Med-Surg Skills Checklist
   NAME  
   Email-Id
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:

This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

 
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
Rating Stars (Click)
CARDIAC 1
2
3
4
Angina
Post Acute MI
Congestive Heart Failure
Post Cardiac Cath
Post Cardiac Surgery
Aneurysm
Carotid Endarterectomy
Post Vascular Surgery
Post Cardiac Transplant
Rating Stars (Click)
PULMONARY 1
2
3
4
Pneumonia
COPD
Tuberculosis
Pulmonary Embolism
Tracheostomy Management
CPAP/BiPAP
Interpretation of Arterial Blood Gases
Post Lung Transplant
Rating Stars (Click)
NEUROLOGICAL & PSYCHIATRIC 1
2
3
4
Stroke Scale Assessment
Traumatic Brain Injury
CVA
Post Craniotomy
Seizure Disorders
Spinal Cord Injuries
Mood Disorders
Substance Withdrawal
Rating Stars (Click)
ORTHOPEDICS 1
2
3
4
Circulation/Skin Checks
Continuous Passive Motion Devices
Ambulation Assistive Devices
Prosthetics
Cast Care
Pin Care
Traction
Total Joint Replacement
Amputation
Rating Stars (Click)
GASTROINTESTINAL 1
2
3
4
Bariatrics
Feeding Tubes
GI Bleeding
Bowel Obstruction
GI Surgery
Liver Disease
Pancreatitis
Post Liver Transplant
Post Pancreas Transplant
Rating Stars (Click)
RENAL/GENITOURINARY 1
2
3
4
Arteriovenous Fistula/Shunt
3 Way Catheter & Bladder Irrigation
Suprapubic Catheter
Renal Failure
Peritoneal Dialysis
GU Surgery
Nephrostomy Tubes
Renal Transplant
Management Pre/Post Hemodialysis
Gyn Surgery
Rating Stars (Click)
ENDOCRINE METABOLIC 1
2
3
4
Diabetes Type I
Diabetes Type II
Blood Glucose Monitoring
IV Insulin Protocols
Management of Hypoglycemia
Indwelling Insulin Pumps
Pituitary Disorders
Rating Stars (Click)
ONCOLOGY 1
2
3
4
Chemotherapy Administration
Radiation Therapy
Medical Oncology
Surgical Oncology
Radiation Implants
Bone Marrow Transplant
Rating Stars (Click)
MEDICATIONS 1
2
3
4
Antiarrhythmics
Anticoagulants (IV, oral, & injection)
Anti-Depressants
Anti-Hypertensives
Anti-Psychotics
Benzodiazepines
Emergency Medications
Epidural Analgesia
Inhaled Medications
Insulin
Narcotics/Opioid Analgesics (IV, oral, & injection)
Nitrates (Oral & Topical)
Non-Opioid Analgesics (IV, Oral, & Injection)
Oral Hypoglycemics
Patient Controlled Analgesia
Procedural Sedation Administration
Reversal Agents
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Rating Stars (Click)
IV THERAPY 1
2
3
4
Starting IVs
Central Line Blood Draws
Central Line/Implanted Line Care
TPN & Lipids
Blood Product Administration
Monitoring of Chemotherapy
Rating Stars (Click)
CARDIAC MONITORING & EMERG. RESPONSE 1
2
3
4
Placement of Telemetry Leads
Rhythm Interpretation
Dysrhythmia Management
Obtain 12 Lead EKG
Use of Rapid Response Teams
Rating Stars (Click)
PROFESSIONAL KNOWLEDGE AND SKILLS 1
2
3
4
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Patient/Family Teaching
Age Specific/Population-Based Care
Isolation Precautions
Infection Prevention
Pain Assessment & Management
Charge Experience
Interpretation and Communication of Lab Values
Wound Care /Wound Vac
Specialty Beds
Rating Stars (Click)
EMR 1
2
3
4
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration