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REGISTERED NURSE LONG TERM ACUTE CARE 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)
Cardiovascular
1
2
3
4
Assessment:
Auscultation (rate, rhythm)
Blood Pressure, Non-Invasive
Doppler
Heart Sounds/ Murmurs
Pulses/ Circulation Checks
Care of Patient with:
Abdominal Aortic Bypass
Aneurysm
Angina
Oral & IVP Antihypertensives
Cardiac Arrest
Oral Anticoagulants
Cardiomyopathy
Carotid Endarterectomy
Femoral-popliteal Bypass
Myocarditis
Post Acute MI (24-48 hours)
Post Angioplasty
Post Cardiac Cath
Post Cardiac Surgery
Thrombophlebitis
Medications:
Oral & Topical Nitrates
Congestive Heart Failure (CHF)
Rating Stars (Click)
Cardiovascular cont'd - Telemetry:
1
2
3
4
Basic 12 Lead Interpretation
Basic Arrythmia Interpretation
Lead Placement
Pacemaker:
Permanent
Temporary
Endocrine/ Metabolic - Assessment:
S/S Diabetic Coma
S/S Insulin Reaction
Care of Patient with:
Diabetes Mellitus
Disorders of Adrenal Gland
Disorders of Pituitary Gland
Hyperthyroidism
Hypothyroidism
Thyroidectomy
Administration/ Teaching of Medications:
Insulin
Oral Hypoglycemics
Steroids
Thyroid
Blood Glucose Equipment & Procedures:
Electronic Measuring Device
Performing Finger Stick
Visual Blood Glucose Strips
Indwelling Insulin Pump
Rating Stars (Click)
Gastrointestinal cont'd
1
2
3
4
Interpretation of Blood Chemistry
Assessment:
Abdominal/ Bowel Sounds
Fluid Balance
Nutritional
Care of Patient with:
Bowel Obstruction
Colostomy/ Ileostomy
Nutritional
GI Surgery
Hepatitis
Inflammatory Bowel Disease
Invasive Diagnostic Testing
Liver Failure
Paralytic Ileus
Equipment & Procedures:
Flexible Feeding Tube
Placement of Nasogastric Tube
Salem Sump to Suction
Administration of Tube Feeding:
Feeding Pump
Gravity Feeding
Saline Lavage
Management of :
Gastrostomy Tube
Jejunostomy Tube
T-Tube
Rating Stars (Click)
Infectious Diseases
1
2
3
4
Interpretation of Lab Results:
Blood Count
Care of Patient with:
AIDS
Hepatitis
Lyme Disease
Equipment & Procedures:
Fever Management
Isolation
Rating Stars (Click)
Neurological
1
2
3
4
Administration of Anticonvulsants
Assessment:
Glasgow Coma Scale
Level of Consciousness
Care of Patient with:
Aneurysm Precautions
Basal Skull Fracture
Closed Head Injury
Coma
CVA
DTs
Encephalitis
Externalized VP Shunts
Meningitis
Neuromuscular Disease
Post Craniotomy
Seizures
Rating Stars (Click)
Neurological cont'd - Equipment & Procedures
1
2
3
4
Assist with Lumbar Puncture
Hyper/ Hypothermia Blanket
Rating Stars (Click)
Oncology
1
2
3
4
Assessment:
Nutritional Status
Pain Control
Interpretation of Lab Results:
Blood Chemistry
Blood Counts
Care of Patient with:
Bone Marrow Transplant
Fresh Oncologic Surgery
Inpatient Chemotherapy
Inpatient Hospice
Leukemia
Radiation Implant
Equipment & Procedures:
Reverse Isolation
Rating Stars (Click)
Orthopedics
1
2
3
4
Assessment:
Gait
Range of Motion
Skin
Rating Stars (Click)
Orthopedics cont'd
1
2
3
4
Care of Patient with:
Amputation
Arthroscopic Surgery
Cast
Osteoporosis
Pinned Fractures
Rheumatic/ Arthritic Disease
Total Hip Replacement
Total Knee Replacement
Equipment & Procedures:
Continuous Passive Motion Devices
Traction
Support Devices:
Cane
Cervical Collar
Gait Belt
Prosthetic
Sling
Transfer Boards
Walker
Wheelchair
Rating Stars (Click)
Pain Management
1
2
3
4
Assessment of Pain Level/ Tolerance
Care of Patient with:
Epidural Anesthesia/ Analgesia
IV Conscious Sedation
Narcotic Analgesia
Patient Controlled Analgesia
Rating Stars (Click)
Phlebotomy/ IV Therapy
1
2
3
4
Drawing Blood from Central Line
Drawing Venous Blood
Use of Blood/ Blood Products
Equipment & Procedures:
Albumin
Cryoprecipitate
Packed Red Blood Cells
Plasma
Whole Blood
Starting IVs:
Angiocath
Butterfly
Heparin Lock
Care of Patient with:
Central Line- Broviac
Central Line- Groshong
Central Line- Hickman
Central Line- Portacath
Central Line- Quinton
Peripheral Line/ Dressing
Rating Stars (Click)
Pulmonary
1
2
3
4
Assessment:
Breath Sounds
Rate and Work of Breathing
Interpretation of Lab Results:
Blood Chemistry
Blood Gases
Rating Stars (Click)
Pulmonary cont'd - O2 Therapy & Medication Delivery
1
2
3
4
Bag and Mask
External CPAP
Face Masks
Inhalers
Nasal Cannula
Portable O2 Tank
Trach Collar
Rating Stars (Click)
Renal/ Genitourinary
1
2
3
4
Assessment:
Arterio Venous Fistula/ Shunt
Fluid Balance
Interpretation of Lab Results:
BUN & Creatinine
Electrolytes
Care of Patient with:
Hemodialysis
Nephrectomy
Peritoneal Dialysis
Renal Failure
Renal Transplant
TURP
Urinary Diversion
Ileal Conduit Nephrostomy
Urinary Tract Infection
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)
Rating Stars (Click)
Ability to:
1
2
3
4
Adapt Care to Incorporate Normal Growth & Development
Adapt Method & Terminology of Patient Instructions to their Age, Comprehension and Maturity Level
Ensure a Safe Environment Reflecting Specific Needs
Understand the Different Medications, Dosages and Possible Side Effects for Age Group
Administer Medications Properly
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