CYNET_SYSTEMS_MAIN_LOGO.gif   REGISTERED NURSE PACU 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  
Open Heart Recovery  
AAA Repair  
Vascular Surgery  
 Pacemaker-Permanent & Temporary  
Cardioversion  
AICD Insertion  
Cardiac Arrest  
Cardiac Tamponade  
CHF/Pulmonary Edema  
Abnormal Heart Sounds/Murmurs  
Pulses/Circulation Checks  
Rating Stars (Click) PULMONARY 1 2 3 4  
Ventilator Management  
Fresh Tracheostomy  
Thoracotomy/Lobectomy/Pneumonectomy  
Pneumothorax/Hemothorax  
Laryngospasm  
Pulmonary Embolism  
COPD  
ABG Interpretation  
Rating Stars (Click) NEUROLOGIC 1 2 3 4  
Post Craniotomy  
Anterior/Posterior Spinal Fusion  
Carotid Endardarectomy  
Spine Surgery  
CVA  
Stroke Scale  
Glascow Coma Scale  
Spinal Precautions  
Hypothermia Protocol  
Hypo/Hyperthermia Blanket  
Sedation Scales/Levels  
Rating Stars (Click)  GASTROINTESTINAL 1 2 3 4  
Pancreas/Liver Transplant  
Colon Surgery  
Colostomy/Ileostomy  
ERCP  
G Tube/J Tube Management  
T Tube Management  
Rating Stars (Click) RENAL/GENITOURINARY 1 2 3 4  
Renal Surgery  
TURP  
Arteriovenous Fistula/Shunt  
Nephrostomy Tubes  
Rating Stars (Click)  ENDOCRINE METABOLIC 1 2 3 4  
Diabetes - Hypo/Hyperglycemic Crisis  
IV Insulin Protocols  
Rating Stars (Click)   ORTHOPEDIC 1 2 3 4  
Laminectomy  
Total Joint Replacement  
Amputation  
Open Reduction/Internal Fixation  
General Orthopedic Surgeries  
CPM/Traction  
Circulation Checks  
Rating Stars (Click) WOUND MANAGEMENT 1 2 3 4  
Surgical Drains  
Wound Vac  
Surgical Wound Assessment  
Skin Assessment for Breakdown  
Staging Decubitus Ulcers  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Procedural Sedation  
Anesthesia Medications  
Anti-Arrhythmics  
Anticoagulants  
Anti-Hypertensives  
Anti-Seizure Medications  
Benzodiazepines  
Emergency Medications  
Insulin  
Narcotics/Opioid Analgesics  
Nitrates  
Non-Opioid Analgesics  
Reversal Agents  
Steroids  
Automated Medication Dispensing (i.e. Pyxis, Omnicell)  
Rating Stars (Click)  IV THERAPY 1 2 3 4  
Starting Ivs  
Central Line Blood Draws  
Central Line/Implanted Line Care  
Blood Product Administration  
Rating Stars (Click)  CARDIAC MONITORING & EMERG. RESPONSE 1 2 3 4  
Malignant Hyperthermia  
Dysrhythmia Interpretation  
Dysrhythmia Management  
12 Lead EKG  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals/Core Measures  
Fall Risk Assessment/Prevention  
Pressure Ulcer Risk Assessment/Prevention  
Age Specific/Population-Based Care  
Pain Assessment & Management  
Charge Experience  
Interpretation and Communication of Lab Values  
Specialty Beds  
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  
PULMONARY  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN
 
CRITICAL UNIT
 
PACU
 
NEUROLOGY
 
TELEMETRY
 
MEDICAL
 
SURGICAL 
 
ONCOLOGY
 
ORTHOPEDICS
 
OPERATING ROOM
 
EMERGENCY ROOM
 
TRAUMA CENTER LEVEL 1
 
COMMUNITY ER
 
RURAL ER
 
CERTIFICATIONS     Expiry Date :   
BLS  
ACLS  
PALS  
Certification: CAPA or CPAN  
   
     
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)