EMERGENCY ROOM RN SKILLS CHECKLIST One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreOut of 3Name(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale0– Theory, no practice 1 – Limited 2 – Confident 3 – Very ConfidentTraumaTransport of trauma patient(Required) 0 1 2 3 Care of patient with minor/major trauma(Required) 0 1 2 3 BurnsCare of patient with burns(Required) 0 1 2 3 Care of patient with electrocution(Required) 0 1 2 3 Care of patient with hazardous materials exposure(Required) 0 1 2 3 RespiratoryCare of patient with pulmonary edema(Required) 0 1 2 3 Care of patient with COPD(Required) 0 1 2 3 Care of patient with Pneumothorax(Required) 0 1 2 3 Assist with intubation and extubation(Required) 0 1 2 3 Care of patient with ventilator(Required) 0 1 2 3 Set up for insertion of arterial line(Required) 0 1 2 3 Obtain arterial blood gases from arterial line(Required) 0 1 2 3 Care of patient with oxygen(Required) 0 1 2 3 Use of Ambu bag(Required) 0 1 2 3 Assist with chest tube insertion(Required) 0 1 2 3 Use of Pleura vac drainage system(Required) 0 1 2 3 Gastrointestinal/RenalCare of the patient with GI bleed(Required) 0 1 2 3 Care of the patient with abdominal wounds(Required) 0 1 2 3 Care of the patient with GI tubes(Required) 0 1 2 3 Care of the patient with acute abdominal disorders(Required) 0 1 2 3 Insertion of nasogastric tube(Required) 0 1 2 3 Assist with gastric lavage(Required) 0 1 2 3 Care of the patient with acute renal failure(Required) 0 1 2 3 Care of the patient with chronic renal failure(Required) 0 1 2 3 OrthopedicSet up for cast application(Required) 0 1 2 3 Check CMS(Required) 0 1 2 3 Set up for OCL splinting(Required) 0 1 2 3 Set up for insertion of Steinman Pin/K-wires(Required) 0 1 2 3 Assist with closed fracture/dislocation reduction(Required) 0 1 2 3 Application of orthopedic appliances(Required) 0 1 2 3 Fent DisordersSet up for fluorescein/Woods Lamp exam(Required) 0 1 2 3 Use of Morgan Lens irrigation(Required) 0 1 2 3 Ear and Eye irrigation(Required) 0 1 2 3 Nasal packing(Required) 0 1 2 3 Remove contact lens(Required) 0 1 2 3 Assess visual acuity(Required) 0 1 2 3 LacerationsAssist with sutures and removal(Required) 0 1 2 3 Assist with staples and removal(Required) 0 1 2 3 Apply steri strips(Required) 0 1 2 3 PediatricsCalculate medication dosages(Required) 0 1 2 3 Care of the patient with epiglottitis(Required) 0 1 2 3 Care of the patient with overdose/poison ingestion(Required) 0 1 2 3 Care of the patient with near drowning(Required) 0 1 2 3 Care of the patient with child abuse(Required) 0 1 2 3 Obstetrics / GynecologyCare of the patient with spontaneous abortion(Required) 0 1 2 3 Care of the patient with hemorrhage(Required) 0 1 2 3 Care of the patient with placenta previa(Required) 0 1 2 3 Care of the patient with abruptio placenta(Required) 0 1 2 3 Care of the patient with pre-eclampsia/eclampsia(Required) 0 1 2 3 Care of the patient with emergency delivery(Required) 0 1 2 3 Care of the patient with communicable disease(Required) 0 1 2 3 PsychiatricCrisis intervention(Required) 0 1 2 3 Upholding patient's rights(Required) 0 1 2 3 Care of the suicidal patient(Required) 0 1 2 3 Care of the patient with overdose(Required) 0 1 2 3 Care of the patient in restraints(Required) 0 1 2 3 NeurologicalNeuro assessment(Required) 0 1 2 3 Use of Glasgow Coma Scale(Required) 0 1 2 3 Care of the patient with acute head injury(Required) 0 1 2 3 Care of the patient with acute TIA/CVA(Required) 0 1 2 3 Care of