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REGISTERED NURSE EMERGENCY ROOM
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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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WORK SETTINGS
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1
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2
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3
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4
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Level I Trauma Center
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Level II Trauma
Center
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Non-Trauma Center
Emergency Department
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Pediatric Emergency
Department
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Emergency Department -
Combined Adult/Pediatric
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Critical Care Transport
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Rating Stars
(Click)
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CARDIAC
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1
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2
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3
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4
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Acute Coronary
Syndrome
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Congestive Heart
Failure/Pulmonary Edema
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Aneurysm
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Cardioversion
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Transcutaneous
Pacemaker
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Heart Sound
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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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Respiratory Failure
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COPD/Asthma
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Aspiration
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Pneumonia
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Pneumo/Hemothorax
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Chest Tube
Insertion/Management
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Pulmonary Embolism
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Tuberculosis
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External CPAP/BiPAP
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Intubation
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Ventilated Patients
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ABG Interpretation
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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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CVA
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Stroke Scale
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Brain Injury
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Glascow Coma Scale
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Spinal Cord Injury
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Meningitis
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Seizures
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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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Fractures/Casting
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Open/Complex
Fractures
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Apply/Manage Splints
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Circulation Checks
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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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GI Bleeding
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Liver Disease
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GI Obstruction
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Abdominal
Pain/Distress
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Gastric Tubes
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Rating Stars
(Click)
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RENAL/GU
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1
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2
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3
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4
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Acute Renal Failure
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Renal Calculi
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Renal Trauma
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Testicular Torsion
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Rating Stars
(Click)
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ENDOCRINE
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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
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Hyperglycemia
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DKA
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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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Skin Integrity
Assessment
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Wound Repair
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Rating Stars
(Click)
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SHOCK/TRAUMA
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1
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2
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3
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4
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Some items are covered in
system specific areas.
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Injury Severity Score
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Trauma Code
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Trauma Team Member
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Major Trauma
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Traumatic Amputation
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Peritoneal Lavage
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Hypovolemic Shock
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Neurogenic Shock
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Anaphylactic Shock
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Septic Shock
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Cardiogenic Shock
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Burns - 2nd Degree
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Burns - 3rd Degree
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Rating Stars
(Click)
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INFECTIOUS
DISEASE/IMMUNOSUPPRESSED PATIENTS
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1
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2
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3
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4
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Contagious/Infectious
Patients
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Isolation
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Neutropenia/Reverse
Isolation
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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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Placenta
Abruptio/Previa
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Precipitous Delivery
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Pregnancy Induced
Hypertension
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Fetal Heart Tones
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Sexual Assault
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Reporting Acts of Violence
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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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Management of Pediatric
Emergency Patients
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Identification/Reporting
Abuse
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Abdominal Pain
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Epiglottitis
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Asthma/Reactive Airway
Disease
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Fractures
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Head/Spinal Injury
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Poison Ingestion
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Seizures
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Sickle Cell Crisis
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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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Acute Psychotic
Patient
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Managing Violent
Behavior
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Drug /ETOH
Overdose/Withdrawal
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Psychiatric Hold
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Suicidal Patient
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Rating Stars
(Click)
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MISCELLANEOUS
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1
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2
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3
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4
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Bites-
Animal/Snake/Human
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Hazardous Material
Exposure
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Heat
Exhaustion/Stroke
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Drowning
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Rating Stars
(Click)
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IV THERAPY
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1
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2
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3
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4
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Starting IVs
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Central Line
Placement
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Intraosseous Infusion
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Blood Product
Administration
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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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Anti-Arrhythmics
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Anticoagulants (IV, oral,
& injection)
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Anti-Hypertensives
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Anti-Psychotics
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Anti-Seizure
Medications
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Benzodiazepines
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Continuous IV
Paralytics
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Continuous IV Sedation
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Procedural Sedation -
Administration
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Emergency Medications
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Inhaled Medications
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Insulin
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IV Vasopressors
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Narcotics/Opioid
Analgesics (IV, oral, & injection)
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Nitrates (Oral &
Topical)
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Non-Opioid Analgesics (IV,
Oral, & Injection)
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Reversal Agents
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Thrombolytic Therapy
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Steroids (IV, Oral,
Inhaled)
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Automated Medication
Dispensing (i.e. Pyxis, Omnicell)
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Rating Stars
(Click)
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CARDIAC MONITORING &
EMERG. RESPONSE
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1
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2
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3
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4
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Dysrhythmia Interpretation
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Dysrhythmia Management
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Obtain 12 Lead EKG
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Interpret 12 Lead EKG
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Management of Cardiac
Arrest
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Rating Stars
(Click)
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PROFESSIONAL KNOWLEDGE AND
SKILLS
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1
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2
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3
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4
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Triage
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Ambulance/Paramedic Radio
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Charge Experience
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AMA procedures
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EMTALA
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National Patient Safety
Goals/Core Measures
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Fall Risk
Assessment/Prevention
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Pressure Ulcer Risk
Assessment/Prevention
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Restraints/Use of Least
Restrictive Device
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Patient/Family Teaching
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Age
Specific/Population-Based Care
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Isolation Precautions
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Infection Prevention
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Pain Assessment &
Management
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Interpretation and
Communication of Lab Values
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MY EXPERIENCE IS
PRIMARILY IN:
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Unit
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No. of Years
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Unit
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No. of Years
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BURN
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POST PARTUM
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CRITICAL UNIT
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LABOR & DELIVERY
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PACU
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NEWBORN NURSERY
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NEUROLOGY
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LEVEL II NICU
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TELEMETRY
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LEVEL III NICU
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MEDICAL
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PICU
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SURGICAL
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PEDIATRICS
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ONCOLOGY
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OB/GYN
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ORTHOPEDICS
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PSYCHIATRY
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OPERATING
ROOM
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RRT
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EMERGENCY
ROOM
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CRT
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TRAUMA CENTER
LEVEL 1
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COMMUNITY ER
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RURAL ER
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Rating Stars
(Click)
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AGE APPROPRIATE CARE
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1
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2
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3
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4
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Newborn/Neonatal (birth –
30 days)
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Infant (30 days-1 year)
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Toddler (1-3 years)
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Preschool (3-5 years)
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School Age Children (5-12
years)
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Adolescent (12-17 years)
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Young Adults (18-44 years)
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Middle Adults (45-64
years)
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Older Adults (>65
years)
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Rating Stars
(Click)
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EMR
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1
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2
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3
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4
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Epic
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Cerner
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Eclipsys
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McKesson
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Meditech
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Allscripts
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Other Computerized System
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Computerized Physician
Order Entry
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Bar Coding for Medication
Administration
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EMR Conversion
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CERTIFICATIONS
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Expiry Date :
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BLS
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ACLS
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PALS
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PEARS
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TNCC
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ENPC
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CEN
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