Progressive Care Unit/PCU 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 4Name(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 Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAGE OF PATIENTS CARED FORNewborn/Neonate (birth to 30 days)(Required) 1 2 3 4 Infant (31 days to 12 months)(Required) 1 2 3 4 Toddler/Preschool (13 months to 5 years)(Required) 1 2 3 4 School Age Child/adolescent (6 years to 18 years)(Required) 1 2 3 4 Young Adults/ Middle Adult (19 years to 64 years)(Required) 1 2 3 4 Peripheral IV Insertion, Care and Maintenance(Required) 1 2 3 4 GENERAL SKILLSCare of Patient in Restraints(Required) 1 2 3 4 Automated Med Dispensing Systems(Required) Accudose Metro Omnicell Promanager Rx Pyxis N/A Other Automated Med Dispensing Systems:Electronic Documentation(Required) Allscripts Care360 Cerner eCLinicalWorks EPIC EPIC McKesson Meditech PACS Soarian N/A Other Electronic Documentation:IV Pumps(Required) Alaris Alibaba Bard Baxter Braun CADD IVAC Zynomed N/A Other IV Pumps:Older Adults/Elderly (65+ years)(Required) 1 2 3 4 Access/Management of Implanted Ports(Required) 1 2 3 4 Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)(Required) 1 2 3 4 Cardiac Monitoring/Interpretation(Required) 1 2 3 4 PCA/Epidural pumps(Required) 1 2 3 4 Titration of drips(Required) 1 2 3 4 Administration of Blood/Blood Products(Required) 1 2 3 4 Dressing Changes(Required) 1 2 3 4 Knowledge of Normal Serum Lab Values(Required) 1 2 3 4 Obtaining Cultures (Blood, Sputum, Swab, Urine)(Required) 1 2 3 4 Care of Patient with Burns(Required) 1 2 3 4 Care of Patient with HIV/AIDS(Required) 1 2 3 4 Hyperbaric Oxygenation(Required) 1 2 3 4 Suicide Precautions(Required) 1 2 3 4 Post Mortem Cares(Required) 1 2 3 4 Knowledge of current Joint Commission National Patient Safety Goals(Required) 1 2 3 4 Knowledge of "Do Not Use Abbreviations"(Required) 1 2 3 4 Do you have charge/supervisor experience?(Required) 1 2 3 4 MEDICATION KNOWLEDGE AND USE OFModerate/Conscious Sedation & Reversal Agents(Required) 1 2 3 4 Calculate mcg/min and mcg/kg/min(Required) 1 2 3 4 Antiemetics(Required) 1 2 3 4 Amiodarone(Required) 1 2 3 4 Cardizem(Required) 1 2 3 4 Decadron(Required) 1 2 3 4 Dilantin(Required) 1 2 3 4 Magnesium Sulfate(Required) 1 2 3 4 Phenobarbital(Required) 1 2 3 4 Steroids(Required) 1 2 3 4 Valium(Required) 1 2 3 4 Atropine(Required) 1 2 3 4 Diuretics(Required) 1 2 3 4 Digoxin(Required) 1 2 3 4 Dopamine(Required) 1 2 3 4 Dobutrex(Required) 1 2 3 4 Heparin Drip (Precautions & Maintenance)(Required) 1 2 3 4 Inderal(Required) 1 2 3 4 Lidocaine(Required) 1 2 3 4 Neosynephrine/Nipride(Required) 1 2 3 4 Nitroglycerin(Required) 1 2 3 4 Pronestyl(Required) 1 2 3 4 Morphine(Required) 1 2 3 4 Thrombolytic Agents(Required) 1 2 3 4 Prep/Titration of Emergency Drugs(Required) 1 2 3 4 NEURO GENERAL SKILLSAssessment of Neuro Signs(Required) 1 2 3 4 Glascow Coma Scale(Required) 1 2 3 4 Seizure Precautions(Required) 1 2 3 4 Assist with Lumbar Puncture(Required) 1 2 3 4 Halo Traction(Required) 1 2 3 4 NEURO - Care of Patient With:CVA(Required) 1 2 3 4 Seizure Activity(Required) 1 2 3 4 