Skill Checklists
Dialysis RN Clinical
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
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
Assessment of Renal/GU System
Insertion of Foley
Nephrostomy Tube
AV Fistula / AV Graft
Tunneled/Non-Tunneled Catheter
Ileal Conduit
Supra-Pubic Catheter
Chronic Renal Failure
Acute Renal Failure
Nephrectomy
Turp
Peritoneal Dialysis
Hemodialysis
Acute/Inpatient Dialysis
Chronic/Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Predialysis Nursing Assessment
Teaching the Dialysis Patient and Family
Collect Blood Specimens
Anticoagulation
Dialysis
Fistula Gortex / Bovine Graft
Prep Vascular Access
Checking Alarm Settings/Machine
Priming Dialyzer
Conductivity Testing
Bicarbonate Dialysis
Systems Assessment of Patient
Volume Status
Vascular Access Function
Arterial and Venous Pressures
Blood Flow Rate
Subjective Response to Treatment
Management of Anticoagulation
Conductivity
Ultrafiltration Calculation
Operation of Myron L Meter
Administration of Blood/Blood Products
Administration of Mannitol
Sequential Ultrafiltration / PUF
Documentation of Treatment
Fluid Overload
Hypertension
Hypotension
Disequilibrium Syndrome
Hyperkalemia
Seizures
Muscle Cramps
Clotted Access/Poor Blood Flow Rate From Catheter
Pyrogenic Reaction
Hemolysis
Air Embolus
Chest Pain
Anemia
Neuropathy
Pericarditis
Filter Blood Leak
Cardiopulmonary Arrest
Dialysis Catheter
Fistula / Vein Graft
Return of Blood
Post Treatment Access Care
Equipment Clean Up
Sterilization Procedures
Care of Immunosupressed Patient
Care of Patient with AIDS
Isolation Techniques
Assessment of Wound Healing
Sterile Dressing Changes
Phlebotomy / Venous Blood Draw
Discussing Organ & Tissue Donation
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
I hereby certify that ALL information I have provided 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.
