Med-Surg – Alrek Health Group

Medical Surgical RN Checklist

MEDICAL SURGICAL RN SKILLS CHECKLIST

Name *

Date

Email *

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.

Proficiency Scale: 1 = No Experience, 2 = Need Training, 3 = Able to perform with supervision, 4 = Able to perform independently

CARDIAC:

Angina:

Angina *

Post Acute MI:

Post Acute MI *

Congestive Heart Failure:

Congestive Heart Failure: *

Post Cardiac Cath

Post Cardiac Cath: *

Post Cardiac Surgery:

Post Cardiac Surgery: *

Aneurysm:

Aneurysm: *

Carotid Endarterectomy:

Carotid Endarterectomy: *

Post Vascular Surgery:

Post Vascular Surgery: *

Post Cardiac Transplant:

Post Cardiac Transplant: *

PULMONARY:

Pneumonia:

Pneumonia: *

COPD:

COPD: *

Tuberculosis:

Tuberculosis: *

Tracheostomy Management:

Tracheostomy Management: *

CPAP/BiPAP:

CPAP/BiPAP: *

Arterial Blood Gases:

Arterial Blood Gases: *

Post Lung Transplant:

Post Lung Transplant: *

NEUROLOGICAL & PSYCHIATRIC:

Stroke Scale Assessment:

Stroke Scale Assessment: *

Traumatic Brain Injury:

Traumatic Brain Injury: *

CVA:

CVA: *

Post Craniotomy:

Post Craniotomy: *

Seizure Disorders:

Seizure Disorders: *

Spinal Cord Injuries:

Spinal Cord Injuries: *

Mood Disorders:

Mood Disorders: *

Substance Withdrawal:

Substance Withdrawal: *

ORTHOPEDICS:

Circulation/Skin Checks:

Circulation/Skin Checks: *

Continuous Passive Motion Devices:

Continuous Passive Motion Devices: *

Ambulation Assistive Devices:

Ambulation Assistive Devices: *

Prosthetics:

Prosthetics: *

Cast Care:

Cast Care: *

Pin Care:

Pin Care: *

Traction:

Traction: *

Total Joint Replacement:

Total Joint Replacement: *

Amputation:

Amputation: (copy) *

GASTROINTESTINAL:

Bariatrics:

Bariatrics: *

Feeding Tubes:

Feeding Tubes: *

GI Bleeding:

GI Bleeding: *

Bowel Obstruction:

Bowel Obstruction: *

GI Surgery:

GI Surgery: *

Liver Disease:

Liver Disease: *

Pancreatitis:

Pancreatitis: *

Post Pancreas Transplant:

Post Pancreas Transplant: *

RENAL/GENITOURINARY:

Arteriovenous Fistula/Shunt:

Arteriovenous Fistula/Shunt: *

3 Way Catheter & Bladder Irrigation:

3 Way Catheter & Bladder Irrigation: *

Suprapubic Catheter:

Suprapubic Catheter: *

Renal Failure:

Renal Failure: *

Peritoneal Dialysis:

Peritoneal Dialysis: *

GU Surgery:

GU Surgery: *

Nephrostomy Tubes:

Nephrostomy Tubes: *

Management Pre/Post Hemodialysis:

Management Pre/Post Hemodialysis: *

Gyn Surgery:

Gyn Surgery: *

EMR:

Diabetes Type I:

Diabetes Type I: *

Diabetes Type II:

Diabetes Type II: (copy) *

Blood Glucose Monitoring:

Blood Glucose Monitoring: *

IV Insulin Protocols:

IV Insulin Protocols: *

Management of Hypoglycemia:

Management of Hypoglycemia: *

Indwelling Insulin Pumps:

Indwelling Insulin Pumps: *

Pituitary Disorders:

Pituitary Disorders: *

ONCOLOGY:

Chemotherapy Administration:

Chemotherapy Administration: *

Radiation Therapy:

Radiation Therapy: *

Medical Oncology:

Medical Oncology: *

Surgical Oncology:

Surgical Oncology: *

Radiation Implants:

Radiation Implants: *

Bone Marrow Transplant:

Bone Marrow Transplant: *

MEDICATIONS:

Antiarrhythmics:

Antiarrhythmics: *

Anticoagulants (IV, oral, & injection):

Anticoagulants (IV, oral, & injection): *

Anti-Depressants:

Anti-Depressants: *

Anti-Hypertensives:

Anti-Hypertensives: *

Anti-Psychotics:

Anti-Psychotics: *

Benzodiazepines:

Benzodiazepines: *

Emergency Medications:

Emergency Medications: *

IV THERAPY:

Starting IVs:

Starting IVs: *

Central Line Blood Draws:

Central Line Blood Draws: *

Central Line/Implanted Line Care:

Central Line/Implanted Line Care: *

TPN & Lipids:

TPN & Lipids:TPN & Lipids: *

Blood Product Administration:

Blood Product Administration: *

CARDIAC MONITORING & EMERG. RESPONSE:

Placement of Telemetry Leads:

Placement of Telemetry Leads: *

Rhythm Interpretation:

Rhythm Interpretation: *

Dysrhythmia Management:

Dysrhythmia Management: *

Obtain 12 Lead EKG:

Obtain 12 Lead EKG: *

Use of Rapid Response Teams:

Use of Rapid Response Teams: *

PROFESSIONAL KNOWLEDGE AND SKILLS:

National Patient Safety Goals/Core Measures:

National Patient Safety Goals/Core Measures: *

Fall Risk Assessment/Prevention:

Fall Risk Assessment/Prevention: *

Pressure Ulcer Risk Assessment/Prevention:

Pressure Ulcer Risk Assessment/Prevention: *

Restraints/Use of Least Restrictive Device:

Restraints/Use of Least Restrictive Device: *

Patient/Family Teaching:

Patient/Family Teaching: *

Age Specific/Population-Based Care:

Age Specific/Population-Based Care: *

Interpretation and Communication of Lab Values:

Interpretation and Communication of Lab Values: *

Interpretation and Communication of Lab Values:

Wound Care /Wound Vac: *

Specialty Beds:

Specialty Beds: *

ENDOCRINE METABOLIC:

Epic:

Epic: *

Cerner:

Cerner: *

Eclipsys:

Eclipsys: *

McKesson:

McKesson: *

Meditech:

Meditech: *

Other Computerized System:

Other Computerized System: *

Computerized Physician Order Entry:

Computerized Physician Order Entry: *

Bar Coding for Medication Administration:

Bar Coding for Medication Administration: *

EMR Conversion *

CERTIFICATIONS:

Expiry Date of BLS *

Expiry Date of ACLS *

Expiry Date of Telemetry Certificate *

Expiry Date of ONS Chemo/Biotherapy Certification *

Expiry Date of Other Chemo Certification *