Overdose(Required) 1 2 3 4 Neuro/Head Injury/Trauma(Required) 1 2 3 4 Pre/Post Neuro Surgery(Required) 1 2 3 4 Cranial Hemorrhage(Required) 1 2 3 4 Multiple Sclerosis(Required) 1 2 3 4 Post-Op AV-Shunt(Required) 1 2 3 4 CARDIAC GENERAL SKILLSAuscultation of Cardiac Sounds(Required) 1 2 3 4 Dopplers(Required) 1 2 3 4 Tele/EKG Interpretation(Required) 1 2 3 4 Defibrillation/Cardioversion(Required) 1 2 3 4 Permanent Pacemaker(Required) 1 2 3 4 Temporary Pacemaker(Required) 1 2 3 4 AICD(Required) 1 2 3 4 Art-Line (Transducer set-up, D/C)(Required) 1 2 3 4 Sheath Removal(Required) 1 2 3 4 CARDIAC - Care of Patient WithAngina(Required) 1 2 3 4 CHF(Required) 1 2 3 4 Post MI(Required) 1 2 3 4 Pre/Post Cardiac Cath(Required) 1 2 3 4 Pre/Post Cardiac Surgery(Required) 1 2 3 4 Open Sternal Wound (Debridement)(Required) 1 2 3 4 Heart Transplant(Required) 1 2 3 4 RESPIRATORY GENERAL SKILLSEstablishing an Airway(Required) 1 2 3 4 Ambuing Techniques(Required) 1 2 3 4 Chest Tubes(Required) 1 2 3 4 Pulse Oximetry(Required) 1 2 3 4 Interpretation of ABG(Required) 1 2 3 4 Use of IPPB(Required) 1 2 3 4 Incentive Spirometer(Required) 1 2 3 4 GASTROINTESTINAL GENERAL SKILLSNG Tube Insertion, Care and Maintenance(Required) 1 2 3 4 Gastrostomy Tube(Required) 1 2 3 4 Jejunostomy Tube(Required) 1 2 3 4 Enterostomal Care(Required) 1 2 3 4 Tube feedings(Required) 1 2 3 4 GENITOURINARY/RENAL GENERAL SKILLSPeritoneal Dialysis(Required) 1 2 3 4 Hemodialysis(Required) 1 2 3 4 Foley/Straight Catheter Insertion(Required) 1 2 3 4 GU Irrigations(Required) 1 2 3 4 Nephrostomy Tube(Required) 1 2 3 4 Suprapubic Tube(Required) 1 2 3 4 Electrolyte Imbalance/Replacement(Required) 1 2 3 4 GENITOURINARY/RENAL GENERAL SKILLST.U.R.P.(Required) 1 2 3 4 Shunts & Fistulas(Required) 1 2 3 4 Nephrectomy(Required) 1 2 3 4 Renal Transplant(Required) 1 2 3 4 Renal Trauma(Required) 1 2 3 4 Chronic/Acute Renal Failure(Required) 1 2 3 4 GYNECOLOGY GENERAL SKILLSGYN Exam/Pap(Required) 1 2 3 4 GYNECOLOGY - Care of Patient With:Ectopic Pregnancy/Ruptured Ectopic Pregnancy(Required) 1 2 3 4 Hysterectomy(Required) 1 2 3 4 ORTHOPEDIC GENERAL SKILLSAssessment of C/M/S(Required) 1 2 3 4 K-Wires/Steinman Pins(Required) 1 2 3 4 Removal of Hardware(Required) 1 2 3 4 Removal of HardwareTotal Joint Replacement(Required) 1 2 3 4 Spica Cast/Body Cast(Required) 1 2 3 4 Amputation(Required) 1 2 3 4 Traction(Required) 1 2 3 4 Ortho Trauma(Required) 1 2 3 4 Laminectomy(Required) 1 2 3 4 ENDOCRINE GENERAL SKILLSDiabetic Teaching(Required) 1 2 3 4 Blood Glucose Monitoring(Required) 1 2 3 4 ENDOCRINE - Care of Patient With:Hyper/Hypoglycemia(Required) 1 2 3 4 MEDICATION KNOWLEDGE AND USE OF:Insulin (IV,SQ)(Required) 1 2 3 4 D50(Required) 1 2 3 4 CARDIAC MONITORS:(Required) Hewlett-Packard Lifecare Marquette Menne Nihon-Koder Siemens Spacelab N/A Other Cardiac Monitors:VENTILATORS:(Required) Bear Bennett 7200 Emerson EMV Engstrom/Erica MA-I MA-II Monihan Ohio 560 Other PEEP Pressure Pre-set Servo Siemens N/A Other Ventilator/Weaning: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.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
