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Dialysis RN

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.

  • 0 = Not Applicable
  • 1 = No Experience
  • 2 = Some Experience
  • 3 = Intermittent Experience
  • 4 = Experienced
  • 5 = Very Experienced
*Required
n/a
1
2
3
4
5

* Required

Age of Patients Cared For

Newborn/Neonate (birth to 30 days)*

Infant (1 month to 1 year)*

Toddler (1 year to 3 years)*

Preschooler (3 years to 5 years)*

School Age Child (5 years to 12 years)*

Adolescents (12 years to 18 years)*

Young Adults (18 years to 39 years)*

Middle Adults (39 years to 64 years)*

Older Adults (64 years to 79 years)*

Elderly Adults (over 79+ years)*

General Skills

Standard Precautions*

Isolation Precautions*

Pediatric Respiratory/Cardiac Arrest*

Adult Respiratory/Cardiac Arrest*

Crash Carts*

Defibrillators*

Care of Patient in Restraints*

Pain Management*

Automated Med Dispensing Systems*

Care Planning & Discharge Planning*

Patient/Family Education*

Electronic Documentation*

Peripheral IV Insertion, Care and Maintenance*

Renal/Genitourinary

Assessment of Renal/GU System*

Insertion of urinary catheter (straight cath or foley)*

Patient with Nephrostomy Tube*

Patient with A V Fistula/ A V Graft*

Patient with Tunneled/ Non- Tunneled Catheter*

Patient with Ileal Conduit*

Patient with Supra-Pubic Catheter*

Patient with Renal Failure*

Patient with Nephrectomy*

Patient with TURP*

Patient on Peritoneal Dialysis*

Patient on Hemodialysis*

Hemodialysis Skills/Procedures Experience

Acute / Inpatient Dialysis*

Chronic / Outpatient Dialysis*

Dialysis Home Care*

Pediatric Dialysis*

Predialysis Nursing Assessment*

Set Up/Initiate Dialysis Treatment

Bicarbonate Dialysate*

Conductivity Testing*

Priming Dialyzer*

Checks for Machine/Alarm Settings*

Prep Vascular Access*

Fistula Gortex/ Bovine Graft*

Dialysis*

Collect Blood Specimens*

Volume Status*

Vascular Access Function*

Arterial and Venous Pressures*

Blood Flow Rate*

Subjective Response to Treatment*

Management of Anticoagulation*

Conductivity*

Ultrafiltration Calculation*

Myron L. Water Meter*

Administration of Mannitol*

Sequential Ultrafiltration/PUF*

Documentation of Dialysis Treatment*

Fluid Overload*

Hypertension*

Hypotension*

Disequilibrium Syndrome*

Hyperkalemia*

Seizures*

Muscle Cramps*

Clotted Access/Poor Blood Flow Rate from Catheter*

Pyrogenic Reaction*

Hemolysis*

Air Embolus*

Chest Pain*

Anemia*

Neuropathy*

Pericarditis*

Filter Blood Leak*

Alarm

Blood Leak Alarm*

Arterial Pressure Alarm*

Venous Pressure Alarm*

Conductivity Alarm*

Ultrafiltration Alarm*

High Temperature Alarm*

Air / Foam Detector Alarm*

Power Failure Alarm*

Blood Pump Alarm*

Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

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