SHORE STAFFING, INC. Telemetry Nurse Competency Self-Checklist

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1 Directions: Please circle a value for each question to provide us with an assessment of your clinical experience. These values confirm your strengths within your specialty. FREQUENCY EXPERIENCE 1. Observed only, never done 1. No experience. 2. Rarely done (<6 times per year) 2. Some experience (requires assistance) 3. Occasionally done (1-2 times/month) 3. Experienced (performs without assistance) 4. Frequently done (daily or weekly) 4. Very experienced (performs well) PRINT NAME SS# DATE General Skills Frequency Experience Advanced directives Automated medication dispensing Bar coding for medication administration End of life care/palliative care Lift/transfer devices Patient/family teaching Restrictive devices (restraints) Specialty beds Computerized charting Frequency Experience Cerner Eclipsys EPIC McKesson Meditech Others (name) National Patient Safety Goals Frequency Experience Accurate patient identification Anticoagulation therapy Effective communication Infection control Interpretation & Communication of lab values Isolation Labeling (mediation & Specimens) Medication administration Medication reconciliation Labeling (mediation & Specimens) Reconciliation Wound care Minimize risk for falls Page1

2 Moderate sedation Pain assessment & management National Patient Safety Goals continued: Frequency Experience Prevention of pressure ulcers Use of PCA (IV, intrathecal, epidural) Universal precautions Use of Rapid Response Team Cardiac monitoring & emergency care: Frequency Experience Obtain 12 lead EKG Interpretation of rhythm strips Treatment of dysrythmias Use of rapid response team Cardiac arrest/cpr therapy and delivery Pulse Oximetry Use of Doppler IV Therapy Starting & maintaining peripheral IVs Blood draw; venous Central line care Blood draw: central line Care and management of Ports Care and management of PICC/Groshong/Hickman TPN & Lipids Administration of blood/blood products Administration of chemotherapy Monitoring chemotherapy (does not initiate) Other Frequency Experience Diabetes Mellitus Blood Glucose Monitoring (BGM) Insulin administration CARDIOVASCULAR Frequency Experience Assessment of heart sounds External & temporary pacemakers Management of permanent pacemaker/aicd Care of patient with: Frequency Experience Angina CHF Acute MI Pre/post cardiac surgery (CABG & Valves) Page2

3 Pre/post vascular surgery (Abdominal or Thoracic AA, Fem-pop, Carotid) Cardiogenic shock Medication Administration: Frequency Experience Preparation & administration of emergency (ACLS) meds Cardiovascular continued: Frequency Experience Inotropics (i.e. Digoxin, Dopamine, Epinephrine) Antiarrythmics (Beta Blockers/Ca+ Channel Blockers Antianginals (isordil/nitrates) Antihypertensives Antilipemics (statins) Diuretics PULMONARY: Frequency Experience Assessment of breath sounds Airway management/suctioning (ETT, Oral, Trach) Incentive spirometer Recognition & treatment of abnormal ABGS s Management of chest tubes Heimlich valve Care of patient with: Frequency Experience COPD/Emphysema Asthma Tuberculosis Pulmonary embolism Pulmonary edema Pneumothorax Tracheostomy Pneumonia Thoracentesis/paracentesis Medication Administration Frequency Experience Antihistamines Bronchodilators Expectorants & antitussives Use of inhalers Use of nebulizer treatments NEUROLOGY Frequency Experience Comprehensive neuro assessment Glasgow coma scale Utilize seizure precautions/seizures Assist with lumbar puncture Spinal cord injury Page3

4 Care of patient with: Frequency Experience TIA/CVA Cranial hemorrhage & hematoma Aspiration precautions Overdose/DTs Spinal cord injury/trauma TBI (traumatic brain injury) Pre/post neuro surgery Degenerative neurological disorders Halo traction/vest Medication Administration: Frequency Experience Anticonvulsants: Dilantin, Phenobarbital, Neurotin Antidepressants Antiparkinsons (Congentin/Levodopa/Sinemet) Gastrointestinal Frequency Experience Insertion & management of NG tube Insertion & management of small bore feed tubes (Dobhoff, Keofeed) Management of gastrostomy/jejunostomy tube Management of post surgical drains Care of patients with: Frequency Experience GI bleed (upper and lower) Hepatitis Pre/post open abdominal surgery Colostomy/ileostomy Peritonitis IBS ERCP Paralytic ileus Medication Administration Frequency Experience Antiemetics: Reglan, Zofran Antiulcer drugs Antacids Digestive enzymes Genitourinary/RENAL Frequency Experience Foley catheter insertion Care of Suprapubic tube Care of Nephostomy tube Fluid & electrolyte disturbance Care of the patient with: Frequency Experience UTI Page4

5 BPH TURP Prostate cancer Nephrectomy Ilioconduit Renal Surgery Chronic/acute renal failure Hemodialysis Peritoneal dialysis Gynecology Frequency Experience Assist with GYN exam/pap GYN surgeries PROGRESSIVE CARE NURSING REQUIREMENTS Frequency Experience Basic & advanced life support protocols Adenosine administration Chest tube insertion & management Insertion & management of arterial line Management & D/C of arterial & venous sheaths Femoral hemostasis devices (FemStop/Vasoseal) Ventilator management Interpretation of weaning parameters Drug dose calculation for: Frequency Experience Non-titrated IV vasoactive agents (Dobutrex/Dopamine) Nitrates (IV Nitroglycerine) Platelet inhibitors (ReoPro) Fibrinolytics (IIB IIIa inhibitors Anti-arrhythmic agents (amiodarone/cardizem/;lidocaine) Patient Monitoring (Pre/Post Procedures) Frequency Experience Cardioversion TEE Cardiac Catheterizations Bronchoscopy EGD Peg Placement Patient Monitoring (During/Intra Procedures) Frequency Experience Cardioversion TEE Cardiac Catheterizations Bronchoscopy EGD Page5

6 Peg Placement AGE SPECIFIC COMPETENCIES Frequency Experience Newborn/Neonate (birth 30 days) Infant (31 days 1 year) Toddler (2-3 years) Preschool (ages 4-5) School age (ages 6-12) Adolescents (ages 13-21) Young adults (ages 22-39) Adults (ages 40-65) Older Adult (ages 65-79) Elderly (80+ years) The information on this and all preceding pages is true and correct. Signature Page6

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