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1.877.891.4286
1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Ambulatory RN – Skills Checklist
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 Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Age of Patients Cared For
Newborn (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64+ years)
*
0
1
2
3
4
5
General Skills
Standard Precautions
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Adult Respiratory/Cardiac Arrest
*
0
1
2
3
4
5
Pediatric Respiratory/Cardiac Arrest
*
0
1
2
3
4
5
Crash Carts
*
0
1
2
3
4
5
Defibrillators
*
0
1
2
3
4
5
Patient/Family Education
*
0
1
2
3
4
5
Admit and Assess Patients
*
0
1
2
3
4
5
Automated Med Dispensing Systems
*
0
1
2
3
4
5
Automated Med Dispensing Systems - List Types
*
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Obtaining Cultures (Blood, Sputum, Swab, Urine)
*
0
1
2
3
4
5
Advance Directives
*
0
1
2
3
4
5
Collect Appropriate Data
*
0
1
2
3
4
5
Collect Appropriate Data
*
0
1
2
3
4
5
Discharge Teaching
*
0
1
2
3
4
5
Preoperative Teaching
*
0
1
2
3
4
5
Patient Prep
*
0
1
2
3
4
5
Cardiovascular
Assess Heart Tones
*
0
1
2
3
4
5
Bedside Tele Monitoring
*
0
1
2
3
4
5
Interpretation of Coagulation Studies
*
0
1
2
3
4
5
Perform Pulse/Circulation Checks
*
0
1
2
3
4
5
Pre/Post-Op Pacemaker Care
*
0
1
2
3
4
5
Pulmonary
Assess Breath Sounds
*
0
1
2
3
4
5
Apply Oxygen
*
0
1
2
3
4
5
Interpret ABGs
*
0
1
2
3
4
5
Thoracentesis
*
0
1
2
3
4
5
Oximetry
*
0
1
2
3
4
5
Neurology
Assess Neurological Signs
*
0
1
2
3
4
5
Epidurals
*
0
1
2
3
4
5
Selective Nerve Root Blocks
*
0
1
2
3
4
5
Assess Level of Consciousness
*
0
1
2
3
4
5
GI
Insertion/Monitoring NG Tubes
*
0
1
2
3
4
5
Assessment
*
0
1
2
3
4
5
Flexible Sigmoidoscopy
*
0
1
2
3
4
5
Hemorrhoid Banding
*
0
1
2
3
4
5
Liver Biopsy
*
0
1
2
3
4
5
Paracentesis
*
0
1
2
3
4
5
Lap Band Surgery
*
0
1
2
3
4
5
GU
Bladder Biopsy
*
0
1
2
3
4
5
Cystoscopy
*
0
1
2
3
4
5
Urethral Dilation
*
0
1
2
3
4
5
Nephrostomy
*
0
1
2
3
4
5
Kidney Biopsy
*
0
1
2
3
4
5
Suprapubic Catheter
*
0
1
2
3
4
5
Prostate Biopsy
*
0
1
2
3
4
5
Endocrine
Care of Diabetic Patient
*
0
1
2
3
4
5
Diabetic Teaching
*
0
1
2
3
4
5
Blood Glucose Testing
*
0
1
2
3
4
5
ENT and Mouth
Prosthodontics - Restorative Dentistry
*
0
1
2
3
4
5
Mouth Biopsy
*
0
1
2
3
4
5
Myringotomy
*
0
1
2
3
4
5
Maxillofacial Prosthetics
*
0
1
2
3
4
5
Nose Biopsy
*
0
1
2
3
4
5
Thyroid Aspirate Biopsy
*
0
1
2
3
4
5
Fiberoptic Laryngoscopy
*
0
1
2
3
4
5
Tonsillectomy
*
0
1
2
3
4
5
Wounds/Integument
Application of Burn Dressing
*
0
1
2
3
4
5
Application of Burn Dressing
*
0
1
2
3
4
5
Debridement of Wound
*
0
1
2
3
4
5
Wound Care
*
0
1
2
3
4
5
Wound Vac
*
0
1
2
3
4
5
OB/GYN
Electrodesiccation and Curettage (ED7C)
*
0
1
2
3
4
5
Assist with In-Office Procedures
*
0
1
2
3
4
5
