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CYNET_SYSTEMS_MAIN_LOGO.gif   REGISTERED NURSE PCU STEPDOWN 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) A. Phlebotomy/IV Therapy 1 2 3 4  
  Draw Blood:  
0
 Venous Stick  
0
 Central Line  
0
 Arterial Line  
0
  IV Push  
   IV Drip:  
0
 Calculations  
0
 Titration  
0
 Obtain IV Access  
0
 Mix IV Medications  
0
 Regulate IV’s  
0
 IV Infusion Pumps  
0
 Central Line Dressing Changes  
0
 Chemotherapy Administration  
0
 Blood/Blood Product Administration  
0
 TPN/PPN Administration  
0
  Multi-Lumen Central Catheters  
0
 Continuous Subcutaneous Infusion Pumps  
0
 PCA Pumps (Patient Controlled Analgesia)  
Rating Stars (Click) B. Cardiovascular 1 2 3 4  
0
 Cardiac Monitors  
0
 Rhythm Strip Measurements  
0
 Recognize & Interpret Dysrhythmias  
0
 Obtain 12 Lead EKG’s  
0
 CPR  
0
 Cardioversion/Defibrillation  
0
 Pulse Checks  
0
 Use of Doppler  
0
 Automatic BP Cuff  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Acute MI  
0
 CHF  
0
 Angina  
0
 Hypertension  
0
 Cardiomyopathy  
0
 Cardiopulmonary Arrest  
0
 Abdominal Aortic Aneurysm  
0
 Pre/Post Cardiac Surgery  
0
 Carotid Endarterectomy  
0
 Femoral Popliteal Bypass  
0
 Permanent Pacemaker  
0
 Temporary Pacemaker  
0
 External Pacemaker  
0
 Pre/Post Cardiac Cath  
0
 Pre/Post PTCA  
0
 Cardiac Lab Interpretation (CPK, Iso Enzymes)  
0
 Cardiac Rehab/Patient Teaching  
Rating Stars (Click) Use and Administration of:          
0
 Atropine  
0
 Digoxin  
0
 Dopamine  
0
 Dobutamine  
0
 Heparin  
0
 Verapamil  
0
 Lopressor  
0
 Lidocaine  
0
 Nitroglycerine  
0
 Nipride  
0
 Thrombolytic Agents  
0
 Code Cart/Emergency Drugs  
Rating Stars (Click) C. Respiratory 1 2 3 4  
0
 O2 Masks/Cannulas  
0
 Ambu Bag  
0
 Chest PT  
0
 Incentive Spirometry  
0
 Instruction of Coughing/Deep Breathing  
0
 Nebulizer Set Up  
Rating Stars (Click) Suctioning: 1 2 3 4  
0
 Oral  
0
 Tracheostomy Tube  
0
 Endotracheal Tube  
0
 Use of Pleurevac  
0
 Interpret ABG’s  
0
 Arterial Line Maintenance  
0
 Sputum Specimen Collection  
0
 Pulse Oximetry  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Pulmonary Edema  
0
 COPD  
0
 ARDS  
0
 Ventilator  
0
 Tracheostomy  
0
 Pre/Post Thoracic Surgery  
0
 Pneumonia  
0
 Chest Tubes  
0
 Asthma  
0
 Emphysema  
0
 Assist with Intubation/Extubation  
0
 Weaning Patient off Ventilator  
Rating Stars (Click) Use and Administration of: 1 2 3 4  
0
 Aminophylline  
0
 Corticosteroids  
0
 Inhalers  
Rating Stars (Click) D. Neurological 1 2 3 4  
0
 Neuro Assessment  
0
 Glasgow Coma Scale  
0
 Seizure Precautions  
0
 Assist with Lumbar Puncture  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Acute Head Injury  
0
 CVA/TIA  
0
 DT’s  
0
 Spinal Cord Injury  
0
 Pre/Post Neuro Surgery  
0
 Halo Traction  
0
 Multiple Sclerosis  
0
 Overdos  
Rating Stars (Click) Use and Administration of: 1 2 3 4  
0
 Decadron  
0
 Dilantin  
0
 Phenobarbitol  
0
 Magnesium Sulfate  
0
 Valium  
0
 Ativan  
Rating Stars (Click) E. Gastrointestinal 1 2 3 4  
0
 NG Tube Care and Maintenance  
0
 NG Tube Insertion  
0
 Bowel Preparation  
0
 Enterostomal Care  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Tube Feedings  
0
 Ileostomy  
0
 Colostomy  
0
 Pancreatitis  
0
 GI Bleed  
0
 Bowel Obstruction  
0
 Whipple Procedure  
0
 Liver Transplant  
0
 Abdominal Wounds/Surgeries  
0
 Hemovac  
0
 Gastrostomy Tube/Jejunostomy Tube  
Rating Stars (Click) F. Genitourinary/Renal 1 2 3 4  
0
 Urinary Catheter Insertion  
Rating Stars (Click) Bladder Irrigations: 1 2 3 4  
0
 Continuous  
0
 Intermittent  
0
 Electrolyte Imbalance/Replacement  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Peritoneal Dialysis  
0
 Hemodialysis  
0
 T.U.R.P  
0
 Shunts & Fistulas  
0
 Nephrectomy  
0
 Supra-Pubic Catheter  
0
 Nephrostomy Tube  
Rating Stars (Click) G. Orthopedics 1 2 3 4  
0
 Cast Care  
Rating Stars (Click) Tractions: 1 2 3 4  
0
 Skin  
0
 Skeleta  
0
 ROM  
0
 Use of Assistive Devices  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Total Joint Replacement  
0
 Amputation  
Rating Stars (Click) H. Miscellaneous 1 2 3 4  
0
 F.S. Glucose Monitoring  
0
 Dressing Changes  
0
 Use of Air Fluidized Beds  
0
 Normal Serum Lab Values  
0
 Universal Precautions - Isolation  
Rating Stars (Click) Care of the Patient with: 1 2 3 4  
0
 Pressure Sores  
0
 Sickle Cell Anemia  
0
 Cancer  
0
 Alzheimer’s Disease  
0
 HIV/AIDS  
0
 Diabetes  
0
 Discharge Planning  
Rating Stars (Click) EMR 1 2 3 4  
0
 Epic  
0
 Cerner  
0
 Eclipsys  
0
 McKesson  
0
 Meditech  
0
 Other Computerized System  
0
 Computerized Physician Order Entry  
0
 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    
RURAL ER    
Rating Stars (Click)  Age Specific Competencies 1 2 3 4  
0
 Newborn/Neonatal (birth – 30 days)  
0
 Infant (30 days-1 year)  
0
 Toddler (1-3 years)  
0
 Preschool (3-5 years)  
0
 School Age Children (5-12 years)  
0
 Adolescent (12-17 years)  
0
 Young Adults (18-44 years)  
0
 Middle Adults (45-64 years)  
0
 Older Adults (>65 years)