CYNET_SYSTEMS_MAIN_LOGO.gif   REGISTERED NURSE PSYCHIATRY SKILLS 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) TREATMENT SETTINGS 1 2 3 4  
Inpatient  
Outpatient  
Adolescent/Pediatrics  
Substance Abuse/Rehab  
Special Care Unit  
Eating Disorders Unit  
Locked Unit  
Rating Stars (Click) ADULT DISORDERS 1 2 3 4  
Violent Behavior  
Suicidal Ideation  
Suicidal Attempt  
Depression  
Bipolar Disorders  
Anxiety/Panic Disorders  
Psychotic Disorders  
Schizophrenia  
Post Traumatic Stress Disorder  
History of Physical/Sexual Abuse  
Alcohol/Drug Abuse  
Alzheimer's Disease/Dementia  
Anorexia/Bulimia  
Rating Stars (Click) CHILD/ADOLESCENT DISORDERS 1 2 3 4  
Violent Behavior  
Suicidal Ideation/Self Destructive Behavior  
Suicidal Attempt  
Depression  
Bipolar Disorders  
Anxiety/Panic Disorders  
Psychotic Disorders  
Schizophrenia  
History of Physical/Sexual Abuse  
Alcohol/Drug Abuse  
Anorexia/Bulimia  
Autism  
Rating Stars (Click) TREATMENT MODALITIES 1 2 3 4  
Conduct Group Therapy  
Therapeutic Limit Setting  
Follow Behavior Modification Plans  
Medication Management  
Supervise Ancillary staff  
Rating Stars (Click) EQUIPMENT AND PROCEDURES 1 2 3 4  
Managing Assaultive Behavior  
Crisis Prevention  
Electroconvulsive Therapy  
Restraints  
Seclusion  
Suicide Precautions  
Knowledge of State Specific Regulations on Emergency   
Medications  
Head to Toe Assessment  
IV Start  
IV Maintenance  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Antianxiety  
Anticonvulsants  
Antidepressants  
Antipsychotics  
Lithium  
Cholinesterase Inhibitors/Memantine (Aracept/Namenda)  
Sedative/Analgesics  
Insulin  
Anticoagulants  
Digoxin  
Antihypertensives  
Automated Medication Dispensing Systems (i.e. Pyxis, Omnicell)  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals/Core Measures  
Use of Rapid Response Teams  
Fall Risk Assessment/Prevention  
Pressure Ulcer Risk Assessment/Prevention  
Patient/Family Teaching  
Age Specific/Population-Based Care  
Isolation Precautions  
Infection Prevention  
Pain Assessment & Management  
Charge Experience  
Interpretation and Communication of Lab Values  
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  
  EMR Conversion
   
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)  
CERTIFICATIONS     Expiry Date :   
BLS  
Managing Assaultive Behavior  
Crisis Prevention Institute (CPI)  
  Other: Specify   
  Other: Specify