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Skills Assessment - Emergency Room
 
The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.
 
First Name:
Middle Initial:
Last Name:
SSN: - -
E-mail Address:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
City:
State:
 
 
0. Theory, no practice   1. Limited   2. Confident   3. Very Confident
 
Trauma: Experience:
Transport of trauma patient 0   1   2   3  
Care of patient with minor/major trauma 0   1   2   3  
 
Burns:
Care of patient with burns 0   1   2   3  
Care of patient with electrocution 0   1   2   3  
Care of patient with hazardous materials exposure 0   1   2   3  
 
Respiratory:
Care of patient with pulmonary edema 0   1   2   3  
Care of patient with COPD 0   1   2   3  
Care of patient with Pneumothorax 0   1   2   3  
Assist with intubation and extubation 0   1   2   3  
Care of patient with ventilator 0   1   2   3  
Set up for insertion of arterial line 0   1   2   3  
Obtain arterial blood gases from arterial line 0   1   2   3  
Care of patient with oxygen 0   1   2   3  
Use of Ambu bag 0   1   2   3  
Assist with chest tube insertion 0   1   2   3  
Use of Pleura vac drainage system 0   1   2   3  
 
Gastrointestinal/Renal:
Care of the patient with GI bleed 0   1   2   3  
Care of the patient with abdominal wounds 0   1   2   3  
Care of the patient with GI tubes 0   1   2   3  
Care of the patient with acute abdominal disorders 0   1   2   3  
Insertion of nasogastric tube 0   1   2   3  
Assist with gastric lavage 0   1   2   3  
Care of the patient with acute renal failure 0   1   2   3  
Care of the patient with chronic renal failure 0   1   2   3  
 
Orthopedic:
Set up for cast application 0   1   2   3  
Check CMS 0   1   2   3  
Set up for OCL splinting 0   1   2   3  
Set up for insertion of Steinman Pin/K-wires 0   1   2   3  
Assist with closed fracture/dislocation reduction 0   1   2   3  
Application of orthopedic appliances 0   1   2   3  
 
EENT Disorders:
Set up for fluorescein/Woods Lamp exam 0   1   2   3  
Use of Morgan Lens irrigation 0   1   2   3  
Ear and Eye irrigation 0   1   2   3  
Nasal packing 0   1   2   3  
Remove contact lens 0   1   2   3  
Assess visual acuity 0   1   2   3  
 
Lacerations:
Assist with sutures and removal 0   1   2   3  
Assist with staples and removal 0   1   2   3  
Apply steri strips 0   1   2   3  
 
Pediatric:
Calculate medication dosages 0   1   2   3  
Care of the patient with epiglottitis 0   1   2   3  
Care of the patient with overdose/poison ingestion 0   1   2   3  
Care of the patient with near drowning 0   1   2   3  
Care of the patient with child abuse 0   1   2   3  
 
Obstetrics/Gynecology:
Care of the patient with spontaneous abortion 0   1   2   3  
Care of the patient with hemorrhage 0   1   2   3  
Care of the patient with placenta previa 0   1   2   3  
Care of the patient with abruptio placenta 0   1   2   3  
Care of the patient with pre-eclampsia/eclampsia 0   1   2   3  
Care of the patient with emergency delivery 0   1   2   3  
Care of the patient with communicable disease 0   1   2   3  
 
Psychiatric:
Crisis intervention 0   1   2   3  
Upholding patient's rights 0   1   2   3  
Care of the suicidal patient 0   1   2   3  
Care of the patient with overdose 0   1   2   3  
Care of the patient in restraints 0   1   2   3  
 
Neurological:
Neuro assessment 0   1   2   3  
Use of Glasgow Coma Scale 0   1   2   3  
Care of the patient with acute head injury 0   1   2   3  
Care of the patient with acute TIA/CVA 0   1   2   3  
Care of the patient with acute spinal cord injury 0   1   2   3  
Seizure precautions 0   1   2   3  
Transport the patient with spinal cord injury 0   1   2   3  
Assist with lumbar puncture 0   1   2   3  
Knowledge and use of dilantin 0   1   2   3  
Knowledge and use of ph始obarbital 0   1   2   3  
Knowledge and use of Decadron 0   1   2   3  
Knowledge and use of mannitol 0   1   2   3  
Knowledge and use of Solu-Medrol 0   1   2   3  
 
Cardiovascular:
Care of the patient with acute MI 0   1   2   3  
Care of the patient with CHF 0   1   2   3  
Care of the patient with abdominal aortic aneurysm 0   1   2   3  
Recognize arrhythmias 0   1   2   3  
Obtain 12 Lead ECG 0   1   2   3  
Care of the patient with cardioversion 0   1   2   3  
Defibrillation 0   1   2   3  
Assist with insertion of temporary pacemaker 0   1   2   3  
Set up and use of CVP 0   1   2   3  
Thrombolytic therapy 0   1   2   3  
Care of the patient with shocks 0   1   2   3  
Administration of blood an blood products 0   1   2   3  
Preparation and calculation of lidocaine 0   1   2   3  
Preparation and calculation of Nipride 0   1   2   3  
Preparation and calculation of dopamine 0   1   2   3  
Preparation and calculation of Isuprel 0   1   2   3  
Preparation and calculation of digitalis 0   1   2   3  
Preparation and calculation of sodium bicarbonate 0   1   2   3  
Preparation and calculation of atropine 0   1   2   3  
Preparation and calculation of epinephrine 0   1   2   3  
Preparation and calculation of Dobutrex 0   1   2   3  
Preparation and calculation of nitroglycerine 0   1   2   3  
 
Sexual Assault/Child Abuse:
Rape kit 0   1   2   3  
Reporting procedures for acts of violence 0   1   2   3  
 
Environmental:
Care of the patient with with hypothermia 0   1   2   3  
Care of the patient with heat stroke/exhaustion 0   1   2   3  
Care of the patient with snake/animal bite 0   1   2   3  
Administration of antivenom 0   1   2   3  
 
Additional Skills:  
Isolation procedures 0   1   2   3  
Triage procedures 0   1   2   3  
Care of the patient with AIDS 0   1   2   3  
Procedure for signing AMA 0   1   2   3  
Consent for treatment of minor 0   1   2   3  
Disaster protocols 0   1   2   3  
Start adult IV 0   1   2   3  
Start pediatric IV 0   1   2   3  
 
Age-Specific Practice Criteria:
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 Groups:
Calculate body weight to verify correct dosing of medication 0   1   2   3  
Assess immunization status for pediatric, and adolescent 0   1   2   3  
Set age-appropriate short-term and long-term goals in care planning 0   1   2   3  
Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years 0   1   2   3  
 
 
 
 


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