Skill Checklists
Medical Surgical - Telemetry
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
Perform patient admission
Perform post mortem care
Formulate nursing diagnoses
Initiate
Prioritize nursing interventions/activities
Calculate intake and output
Adhere to and implement variety of diets
Apply variety patient restraints as indicated by patient condition/medical status
Implement
Implement aspiration precations
Implement fall precations
Implement suicide precautions
Obtain VS (Manual/automated BP
Determine appropriate size blood pressure cuff
Determine age-appropriate normal vital sign parameters
Initiate interventions for abnormal vital signs
Obtain surgical/procedure informed consent
Complete pre-op checklists
Perform antimicrobial baths
Auscultate heart sounds (rate
Normal heart tones (S1
Abnormal heart tones (murmur
Pulses/Circulation checks
S/S DVT
Atherosclerosis
Cardiac arrest
Cardiomyopathy
Carotid endarterectomy
Chest pain (initiate chest pain protocols)
Congestive Heart Failure (CHF)
Myocardial Infarction (MI)
Pericarditis
Post angioplasty
Post cardiac surgery
Sudden onset of Atrial Fibrillation
Sudden onset of chest pain
Thrombophlebitis
Valve disorders
Apply compression stockings
Assist with central line placement
Assist with central line removal
Assist with emergency tracheostomy
S/S Hyperglycemia
S/S Insulin Reaction
Addisons disease
Cushings Syndrome
Diabetes Insipidus
Diabetes Mellitus
Diabetic Ketoacidosis
Hyperthyroidism (Graves disease)
Hypothyroidism
Insulin Shock
Thyroidectomy
Perform finger stick glucose testing
Interpretation of blood glucose monitoring
Implement interventions for hyperglycemia & hypoglycemia
Implement sliding scale insulin
Administer anti-diabetic agents
Identify contraindications for anti-diabetic medications
Utilize insulin pen
Utilize insulin pump
Alteration in elimination
Bowels sounds
Fluid balance
Nutritional status
Bowel obstruction
Colostomy
ERCP
Esophageal bleed
Gastroenteritis
GI bleed
Hemicolectomy
Hepatitis
Ileostomy
Inflammatory bowel disease
Liver failure
Liver transplant
Pancreatitis
Paralytic ileus
Small bowel resection
Administer tube feedings
Utilize and maintain feeding pump
Utilize and maintain gravity feeding
Insertion & Removal of nasogastric tube
Maintain and monitor nasogastric tube suction
Management of gastrostomy tube
Management of jejunostomy tube
Management of T-tube
Assess residual
Perform ostomy care and maintenance
Perform occult blood testing
Assess skin breakdown & integrity
Assess pressure ulcers
S/S wound infection
Assess Surgical Wounds
Assess wound dehiscence
Assess wound classification system
Implement prevention measures to protect skin (turning
Consult skin/wound care staff as needed
Perform non-sterile dressing changes
Perform sterile dressing changes
Remove staples
Assist with wound debridement
Assist with biopsy
Set-up
Perform wound care/irrigations
Assess cranial nerves
Assess LOC
Assess GCS
Assess visual/communication deficits
Aneurysm precautions
Closed head injury
Coma
CVA
DTs
Encephalitis
Laminectomy
Externalized VP shunts
Meningitis
Neuromuscular disease
Post craniotomy
Seizure disorder
Spinal cord injury
TIA
Assist with lumbar puncture
Use of hyper/hypothermia blanket
Implement seizure precautions
Implement spinal precautions
Assess nutritional status
Assess pain control
Bone marrow transplant
Inpatient chemotherapy
Inpatient hospice
Leukemia
Radiation implant
Reverse isolation
Assessment - circulation checks
Assessment - gait
Assessment - range of motion
Amputation
Arthroscopic surgery
Care of cast
Osteoporosis
Pinned fractures
Rheumatic/arthritic disease
Total hip replacement
Nutritional
Total knee replacement
Equipment & Procedures - Continuous passive motion devices
Equipment & Procedures - cervical collar
Equipment & Procedures - gait belt
Equipment & Procedures - prosthetic device
Equipment & Procedures - sling
Equipment & Procedures - traction devices
Equipment & Procedures - transfer boards/devices
Equipment & Procedures - walker
Assessment - Auscultate breath sounds
Assessment -Identify adventitious lung sounds
Assessment - Assess and interpret pulse oximetry
Assessment - Assess respiratory effort and rate
Assessment - Recognize signs of hypoxia
Assessment - Assess capillary refill
Asthma
Bronchoscopy
Chest trauma
COPD
Lobectomy
Pleural effusion
Pneumonectomy
Pneumonia
Pulmonary Edema
Pulmonary embolism
Status asthmaticus
Thoracotomy
Tuberculosis
Assist with thoracentesis
Perform chest tube set-up
Assist with chest tube insertion
Assist with chest tube removal
Perform chest tube care
Maintain chest tube suction
Identify and intervene for chest tube air leak
Identify and intervene for chest tube suction compromise
Monitor and record chest tube output
Perform chest physiotherapy
Instruct and assess patient to perform deep breathing exercises
Instruct and assess patient use of Incentive spirometer
Perform oral suctioning
Perform tracheal suctioning
Perform nasopharyngeal suctioning
Recognize potential causes for airway obstructions (mucus plugs
Perform trach care
Obtain sputum specimen
Apply variety oxygen delivery systems (nasal cannula
Titrate oxygen therapy based on patient needs
Assess for skin breakdown related to oxygen delivery device
Monitor patient CO2 retention
Assessment - AV fistula/shunt (arterio-venous)
Assessment - Fluid Balance
