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Tele, PCU, Stepdown 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*

Use of Rapid Response Teams*

Care of Patient in Restraints*

Pain Management*

Automated Med Dispensing System*

Care Planning and Discharge Planning*

Patient/ Family Education*

Organ/Tissue Donation*

Electronic Documentation*

Patient Head to Toe Assessment*

Dressing Changes*

Knowledge of Normal Serum Lab Values*

Obtaining Cultures (Blood, Sputum, Swab, Urine)*

Administration of Blood and Blood Products*

PCA Pumps*

Infusion Pumps*

Calculate mcg/min and mcg/kg/min*

Titrating Medications*

Moderate/Conscious Sedation & Reversal Agents*

Psychological

Overdose/ Withdrawal*

Suicidal Precautions*

Manic Disorder/ Behavior*

De-escalation Techniques*

Depression*

Psychological - Knowledge and Use Of

Anti-depressants*

Anti-anxiety Medications*

Psych Medications*

IV Therapy

Initiate Peripheral IV*

Discontinue Peripheral IV*

Central Line Blood Draw*

Central Line Care & Maintenance*

PICC Line Blood Draw*

PICC Line Care & Maintenance*

IV Conscious Sedation*

Neuro General Skills

Assessment of Neuro Signs*

Glasgow Coma Scale*

Seizure Precautions*

Dysphagia Screen*

Visual/Communication Deficits*

Reflex/Motor Deficits*

Monitoring ICP*

Assist With Lumbar Puncture*

Halo Traction*

NEURO-Care of Patients with:

CVA*

Seizure Activity*

Overdose*

Neuro/Head Injury/ Trauma*

Spinal Cord Injury*

Aneurysm*

Ischemic/Hemorrhagic Stroke*

Encephalitis*

Meningitis*

Pre/Post Neuro Surgery*

Cranial Hemorrhage*

Multiple Sclerosis*

Neuromuscular Disease*

Metastatic Tumor*

Hydrocephalus*

Post-Op AV Shunt*

Neuro - Medications Knowledge and Use Of

Decadron*

Dilantin*

Magnesium Sulfate*

Phenobarbital*

Steroids*

Valium*

Versed*

Cardiac General Skills

Auscultation of Cardiac Sounds*

Abnormal Heart Sounds/Murmurs*

Capillary Refill*

Dopplers*

Interpretation of 12 lead EKG*

Interpretation of Arrhythmias*

Cardiac Monitoring*

Defibrillation/Cardioversion*

Permanent Pacemaker*

Temporary Pacemaker*

AICD*

Art-Line (transducer set-up, D/C)*

Sheath Removal*

Interpretation of Cardiac Enzymes*

Management of Dysrhythmia*

Cardiac - Care of Patients With

Angina*

CHF*

Acute MI*

Abdominal Aortic Aneurysm*

Cardiac Tamponade*

Pericarditis*

Cardiomyopathy*

Carotid Endarterectomy*

Carotid Stent*

Femoral Popliteal Bypass*

Post MI*

Pre/Post Cardiac Cath*

Pre/Post Cardiac Surgery*

Post AICD Insertion*

Pre/Post PTCA/Stents*

Valve Replacement*

Ventricular Assist Device*

Open Sternal Wound (Debridement)*

Heart Transplant*

Cardiac - Medications Knowledge and Use Of

Atropine*

Diuretics*

Digoxin*

Dopamine*

Dobutrex*

Heparin Drip (Precautions & Maintenance)*

Inderal*

Inocor*

Isuprel*

Lidocaine*

Nipride*

Nitroglycerin*

Pronestyl*

Morphine*

Thrombolytic Agents*

Magnesium Sulfate*

Versed*

Prep/Titration of Emergency Drugs*

Respiratory General Skills

Establishing an Airway*

Assessment of Lung Sounds*

Ambuing Techniques*

Administration of O2*

O2 Cannulas/Masks*

Nebulizer Set-up/use*

Chest Tubes*

Pulse Oximetry*

End Tidal CO2*

Capnography*

Interpretation of ABG*

Use of IPPB*

Incentive Spirometer*

Oral Suctioning*

Nasotracheal Suctioning*

ET Suctioning*

Respiratory - Care of Patients With

COPD*

ARDS*

Pre/Post Thoracic Surgery*

Lobectomy*

Chest Trauma*

Pulmonary Embolism*

Pulmonary Edema*

Pneumothorax*

Pneumonia*

Inhalation Injuries*

Emphysema*

Tracheostomy*

Tuberculosis*

Asthma*

Lung Transplant*

Respiratory - Medications Knowledge and Use Of

Aminophylline*

Corticosteroids*

Bronchodilators*

Gastrointestinal General Skills

NG Tube Insertion, Care and Maintenance*

Gastrostomy Tube*

Jejunostomy Tube*

Enterostomal Care*

Tube Feedings*

Auscultation of Bowel Sounds*

Gastrointestinal - Care of Patients With

Pancreatitis*

Hepatitis*

G.I. Bleed*

Esophageal Bleeding*

Bowel Obstruction*

Post Abdominal Surgery*

Colostomy*

Ileostomy*

Abdominal Trauma*

Compartment Syndrome*

Whipple Procedure*

Liver Transplant*

Liver Failure*

Paralytic Ileus*

E.R.C.P.*

Gastrointestinal - Medications Knowledge and Use Of

Antiemetics*

TPN/Hyperalimentation*

Genitourinary/Renal General Skills

Peritoneal Dialysis*

Hemodialysis*

Foley/Straight Catheter Insertion*

GU Irrigations*

Nephrostomy Tube*

Suprapubic Tube*

Electrolyte Imbalance/ Replacement*

Genitourinary/Renal - Care of Patients With

T.U.R.P.*

Shunts and Fistulas*

Nephrectomy*

Renal Transplant*

Renal Trauma*

Chronic/Acute Renal Failure*

Urinary Tract Infection*

Pyelonephritis*

Gynecology General Skills

GYN Exam Prep*

Gynecology - Care of Patients With

Ectopic Pregnancy/Ruptured Ectopic Pregnancy*

Hysterectomy*

Repair of Cystocele/ Rectocele*

Orthopedic General Skills

Assessment of C/M/S*

K-Wises/Steinman Pins*

Removal of Hardware*

Cast Care*

Traction – Skin*

Traction – Skeletal*

Range of Motion*

Use of Assistive Devices*

Applications of Splints Extremities*

Continuous Passive Motion Machine (CPM)*

Orthopedic - Care of Patients With

Total Joint Replacement*

Spica Cast/Body Cast*

External Fixation*

Multiple Trauma*

Paraplegia/Quadriplegia*

Amputation*

Traction*

Ortho Trauma*

Laminectomy*

Endocrine General Skills

Diabetic Teaching*

Blood Glucose Monitoring*

ENDOCRINE- Care of Patients With:

Hyper/Hypoglycemia*

Diabetes*

DKA*

Thyroid Disorders*

MEDICATION KNOWLEDGE AND USE OF

Insulin (IV, SQ)*

D50*

Wounds/Integument

Skin Assessment*

Pressure Injury/Ulcers*

Stasis Ulcers*

Surgical Wounds with Drains*

Trauma Wounds*

Braden Scale*

Wound VACs

Hemovacs*

Jackson-Pratt Tubes*

Penrose Drains*

T-Tubes*

Surgical Wound Irrigations & Dressings*

Phlebotomy/IV Therapy

Peripheral IV Insertion, Care and Maintenance*

Assisting with Insertion of Central Lines*

Care and Maintenance of Central Lines*

Assisting with Insertion of PICC Lines*

Care and Maintenance of PICC Lines*

Assist with IC Cutdown*

Phlebitis*

Other

Heparin Drip (Precautions and Maintenance)*

Care of Oncology Patient*

Chemotherapy Administration*

Care of Patient with Burns*

Care of Patient with HIV/AIDS*

Care of Patient with Sepsis*

Hyperbaric Oxygenation*

Suicide Precautions*

Post Mortem Cares*

Cardiac Monitors

Hewlett-Packard*

Spacelab*

Siemens*

Marquette*

Mennen*

Lifecare*

Nihon-Koder*

Ventilators

Bear*

Bennett 7200*

CPAP*

Emerson*

Engstrom/ Erica*

EMV*

MA-I*

MA-II*

Monihan*

Ohio 560*

PEEP*

Pressure Pre-Set*

Servo*

Siemens*

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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