Ortho
Arthrocentesis
*
0
1
2
3
4
5
External Hardware and Pin Care
*
0
1
2
3
4
5
Arthroscopy
*
0
1
2
3
4
5
Open Reduction and Internal Fixation
*
0
1
2
3
4
5
Closed Reduction and Internal Fixation
*
0
1
2
3
4
5
Trigger Point Injections
*
0
1
2
3
4
5
Plastics
Rhinoplasty
*
0
1
2
3
4
5
Liposuction
*
0
1
2
3
4
5
Nipple Reconstruction
*
0
1
2
3
4
5
MOHS Repairs
*
0
1
2
3
4
5
Blepharoplasty
*
0
1
2
3
4
5
Mole/Cyst Removal
*
0
1
2
3
4
5
General Medications/Therapeutic Interventions
Administer IM and SQ Medications
*
0
1
2
3
4
5
Administer Inhalation Medications
*
0
1
2
3
4
5
Administer PO Medications
*
0
1
2
3
4
5
Bladder Irrigation and Installation
*
0
1
2
3
4
5
Needleless System
*
0
1
2
3
4
5
Chemotherapy
*
0
1
2
3
4
5
IV Therapy
Infusion Pumps
*
0
1
2
3
4
5
Peripheral IV Insertion
*
0
1
2
3
4
5
Syringe Pumps
*
0
1
2
3
4
5
Vascular Access Devices Care/Maintenance
*
0
1
2
3
4
5
Administer IV Medications
*
0
1
2
3
4
5
Oxygen Administration
Ambu-Bag
*
0
1
2
3
4
5
Nasal Cannula
*
0
1
2
3
4
5
Non-Rebreather Mask
*
0
1
2
3
4
5
Venti Mask
*
0
1
2
3
4
5
Face Mask
*
0
1
2
3
4
5
Nutritional Therapy
Lipids
*
0
1
2
3
4
5
TPN
*
0
1
2
3
4
5
Procalamine
*
0
1
2
3
4
5
Enteral Administration
*
0
1
2
3
4
5
Pain Management/Anesthesia
Implantable Narcotic Pump
*
0
1
2
3
4
5
Moderate Sedation
*
0
1
2
3
4
5
Epidural
*
0
1
2
3
4
5
Spinal
*
0
1
2
3
4
5
Local
*
0
1
2
3
4
5
General
*
0
1
2
3
4
5
Axillary Block
*
0
1
2
3
4
5
Bier Block
*
0
1
2
3
4
5
General Procedures/Equipment
Apply Immobilizers (clavicle, knee, etc.)
*
0
1
2
3
4
5
Assist with Code Resuscitation
*
0
1
2
3
4
5
Assist with Lumbar Puncture
*
0
1
2
3
4
5
Laser
*
0
1
2
3
4
5
Dermabrasion
*
0
1
2
3
4
5
Drain Removal
*
0
1
2
3
4
5
Incision and Drainage
*
0
1
2
3
4
5
NGT Insertion
*
0
1
2
3
4
5
Patch Test
*
0
1
2
3
4
5
Punch Biopsy
*
0
1
2
3
4
5
Shave Biopsy
*
0
1
2
3
4
5
Procedure Set Up
*
0
1
2
3
4
5
Remove External Fixators with Pin
*
0
1
2
3
4
5
Scrub
*
0
1
2
3
4
5
Screw/Hardware Removal
*
0
1
2
3
4
5
Set-Up/Assist Suturing
*
0
1
2
3
4
5
Staple Removal
*
0
1
2
3
4
5
Suture Removal
*
0
1
2
3
4
5
Foley/Straight Catheter - Male
*
0
1
2
3
4
5
Foley/Straight Catheter - Female
*
0
1
2
3
4
5
TENS Unit
*
0
1
2
3
4
5
Use of Doppler
*
0
1
2
3
4
5
Specimen Collections
Venipuncture
*
0
1
2
3
4
5
Clean Catch Urine
*
0
1
2
3
4
5
Sterile Urine Collection
*
0
1
2
3
4
5
Stool
*
0
1
2
3
4
5
Sputum
*
0
1
2
3
4
5
Butterfly Stick
*
0
1
2
3
4
5
Central Line Draw
*
0
1
2
3
4
5
Clinical Settings
Surgi-Center
*
0
1
2
3
4
5
Outpatient Clinic
*
0
1
2
3
4
5
Physician Office
*
0
1
2
3
4
5
Ambulatory Surgery Clinic
*
0
1
2
3
4
5
Other Skills
Please list any other relevant skills
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
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 Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*