Acute Renal failure
Chronic Renal failure
Fluid restrictions
Hemodialysis
Nephrectomy
Peritoneal dialysis
Renal transplant
Renal rejection syndrome
TURP
Urinary diversion (ileal conduit
Urinary tract infection
Bladder irrigation (Intermittent)
Continuous bladder irrigation (CBI)
Insert/Remove & care for indwelling urinary catheter
3-way urinary catheter
Suprapubic catheter
Urine specimen collection
Perform bladder scan
Application of Standard Precautions/Universal Precautions
Application of Isolation Precautions (droplet
Utilize aseptic technique as indicated
Utilize sterile technique as indicated
Ensure cardiac stability through the analysis and interpretation of ECG
Apply portable ECG monitor
Verify correct placement of leads
Troubleshoot ECG monitor
Recognize characteristics of ECG (P wave
Utilize calipers or other acceptable methods to ensure correct measurements of ECG
Determine time and time intervals on ECG strip
Obtain 12-lead ECG
Sinus bradycardia
Sinus tachycardia
Atrial fibrillation
Atrial flutter
Premature atrial contractions
Premature ventricular contractions
Ventricular fibrillation
Ventricular tachycardia
Paced rhythms
Asystole
Implement ACLS guidelines
Initiate CPR/Basic Life Support
Utilize AED
Perform chest compressions
Perform defibrillation
Perform manual ventilation
Administer IVP medications
Initiate rapid response team
Identify and intervene shock states (hypovolemic
Adhere to advance directives/DNR orders
Respond to a variety of codes (fire
Perform heimlich maneuver
Collect variety of specimens (blood
Properly label specimens
Properly transport specimens
ABGs
BUN & Creatinine
Cardiac enzymes
Coagulation Studies
Complete Blood Count (CBC)
Serum chemistries
Thyroid Panel
Insert and maintain peripheral IV line
Identify and manage IV complications (erythema
Perform venipuncture
Perform blood draw from central line
Perform central line dressing change
Perform IV site care
Perform tubing changes
Administer medications utilizing 6 rights of medication administration (patient
Recognize contraindications related allergies
Monitor medication administration for effectiveness
Monitor patient for side effects
Monitor and intervene for adverse reactions
Perform monitoring of therapeutic parameters for desired responses
Waste narcotics per protocols
Infuse IV solutions by gravity and/or via IV infusion pump
Administer medications via - Intradermal
Administer medications via - Intramuscular
Administer medications via - Intravenous
Administer medications via - Oral
Administer medications via - Subcutaneous
Administer medications via - Sublingual
Administer medications via - Topical
Accurately perform dosage calculations - oral dosages
Accurately perform dosage calculations - Parenteral dosages
Accurately perform dosage calculations - IV drip rates
Accurately perform dosage calculations - IV flow rates
Administer
Blood Product Administration - Administer a variety of blood products (packed cells
Blood Product Administration - Assess for signs of transfusion reactions
Blood Product Administration - Initiate appropriate treatment for reactions
Provide and assess patients understanding of: Pre-op teaching
Provide and assess patients understanding of: Post-op teaching
Provide and assess patients understanding of: Medication information
Provide and assess patients understanding of: Discharge instructions
Provide and assess patients understanding of: Disease process education
Provide and assess patients understanding of: Treatment/Procedure education
Provide and assess patients understanding of: Infection control education
Assess pain level - Utilize variety of approved pain scales
Assess pain level - Utilize age appropriate pain assessment techniques
Initiate non-pharmacologic comfort measures
Administer pain medication per doctor�s orders
Monitor for effectiveness of pain management
Administer and monitor patient controlled analgesia (PCA)
Monitor and maintain epidural pain pump
Monitor for adverse side effects
Initiate reversal agents when necessary
Administer and/or monitor IV conscious sedation
Joint Commission Standards
HIPAA Guidelines
Patient Rights
Privacy Rights
Advance Directives
Participate in a variety of quality/performance improvement activities (such as NDNQI data
Patient Advocacy - Demonstrate spiritual and cultural considerations
Patient Advocacy - Provide care for end-of-life decisions
Patient Advocacy - Provide for the integration of comfort care and death with dignity
Patient Advocacy - Provide education and assist with protocols for organ donation
Patient Advocacy - Recognize and report abuse/neglect
Patient Advocacy - Recognize and report other patient conditions per state/federal regulations (gunshot wound
Patient Advocacy - Report errors
Initiate use of interpreter when appropriate
Demonstrate assertiveness when advocating for patients
Utilize chain of command to ensure patient safety
Utilize conflict resolution techniques effectively
Utilize SBAR communication
Appropriately delegate using the 5 rights for delegation
Communicate clearly and effectively in delegating care/tasks
Assess skills and abilities of person chosen for delegation
Supervise care provided by others (patient care technicians
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 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.