2
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3
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4
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Pulse Oximetry
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ABGs
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Oxygen Therapy (Nasal
Cannula, Face Mask)
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Manual Resuscitation Bag
(MRB, Ambu Bag)
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Metered-Dose Inhaler (MDI)
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Nebulizers
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Aspiration
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Asthma/Reactive Airway
Disease
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COPD
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Pneumonia
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Pulmonary Edema
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Pulmonary Embolism
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Steroids
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Diuretics
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Rating Stars
(Click)
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NEUROLOGICAL
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1
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2
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3
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4
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Signs & Symptoms of
Stroke
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Altered LOC
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Assist with Lumbar
Puncture
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Cervical Collar
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Spinal Immobilization
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Head Injury
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Meningitis
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Migraine
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Seizures
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TIA/Stroke
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Imitrex (Sumatriptan
Succinate)
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Phenobarbitol
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Dilantin (Phenytoin)
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Depakote
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Analgesics
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Rating Stars
(Click)
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ORTHOPEDICS
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1
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2
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3
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4
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Range of Motion
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Color, Warmth, Movement,
Sensation
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Fracture/Dislocation
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Apply Splints
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Assist with Casting
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Assist with Reduction of
Dislocation
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Spinal Immobilization
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Transfer Boards
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Cast/Splint
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Dislocation
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External Appliance
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Sprain/Fracture
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Analgesia/Sedation
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Rating Stars
(Click)
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GASTROINTESTINAL
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1
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2
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3
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4
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Bowel Sounds
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Distention
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Fluid Balance
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Nutritional Status
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Enemas
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Gastric Lavage
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G-Tubes
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NG Tubes
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Colostomy
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Constipation/Impaction
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Diarrhea
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G-Tube
(Reinsertion/Replacement)
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Nausea/Vomiting
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Ipecac
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Charcoal
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Antiemetics
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Antispasmodics
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Rating Stars
(Click)
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RENAL/GENITOURINARY
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1
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2
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3
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4
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Fluid Status
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Shunt/Fistula
(Thrill/Bruit)
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Rating Stars
(Click)
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Interpretation of Labs
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1
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2
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3
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4
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BUN/Creatinine/Electrolytes
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Urine Dipstick/C&S
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Placement & Management
of Bladder Catheters
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Pyelonephritis/UTI
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Obstruction
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Renal Calculi
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Renal Trauma
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Testicular Torsion
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Priapism
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Antibiotics
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Hypo/Hyperglycemia
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Blood Glucose
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Urine Ketones
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Bedside Blood Glucose
Monitoring
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Hypoglycemia/Insulin Shock
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Hyperglycemia/DKA
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Dextrose
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Insulin
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Oral Hypoglycemics
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Rating Stars
(Click)
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EENT
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1
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2
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3
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4
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Visual Acuity
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Foreign Body
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Enlarged Tonsils
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Ear Irrigation/Removal
Foreign Body
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Eye Injury/Foreign
Body/Detached Retina
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Assist with Removal of
Nasal Foreign Body
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Epistaxis
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Set Up/Assist Cautery
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Set Up Slit Lamp
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Silver Nitrate
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Liquid Cocaine
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Anti-Hypertensives
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Rating Stars
(Click)
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INFECTIOUS DISEASE
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1
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2
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3
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4
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Communicable Disease
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Interpret Culture Results
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Obtain Cultures
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Fever Management
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Isolation
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Reverse Isolation/Hepa
Filter
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Use of Personal Protective
Equipment
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Communicable Disease
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Infectious Disease
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Immunosuppression/Neutropenia
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Antibiotics
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Antivirals
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Rating Stars
(Click)
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WOUND MANAGEMENT
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1
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2
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3
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4
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Burn Care
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Dressing Change
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Ostomy Care
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Wound Repair
(Staples/Sutures, etc.)
