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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
Dialysis 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/Neonate (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 Child (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 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (79+ 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
Pediatric Respiratory/Cardiac Arrest
*
0
1
2
3
4
5
Adult Respiratory/Cardiac Arrest
*
0
1
2
3
4
5
Crash Carts
*
0
1
2
3
4
5
Defibrillators
*
0
1
2
3
4
5
Care of Patient in Restraints
*
0
1
2
3
4
5
Pain Management
*
0
1
2
3
4
5
Automated Med Dispensing Systems
*
0
1
2
3
4
5
Automated Med Dispensing Systems - List Types
*
Care Planning & Discharge Planning
*
0
1
2
3
4
5
Patient/Family Education
*
0
1
2
3
4
5
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Peripheral IV Insertion, Care and Maintenance
*
0
1
2
3
4
5
Renal/Genitourinary
Assessment of Renal/GU System
*
0
1
2
3
4
5
Insertion of urinary catheter (straight cath or foley)
*
0
1
2
3
4
5
Patient with Nephrostomy Tube
*
0
1
2
3
4
5
Patient with AV Fistula/AV Graft
*
0
1
2
3
4
5
Patient with Tunneled/Non-Tunneled Catheter
*
0
1
2
3
4
5
Patient with Ileal Conduit
*
0
1
2
3
4
5
Patient with Supra-Pubic Catheter
*
0
1
2
3
4
5
Patient with Renal Failure
*
0
1
2
3
4
5
Patient with Nephrectomy
*
0
1
2
3
4
5
Patient with TURP
*
0
1
2
3
4
5
Patient on Peritoneal Dialysis
*
0
1
2
3
4
5
Patient on Hemodialysis
*
0
1
2
3
4
5
Hemodialysis Skills/Procedures Experience
Acute/Inpatient Dialysis
*
0
1
2
3
4
5
Chronic/Outpatient Dialysis
*
0
1
2
3
4
5
Dialysis Home Care
*
0
1
2
3
4
5
Pediatric Dialysis
*
0
1
2
3
4
5
Predialysis Nursing Assessment
*
0
1
2
3
4
5
Set-Up/Initiate Dialysis Treatment
Bicarbonate Dialysate
*
0
1
2
3
4
5
Conductivity Testing
*
0
1
2
3
4
5
Priming Dialyzer
*
0
1
2
3
4
5
Checks for Machine/Alarm Settings
*
0
1
2
3
4
5
Prep Vascular Access
*
0
1
2
3
4
5
Fistula Gortex/Bovine Graft
*
0
1
2
3
4
5
Dialysis
*
0
1
2
3
4
5
Collect Blood Specimens
*
0
1
2
3
4
5
Volume Status
*
0
1
2
3
4
5
Vascular Access Function
*
0
1
2
3
4
5
Arterial and Venous Pressures
*
0
1
2
3
4
5
Blood Flow Rate
*
0
1
2
3
4
5
Subjective Response to Treatment
*
0
1
2
3
4
5
Management of Anticoagulation
*
0
1
2
3
4
5
Conductivity
*
0
1
2
3
4
5
Ultrafiltration Calculation
*
0
1
2
3
4
5
Myron L. Water Meter
*
0
1
2
3
4
5
Administration of Mannitol
*
0
1
2
3
4
5
Sequential Ultrafiltration/PUF
*
0
1
2
3
4
5
Documentation of Dialysis Treatment
*
0
1
2
3
4
5
Fluid Overload
*
0
1
2
3
4
5
Hypertension
*
0
1
2
3
4
5
Hypotension
*
0
1
2
3
4
5
Disequilibrium Syndrome
*
0
1
2
3
4
5
Hyperkalemia
*
0
1
2
3
4
5
Seizures
*
0
1
2
3
4
5
Muscle Cramps
*
0
1
2
3
4
5
Clotted Access/Poor Blood Flow Rate from Catheter
*
0
1
2
3
4
5
Pyrogenic Reaction
*
0
1
2
3
4
5
Hemolysis
*
0
1
2
3
4
5
Air Embolus
*
0
1
2
3
4
5
Chest Pain
*
0
1
2
3
4
5
Anemia
*
0
1
2
3
4
5
Neuropathy
*
0
1
2
3
4
5
Pericarditis
*
0
1
2
3
4
5
Filter Blood Leak
*
0
1
2
3
4
5
Alarm
Blood Leak Alarm
*
0
1
2
3
4
5
Arterial Pressure Alarm
*
0
1
2
3
4
5
Venous Pressure Alarm
*
0
1
2
3
4
5
Conductivity Alarm
*
0
1
2
3
4
5
Ultrafiltration Alarm
*
0
1
2
3
4
5
High Temperature Alarm
*
0
1
2
3
4
5
Air/Foam Detector Alarm
*
0
1
2
3
4
5
Power Failure Alarm
*
0
1
2
3
4
5
Blood Pump Alarm
*
0
1
2
3
4
5
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
*