About PNI | Per Diem Nurses | Travel Nurses | Allied Health Professionals | Healthcare Facilities | Contact Us | Home | Apply

 
 


 
Skills Assessment - Medical / Surgical
 
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
 
Cardiac: Experience:
Permanent pacemakers 0   1   2   3  
Cardiac arrest/CPR 0   1   2   3  
Care of a patient with aneurysm 0   1   2   3  
Care of a patient post MI 0   1   2   3  
Care of a patient with pre/post cardiac cath 0   1   2   3  
Care of a patient pre/post cardiac surgery 0   1   2   3  
Administration of atropine 0   1   2   3  
Administration of digoxin 0   1   2   3  
Administration of Inderal 0   1   2   3  
Administration of NTG 0   1   2   3  
Administration of Pronestyl 0   1   2   3  
Administration of quinidine 0   1   2   3  
Administration of verapamil 0   1   2   3  
Administration of thrombolytic agents 0   1   2   3  
Preparation of emergency drugs 0   1   2   3  
 
Respiratory:
Establish an airway 0   1   2   3  
Use Ambu bag 0   1   2   3  
Pulse Oximetry 0   1   2   3  
Interpretation of ABG 0   1   2   3  
Incentive spirometer 0   1   2   3  
Oral suctioning 0   1   2   3  
Nasotracheal suctioning 0   1   2   3  
Care of patient with COPD 0   1   2   3  
Care of patient with pre/post thoracic surgery 0   1   2   3  
Care of patient with pulmonary edema 0   1   2   3  
Care of patient with pneumothorax 0   1   2   3  
Care of patient with pneumonia 0   1   2   3  
Care of patient with emphysema 0   1   2   3  
Care of patient with asthma 0   1   2   3  
Administration of aminophylline 0   1   2   3  
Administration of corticosteroids 0   1   2   3  
Administration of Bronkosol/Ventolin/Alupent 0   1   2   3  
 
Neurology:
Assess neuro signs 0   1   2   3  
Glasgow coma scale 0   1   2   3  
Seizure precautions 0   1   2   3  
Assist with lumbar puncture 0   1   2   3  
Care of patient with CVA 0   1   2   3  
Care of patient with seizure activity 0   1   2   3  
Care of patient with multiple sclerosis 0   1   2   3  
Care of patient post-op shunt 0   1   2   3  
Administration of Decadron 0   1   2   3  
Administration of dilantin 0   1   2   3  
Administration of magnesium sulfate 0   1   2   3  
Administration of phenobarbital 0   1   2   3  
Administration of steroids 0   1   2   3  
Administration of valium 0   1   2   3  
 
Vascular:
Peripheral pulses 0   1   2   3  
Fluid overload 0   1   2   3  
Ultrasonic Doppler 0   1   2   3  
Start IV 0   1   2   3  
Subcutaneous central line 0   1   2   3  
Hickman/Broviac/Groshong catheters 0   1   2   3  
Maintain heparin lock 0   1   2   3  
TPN/hyperalimentation 0   1   2   3  
Air occlusive dressing 0   1   2   3  
Recognize normal serum lab values 0   1   2   3  
Administer blood and blood products 0   1   2   3  
Infusion pumps 0   1   2   3  
Heparin Drip 0   1   2   3  
Sickle cell anemia 0   1   2   3  
Thrombophlebitis 0   1   2   3  
 
Gastrointestinal:
NG tube insertion 0   1   2   3  
Care of patient with GI tubes 0   1   2   3  
Care of patient with pancreatitis 0   1   2   3  
Care of patient with GI bleed 0   1   2   3  
Care of patient with esophageal bleeding 0   1   2   3  
Care of patient with bowel obstruction 0   1   2   3  
Care of patient with Whipple procedure 0   1   2   3  
Care of patient with paralytic ileus 0   1   2   3  
 
Genitourinary/Renal:
Foley catheter insertion 0   1   2   3  
GU irrigation 0   1   2   3  
Nephrostomy tube 0   1   2   3  
Suprapubic tube 0   1   2   3  
Electrolyte imbalance/replacement 0   1   2   3  
Care of patient with TURP 0   1   2   3  
Care of patient with shunts and fistulas 0   1   2   3  
Care of patient with nephrectomy 0   1   2   3  
Care of patient with renal transplant 0   1   2   3  
Care of patient with chronic/acute renal failure 0   1   2   3  
 
Orthopedics:
Assess circulation/gait/ROM 0   1   2   3  
Assess skin status 0   1   2   3  
Care of patient with continuous passive motion devices 0   1   2   3  
Care of patient with cane/walker 0   1   2   3  
Care of patient with cervical collar 0   1   2   3  
Care of patient with gate belt 0   1   2   3  
Care of patient with sling 0   1   2   3  
Care of patient with transfer boards 0   1   2   3  
Care of patient with wheelchair 0   1   2   3  
Care of patient with traction 0   1   2   3  
Care of the patient with amputation 0   1   2   3  
Care of the patient with cast 0   1   2   3  
Care of the patient with osteoporosis 0   1   2   3  
Care of the patient with pinned fracture 0   1   2   3  
Care of the patient with total hip replacement 0   1   2   3  
Care of the patient with total knee placement 0   1   2   3  
 
Pain/Wound Management:
Assess pain level/tolerance/control 0   1   2   3  
Care of the patient with narcotic analgesia 0   1   2   3  
Assess skin for impending breakdown 0   1   2   3  
Assess wound status/healing 0   1   2   3  
Care of the patient with air fluidized, low air loss beds 0   1   2   3  
Care of the patient with sterile dressing changes 0   1   2   3  
Care of the patient with pressure sores 0   1   2   3  
 
Oncology:
Assess nutritional status 0   1   2   3  
Interpretation of blood chemistry/counts 0   1   2   3  
Care of the patient with bone marrow transplant 0   1   2   3  
Care of the patient with inpatient chemotherapy 0   1   2   3  
Medications: Chemotherapy certification? Yes   No  
 
General:
Care of patient with delirium tremens 0   1   2   3  
Isolation technique 0   1   2   3  
Administration of blood/blood products 0   1   2   3  
Blood sugar monitor (accu check, one touch, etc.) 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. Pediatric (1-12years)  
Adolescents (12 - 18 years)  
Adult (19 - 65 years)  
Older adults (Older than 65years)  
 
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  
 
 
 
 


© professional nursing, inc.   

  About PNI | Per Diem Nurses | Travel Nurses | Allied Health Professionals | Healthcare Facilities | Contact Us | Home | Apply