REGISTERED NURSE TELEMETRY STEPDOWN CHECKLIST

		REGISTERED NURSE TELEMETRY 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)	CARDIOVASCULAR Care of Patient with		1	2	3	4
	Acute MI
	CHF
	Angina Hypertension
	Cardiomyopathy Cardiopulmonary Arrest
	Abdominal Aortic Aneurysm
	Carotid Endarterectomy
	Femoral Popliteal Bypass
	Pre & Post Cardiac Surgery
	Pre & Post Cardiac Cath
	Pre & Post PTCA
	Permanent Pacemaker Temporary PacemakerExternal Pacemaker
	Cardiac Lab Interpretation
	Cardiac Patient/Family Teaching
Rating Stars (Click)	RESPIRATORY		1	2	3	4
	Respiratory assessment
	Assess Lung sounds
	Chest percussion
	Establish/Protect Airway
	Chest tubes/Pleurevac
	Oxygen therapy
	Drawing ABGs
	Interpretation of ABGs
	Incentive Spirometry
	Suctioning: oral nasotracheal endotracheal tube tracheostomy tube
	Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET
	Inturbation/extubationambu bag pulse oximetry
	Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema
Rating Stars (Click)	NEUROLOGY		1	2	3	4
	Neurological assessment
	Seizure precautions
	Assessment and Management of Seizure Activity
	Assisting with lumbar puncture
	Signs/Symptoms of increasing ICP
	Glascow Coma Scale
	Crutchfield tongs
	Circo-electric bed Halo traction
	Stryker frame
	Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery
Rating Stars (Click)	GASTROINTESTINAL		1	2	3	4
	G.I. assessment
	Bowel sounds
	Inserting N-G tubes
	Colostomy care
	Measurement of I & O
	Administration of tube feedings
	Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction
Rating Stars (Click)	RENAL/GENITOURINARY		1	2	3	4
	Insertion and care of: straight cath Indwelling urinary cath: male female 3-way
	Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp
Rating Stars (Click)	ORTHOPEDIC		1	2	3	4
	Total Knee Replacement
	Bucks Extension
	Cast Care
	Crutch Walking
	K-Wires
	Spica Casts
	Balanced Suspension Traction
	Circulation Checks
	Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty
Rating Stars (Click)	GENERAL		1	2	3	4
	Blood Glucose Monitoring
	Dressing Changes
	Universal Precautions
	Isolation
	Discharge Planning
	Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS
Rating Stars (Click)	MEDICATIONS		1	2	3	4
	Unit Dose
	Dosage Calculation
	Pouring from stock medication
	Administration of Code Cart Emergency Drugs
Administration of :
	Aminophylline
	Ativan
	Atropine
	Chemotherapy Agents
	Corticosteroids
	Decadron
	Digoxin
	Dilantin
	Dobutamine
	Dopamine
	Heparin Inhalers
	Lidocaine
	Lopressor
	Magenesium Sulfate
	Nipride Nitroglycerin
	Phenobarbital
	Thrombolytic Agents
	Valium
	Verapamil
Rating Stars (Click)	IV THERAPY		1	2	3	4
	Inserting IVs Mixing IV solutions
	Heparin locks
	TPN/Hyperalimentation
	IV push IV drip Infusion pumps Syringe pumps
	Continuous Subcutaneous Infusion Pumps
	PCA Pumps
	Ultrasonic Doppler
	CVP lines/measurement of CVP
	Central line dressing change
	Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction
	Multi-lumen central venous catheters Implanted CVC (port-a-cath)
	Assessment of IV insertion site
	Assist with insertion of central line
	X-ray/assessment after insertion
	Care of patient with Central Line
	Charge Nurse Experience?
	CPR certified?
	BCLS certified?
	ACLS certified?
	Knowledge of normal values?
	Have you had a dysrhythmia course?
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)