the patient with acute spinal cord injury(Required) 0 1 2 3 Seizure precautions(Required) 0 1 2 3 Transport the patient with spinal cord injury(Required) 0 1 2 3 Assist with lumbar puncture(Required) 0 1 2 3 Knowledge and use of dilantin(Required) 0 1 2 3 Knowledge and use of phénobarbital(Required) 0 1 2 3 Knowledge and use of Decadron(Required) 0 1 2 3 Knowledge and use of mannitol(Required) 0 1 2 3 Knowledge and use of Solu-Medrol(Required) 0 1 2 3 CardiovascularCare of the patient with acute MI(Required) 0 1 2 3 Care of the patient with CHF(Required) 0 1 2 3 Care of the patient with abdominal aortic aneurysm(Required) 0 1 2 3 Recognize arrhythmias(Required) 0 1 2 3 Obtain 12 Lead ECG(Required) 0 1 2 3 Care of the patient with cardioversion(Required) 0 1 2 3 Defibrillation(Required) 0 1 2 3 Assist with insertion of temporary pacemaker(Required) 0 1 2 3 Set up and use of CVP(Required) 0 1 2 3 Thrombolytic therapy(Required) 0 1 2 3 Care of the patient with shocks(Required) 0 1 2 3 Administration of blood an blood products(Required) 0 1 2 3 Preparation and calculation of lidocaine(Required) 0 1 2 3 Preparation and calculation of Nipride(Required) 0 1 2 3 Preparation and calculation of dopamine(Required) 0 1 2 3 Preparation and calculation of Isuprel(Required) 0 1 2 3 Preparation and calculation of digitalis(Required) 0 1 2 3 Preparation and calculation of sodium bicarbonate(Required) 0 1 2 3 Preparation and calculation of atropine(Required) 0 1 2 3 Preparation and calculation of epinephrine(Required) 0 1 2 3 Preparation and calculation of Dobutrex(Required) 0 1 2 3 Preparation and calculation of nitroglycerine(Required) 0 1 2 3 Sexual Assult / Child AbuseRape kit(Required) 0 1 2 3 Reporting procedures for acts of violence(Required) 0 1 2 3 EnvironmentalCare of the patient with with hypothermia(Required) 0 1 2 3 Care of the patient with heat stroke/exhaustion(Required) 0 1 2 3 Care of the patient with snake/animal bite(Required) 0 1 2 3 Administration of antivenom(Required) 0 1 2 3 Additional SkillsIsolation procedures(Required) 0 1 2 3 Triage procedures(Required) 0 1 2 3 Care of the patient with AIDS(Required) 0 1 2 3 Procedure for signing AMA(Required) 0 1 2 3 Consent for treatment of minor(Required) 0 1 2 3 Disaster protocols(Required) 0 1 2 3 Start adult IV(Required) 0 1 2 3 Start pediatric IV(Required) 0 1 2 3 Age Specific Practice CriteriaAge Specific Practice Criteria(Required)Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Newborn/Neonate (birth-30 days) Infant (30 days-1year) Toddler (1-3 years) Preschooler (3-5 years) School age children (5-12 years) Adolescents (12-18 years) Young adults (18-39 years) Middle adults (39-64 years) Older adults (64+) Experience With Age GroupsCalculate body weight to verify correct dosing of medication(Required) 0 1 2 3 Assess immunization status for pediatric, and adolescent(Required) 0 1 2 3 Set age-appropriate short-term and long-term goals in care planning(Required) 0 1 2 3 Provide age-appropriate education, considering possible vision and hearing impairment for Older than 65years(Required) 0 1 2 3 CertificationsBCLS(Required) Yes No Completion DateTNCC(Required) Yes No Completion DateACLS(Required) Yes No Completion DateOther(Required) Yes No List Type(s) and Completion Date(s)AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. Paper Copies You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies. Withdrawal of Consent You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
