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REGISTERED NURSE INTENSIVE CARE UNIT CHECKLIST
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)
Cardiac
1
2
3
4
Defibrillation/Cardioversion
Assisting with Insertion of Central Lines
Pacemakers‐External
Permanent or Temporary Pacemaker
Cardiac Arrest/CPR
A‐Line (Transducer setup‐D/C)
Swan Ganz (Transducer setup‐D/C)
Balloon Pump (IABP)
SVO2 Monitoring
Automatic Internal Cardioverter Defib
Rating Stars (Click)
Care of patient with
1
2
3
4
Aneurysm
Acute MI/Unstable Angina
Cardiogenic/Hypovolemic Shock
Pre/Post Cardiac Surgery
Heart Transplant
PTCA
COPD
ARDS
Pulmonary Embolism
Pulmonary Edema
Pneumonia
Inhalation Injuries
CVA
Seizure Disorder
Overdose
Neuro Injury/Trauma
Pre/Post Neuro Surgery
Cranial Hemorrhage
Aphasia
Multiple Sclerosis
Pancreatitis
GI Bleed
Esophageal Bleeding
Bowel Obstruction
Liver Transplant
Paralitic Ileus
TURP
Shunts and Fistulas
Nephrectomy
Renal Transplant
Renal Trauma
Rating Stars (Click)
Use and Administration of the following
1
2
3
4
Atropine
Bretylol
Bumex
Digoxin
Dopamine
Dobutrex
Inderal
Inocor
Isuprel
Lidocaine
Neosynephrine/Nipride
NTG
Pronestyl
Titrate Morphine
Verapamil
Thrombolitic Agents
Prep/Titration of Emergency Drugs
Aminophylline
Corticosteroids
Bronkosol
Ventolin
Alupent
Decadron
Dilantin
Magnesium Sulfate
Phenobarbital
Steroids
Valium
Versed
Rating Stars (Click)
Respiratory
1
2
3
4
Lung Transplant
Establishing an Airway
Pulse Oximetry
Interpretation of ABG
Drawing ABG Blood Sample from A‐Line
Incentive Spirometer
Rating Stars (Click)
Neurology
1
2
3
4
Assessment of Neuro Signs
Use of Glascow Coma Scale
Seizure Precautions
Assist with Lumbar Puncture
ICP Monitoring
Crutchfield Tongs
Halo Traction
Stryker Frame
Assessment of Sensory‐Motor Function
Cervical Traction
Cranial Nerve Assessment
LOC Assessment
Pre/Post Neuro Surgical Care
Visual Acuity Measurement
Rating Stars (Click)
Vascular
1
2
3
4
Peripheral Pulses
Fluid Overload
Starting IV's
Subcutaneous Central Line
Hickman/Broviac/Groshong Catheters
Mainenance of Heparin Lock
TPN/Hyperalimentation
Air Occlusive Dressing
Infusion Pump
Peritoneal Dialysis
Hemodialysis
Heparin Drip ‐ Precautions and Maintenance
Rating Stars (Click)
Gastrointestinal
1
2
3
4
NG Tube Insertion
Gastronomy Tube
Jejunoostomy Tube
Enterostomal Care
Rating Stars (Click)
Genito Urinary/Renal
1
2
3
4
Foley Catheter Insertion
GU Irrigations
Nephrostomy Tube
Suprapubic Tube
Electrolyte Imbalance/Replacement
Rating Stars (Click)
Other
1
2
3
4
Oncology
Chemotherapy
Isolation Techniques
Hyperbaric Oxygenation
Fingerstick Blood Glucose monitoring
Rating Stars (Click)
Equipment
1
2
3
4
Bear I
Bear II
Bear V
Bennett 7200
CPAP
Emerson
EMV
MA‐I
MA‐II
Monihan
Ohio 560
PEEP
Pressure Pre‐Set
Servo 900b
Servo 900c
Servo 900e
Siemens
Hewlett‐Packard
Spacelab
Marquette
Mennen
Lifecare
Nihon‐Koder
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 LEV
EL 1
COMMUNITY ER
RURAL ER
Rating Stars (Click)
AGE APPROPRIATE CARE
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)
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