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