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Rating Stars
(Click)
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PAIN MANAGEMENT
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1
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2
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3
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4
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Assessment of Pain
Level/Use of Pain Scale
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Assessment of Response to
Pain Management Interventions
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Monitoring of Patients
after Pain Medication
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Comfort Care
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Moderate Sedation
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Rating Stars
(Click)
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PSYCHIATRIC
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1
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2
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3
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4
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Behavior
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Drug/ETOH
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Risk for Violence
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Managing
Threatening/Violent Behavior
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Psychiatric Hold
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Drug OD
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ETOH OD
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Depression/Anxiety
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Restraints
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Suicide Risk
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Rating Stars
(Click)
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Medications
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1
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2
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3
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4
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Antipsychotics/Antidepressants
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Reversal Agents
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Rating Stars
(Click)
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WOMEN'S HEALTH
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1
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2
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3
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4
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Vaginal Bleeding
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Doppler/Fetal Heart Tones
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Ectopic Pregnancy
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Obtain Cultures
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Pelvic Tray
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Rating Stars
(Click)
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Care of the Patient with
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1
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2
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3
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4
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Ectopic Pregnancy
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Hemorrhage
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Pelvic Inflammatory
Disease
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Placenta Abruptio/Previa
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Precipitous Delivery
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Pregnancy-Induced
Hypertension
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Spontaneous Abortion
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Rating Stars
(Click)
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PEDIATRICS
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1
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2
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3
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4
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Child Abuse
Recognition/Reporting
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Shaken Baby Syndrome
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Obtaining Consent to Treat
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Rating Stars
(Click)
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Assessment
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1
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2
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3
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4
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Normal VS for age groups
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Use of Dynamap/Doppler Leg
Cuffs for B/P
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Failure to Thrive
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Rating Stars
(Click)
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Equipment & Procedures
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1
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2
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3
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4
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Assist with Fracture
Stabilization
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Cooling/Warming Measures
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Draw Labs
(Venous/Butterfly)
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Ear Care-Assist with
Cleaning/Wash, Insert Ear Drops
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IM/SQ Medications in
Pediatric Patients
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Obtain RSV Culture
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Obtain Urine Culture
(Cath/Bag)
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Lumbar Puncture
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Papoose Board/Therapeutic
Hold
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Start IV in Pediatric
Patient
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Rating Stars
(Click)
|
Care of the Pediatric
Patient with
|
1
|
2
|
3
|
4
|
|
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|
Abdominal Pain
|
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Aspiration
|
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Asthma/Reactive Airway
Disease
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Burns
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Dehydration
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Epiglottitis
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Fever
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Foreign Object
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Fracture
|
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Head Injury
|
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Hypo/Hyperglycemia
|
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Hypo/Hyperthermia
|
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Lacerations
|
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Near Drowning
|
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Nursemaid's Elbow
|
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|
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|
Rating Stars
(Click)
|
Medications (Others
in System Specific Areas)
|
|
1
|
2
|
3
|
4
|
|
|
|
Ipecac/Charcoal
|
|
|
|
|
|
|
|
Bronchodilators/Nebulizers
|
|
|
|
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|
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Fluid Replacement
|
|
|
|
|
|
|
Rating Stars
(Click)
|
EMR
|
1
|
2
|
3
|
4
|
|
|
|
Epic
|
|
|
|
|
|
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Cerner
|
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|
Eclipsys
|
|
|
|
|
|
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|
McKesson
|
|
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|
|
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|
Meditech
|
|
|
|
|
|
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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
|
|
|
|
|
|
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)
|
|
|
|
|
|
|
Rating Stars
(Click)
|
MISCELLANEOUS
|
1
|
2
|
3
|
4
|
|
|
|
Intake and Triage
|
|
|
|
|
|
|
|
National Patient Safety
Goals
|
|
|
|
|
|
|
|
AMA procedures
|
|
|
|
|
|
|
|
Disaster Management
|
|
|
|
|
|
|
|
Computerized Charting
|
|
|
|
|
|
|
Rating Stars
(Click)
|
Care of the Patient with
|
1
|
2
|
3
|
4
|
|
|
|
Bites
|
|
|
|
|
|
|
|
Hazardous Materials
Exposure
|
|
|
|
|
|
|
|
Victims of Acts of
Violence
|
|
|
|
|
|
|
My experience is
primarily in the following settings
|
|
|
Sr. No.
|
Adults
|
Year/No of Days
|
|
|
1
|
Physician's Office
|
|
|
|
2
|
Clinic
|
|
|
|
3
|
Urgent Care
|
|
|
|
4
|
Emergency Dept -
Yrs:
|
|
|
|
|
Sr. No.
|
Pediatrics
|
Year/No of Days
|
|
|
1
|
Physician's Office
|
|
|
|
2
|
Clinic
|
|
|
|
3
|
Urgent Care
|
|
|
|
4
|
Emergency Dept -
Yrs:
|
|
|
|
|
CERTIFICATIONS
|
Expiry Date :
|
|
|
|
BLS
|
|
|
|
|
ACLS
|
|
|
|
|
PALS
|
|
|
|
|
OTHERS
|
|
|
|