Medical Surgical/Telemetry

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WORK SETTING EXPERIENCE

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Inpatient Acute Care Facility *

Trauma Center *

Academic/Teaching Facility *

Outpatient Care Facility *

Long term care/Skilled Nursing *

Clinic/Ambulatory *

Home Health Setting *

GENERAL SKILLS EXPERIENCE

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Advanced directives *

Patient/family teaching *

Restrictive devices (restraints) *

Lift/transfer devices *

Specialty beds *

End of life care/palliative care *

Automated Medication Dispensing System, Pyxis, Omnicell, or other *

Bar coding for medication administration *

National Patient Safety Goals *

Accurate patient identification *

Effective communication *

Interpretation & communication of lab values *

Medication administration *

Labeling *

Anticoagulation therapy *

Reconciliation *

Monitoring conscious sedation *

Pain assessment & management *

Use of PCA (IV, intrathecal, epidural) *

Infection control *

Universal precautions *

Isolation *

Minimize risk for falls *

Prevention of pressure ulcers *

Wound care *

Wound vacs *

Awareness of HCAHPS *

CARDIAC MONITORING & EMERGENCY CARE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Obtains 12 lead EKG *

Interpretation of rhythm strips *

Treatment of dysrhythmias *

Use of rapid response teams *

Cardiac arrest/CPR *

O2 therapy & delivery *

Pulse oximetry *

Use of doppler *

Automatic/manual blood pressure checks *

IV THERAPY

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Starting & maintaining peripheral IVs *

Blood draw: venous *

Central line care *

Blood draw: central line *

Care & management of ports *

Care & management of PICC / Groshong / Hickman *

TPN & lipids *

Administration of blood / blood products *

Administration of chemotherapy *

Monitoring chemotherapy (does not initiate) *

Management of IV Pumps ( Alaris , Baxter,) *

Management of elastomeric infusion *

Management of intrathecal pumps *

OTHER EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Diabetes mellitus *

Blood Glucose Monitoring (BGM) *

Insulin administration *

Sepsis *

External and temporary pacemakers *

Management of permanent pacemaker/AICD *

CARDIAC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Assessment of heart sounds *

Pacemakers – permanent *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Aneurysm *

Angina *

Angioplasty (pre/post) *

CHF *

Carotid endarterectomy *

Post MI *

Pre/post cardiac cath *

Pre/post cardiac surgery (CABG & valves) *

Pre/post vascular surgery (abdominal or thoracic AA, fem-pop, carotid) *

Cardiogenic shock *

USE & ADMINISTRATION OF THE FOLLOWING:

Rank each of the following sections on a scale of 1 to 3::

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Antiarrhythmic *

Antihypertensives *

Beta blockers *

Diuretics *

Nitrates *

Fibrinolytics / IIb IIIa inhibitors *

Preparation & administration of emergency (ACLS) meds *

Antilipemic’s (Statins) *

Inotropic’s (i.e. digoxin, dopamine. epinephrine) *

RESPIRATORY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Assessment of breath sounds *

Airway management/suctioning (ETT, oral,trach) *

Chest tubes (Emerson / Pleuravac) *

Interpretation of ABG *

Incentive spirometer *

Mechanical ventilation *

Ambu Bag *

Nasal Canula *

Non-rebreather *

Bronchoscopy *

Venti Mask *

Oral suctioning *

Nasotracheal suctioning *

Tracheostomy care *

Heimlich Valve *

Bronchoscopy *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

COPD *

Tracheostomy *

Thyroidectomy *

Pulmonary embolism *

Pulmonary edema *

Pneumothorax *

Pneumonia *

Inhalation injuries *

Tuberculosis *

Emphysema *

Asthma *

Thoracentesis/paracentesis *

Lung Transplant *

USE & ADMINISTRATION OF THE FOLLOWING:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Bronchodilators *

Steroids *

Antihistamines *

Use of nebulizer treatments *

GYNECOLOGY/GYN MALIGNANCIES EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Endometriosis *

