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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 LEV
EL 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)
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