Gyn exam / pap *

Self-breast exam *

Tubal ligation *

Ectopic pregnancy *

Mastectomy / lumpectomy *

Hysterectomy (vaginal or TAHBSO) *

Repair of cystocele / rectocele *

Pelvic inflammatory disease *

Abnormal uterine bleeding *

Management of D&C *

EXPERIENCE WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Adenosine administration *

Insertion *

& management of arterial line *

Chest tube insertion & management *

Femoral hemostasis devices (femStop/vasoseal) *

Ventilator management *

Interpretation weaning parameters *

DRUG DOSE CALCULATION FOR:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Non-titrated IV vasoactive agents (Dobutrex/ dopamine) *

Nitrates (IV nitroglycerine) *

Platelet inhibitors (reopro) *

Fibrinolytics/IIb IIIa inhibitors *

Anti-arrhythmic agents (amiodarone/ Cardizem/lidocaine) *

Patient Monitoring (Pre/Post Procedure) *

Cardioversion *

TEE *

Cardiac catheterization *

Bronchoscopy *

EGD *

PEG placement *

NEUROLOGY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Glasgow coma scale *

Seizure precautions *

Assist with lumbar puncture *

Halo traction *

Comprehensive neuro assessment *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

CVA/TIA *

Aspiration precautions *

Overdose/DT’s *

Spinal cord injury/trauma *

TBI (Traumatic Brain Injury) *

Pre/post neuro surgery *

Cranial hemorrhage *

Delirium tremors *

Meningitis *

Neuromuscular diseases *

Degenerative neurological disorders *

CMS Infection *

Metastatic Tumor/ tumor resection *

Encephalitis *

Alzheimer’s *

Laminectomy *

Traumatic Brain Injury *

USE & ADMINISTRATION OF THE FOLLOWING:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Antiepileptics *

Corticosteroids *

Steroids *

Anticonvulsants (Dilantin/Neurontin/phenobarbital) *

Anti-Parkinson (Cogentin/levodopa/Sinemet) *

GASTROINTESTINAL EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

NG tube insertion *

Management of small-bore feeding tubes (Dobhoff, Keofeed) *

Jejunostomy tube *

PEG tube *

Management of post-surgery drains *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Pancreatitis *

Hepatitis *

G.I. bleed *

Esophageal bleeding *

Bowel obstruction *

Bowel resection *

Gastric bypass *

Gastric banding *

Whipple procedure *

Transplants *

Colostomy / ileostomy *

Paralytic ileus *

E.R.C.P. *

Peritonitis *

IBD(Crohn’s/Ulcerative Colitis *

Electrolyte imbalance *

Pancreatic cancer *

Liver failure/cancer *

USE & ADMINISTRATION OF THE FOLLOWING:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Anticholinergics (antispam, Bentyl or Robinul) *

Antiemetics *

Antacids *

Digestive enzymes *

Cathartics *

GENITOURINARY/RENAL EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Catheter insertion *

GU irrigations *

Nephrostomy tube *

Suprapubic tube *

Fluid & electrolyte disturbance *

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Hemodialysis *

T.U.R.P. *

Shunts and fistulas *

Nephrectomy *

Peritoneal dialysis *

Renal transplant *

Chronic/acute renal failure *

UTI *

BPH *

Prostate cancer *

Ileoconduit *

ORTHOPEDIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Total joint replacement *

Arthroscopic surgery *

Bucks extension *

Fasciotomy *

Fractures *

Spika cast/body cast *

Splints *

CPM *

TENS unit *

Cast care & removal *

Amputation *

Skeletal traction *

Ortho trauma *

Cervical fusion *

Laminectomy *

OTHER EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Care of patient with sepsis *

Oncology *

Chemotherapy *

Radiation therapy *

Radiation implants *

Inpatient hospice *

Suicide precautions *

Burn patients *

Leadership skills (team leader or charge nurse) *

AGE-SPECIFIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

Newborn / neonate (birth-30 days) *

Infant (31 days-1 year) *

Toddler (ages 2-3 years) *

Preschool (ages 4-5 years) *

School age (ages 6-12 years) *

Adolescent (ages 13-21 years) *

Young adult (ages 22-39 years) *

Adult (ages 40-64 years) *

Older adult (ages 65-79 years) *

Elderly (ages 80+ years) *