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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
Medical Surgical Nursing 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
Discontinue PIV
*
0
1
2
3
4
5
Initiate Peripheral IV
*
0
1
2
3
4
5
Lift/Transfer Devices
*
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 Patients 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 and 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
*
Patient Head to Toe Assessment
*
0
1
2
3
4
5
Knowledge of Normal Serum Lab Values
*
0
1
2
3
4
5
Obtaining Cultures (Blood, Sputum, Swab, Urine)
*
0
1
2
3
4
5
Calculate mcg/min and mcg/Kg/min
*
0
1
2
3
4
5
Titrating Medications
*
0
1
2
3
4
5
Psychological
Overdose/Withdrawl
*
0
1
2
3
4
5
Suicidal Precautions
*
0
1
2
3
4
5
Manic Disorder/Behavior
*
0
1
2
3
4
5
De-Escalation Techniques
*
0
1
2
3
4
5
Depression
*
0
1
2
3
4
5
Psychological - Knowledge and Use Of
Anti-Depressants
*
0
1
2
3
4
5
Anti-Anxiety Medications
*
0
1
2
3
4
5
Psych Medications
*
0
1
2
3
4
5
Medications
Anticoagulants
*
0
1
2
3
4
5
Narcotics
*
0
1
2
3
4
5
PCA for Pain Control
*
0
1
2
3
4
5
Epidural for Pain Control
*
0
1
2
3
4
5
Non-Narcotic Analgesics
*
0
1
2
3
4
5
Topical Medications
*
0
1
2
3
4
5
IM Medications
*
0
1
2
3
4
5
SQ Medications
*
0
1
2
3
4
5
Oral Medications
*
0
1
2
3
4
5
IV Push Medications
*
0
1
2
3
4
5
IV Drip Medications
*
0
1
2
3
4
5
Antibiotics
*
0
1
2
3
4
5
Chemotherapy
*
0
1
2
3
4
5
Neuro General Skills
Assessing Levels of Consciousness
*
0
1
2
3
4
5
Pupil Checks
*
0
1
2
3
4
5
Seizure Precautions
*
0
1
2
3
4
5
Aneurysm Precautions
*
0
1
2
3
4
5
Assisting with Lumbar Puncture
*
0
1
2
3
4
5
Use of Hyper/Hypothermia Blanket
*
0
1
2
3
4
5
Neuro - Care of Patients With
Stroke
*
0
1
2
3
4
5
Spinal Cord Injury - Acute
*
0
1
2
3
4
5
Spinal Cord Injury - Long Term
*
0
1
2
3
4
5
Neuromuscular Disease
*
0
1
2
3
4
5
Alzheimer's Disease
*
0
1
2
3
4
5
Neuro - Knowledge and Use Of
Anticonvulsants
*
0
1
2
3
4
5
IV Drip Steroids
*
0
1
2
3
4
5
Cardiac General Skills
Cardiac Monitors
*
0
1
2
3
4
5
Auscultation of Cardiac Sounds
*
0
1
2
3
4
5
EKG-12 Lead
*
0
1
2
3
4
5
Recognizing Basic & Life-Threatening Dysrhythmias
*
0
1
2
3
4
5
Cardioversion/Defibrillation
*
0
1
2
3
4
5
Pulse Checks
*
0
1
2
3
4
5
Interpretation of Cardiac Enzymes
*
0
1
2
3
4
5
Use of Doppler
*
0
1
2
3
4
5
Use of Automatic BP Cuff (ie Dinamap)
*
0
1
2
3
4
5
Cardiac - Care of Patients With
Angina
*
0
1
2
3
4
5
CHF
*
0
1
2
3
4
5
Chest Pain
*
0
1
2
3
4
5
Post MI
*
0
1
2
3
4
5
Cardiac - Knowledge and Use Of
Nitrates (Oral, Topical)
*
0
1
2
3
4
5
Antiarrhythmics (Oral)
*
0
1
2
3
4
5
Antihypertensives (Oral)
*
0
1
2
3
4
5
Heparin Drip
*
0
1
2
3
4
5
Respiratory General Skills
O2 Cannulas/Masks
*
0
1
2
3
4
5
Nebulizer Set-up/Use
*
0
1
2
3
4
5
Incentive Spirometry
*
0
1
2
3
4
5
Chest PT
*
0
1
2
3
4
5
Pulse Oximetry
*
0
1
2
3
4
5
Respiratory - Suctioning
Oral
*
0
1
2
3
4
5
Tracheostomy Tube
*
0
1
2
3
4
5
Respiratory - Care of Patient With
SOB
*
0
1
2
3
4
5
Pulmonary Embolism
*
0
1
2
3
4
5
Tracheostomy Tube
*
0
1
2
3
4
5
COPD
*
0
1
2
3
4
5
Asthma Exacerbation
*
0
1
2
3
4
5
Pneumonia
*
0
1
2
3
4
5
Pre/Post Thoracic Surgery
*
0
1
2
3
4
5
Chest Tubes
*
0
1
2
3
4
5
Tuberculosis
*
0
1
2
3
4
5
Respiratory - Knowledge and Use Of
O2 Therapy
*
0
1
2
3
4
5
Bronchodilators
*
0
1
2
3
4
5
Oral Steroids
*
0
1
2
3
4
5
IV Steroids
*
0
1
2
3
4
5
Inhaler
*
0
1
2
3
4
5
Gastrointestinal General Skills
Insertion, Care & Maintenance of Nasogastric Tubes (ie Salem Pump, Levine)
*
0
1
2
3
4
5
Nasointestinal Tubes (ie Cantor, Miller-Abbot)
*
0
1
2
3
4
5
Jejunostomy, Gastrostomy, Cecostomy Tubes
*
0
1
2
3
4
5
Gastrointestinal - Tube Feedings via Flexible Tubes
by Gravity Infusion
*
0
1
2
3
4
5
by Feeding Pump
*
0
1
2
3
4
5
Collection of Stool Specimens
*
0
1
2
3
4
5
Bowel Preparation & Cleansing Procedures
*
0
1
2
3
4
5
Gastrointestinal - Care of Patients With
Stoma
*
0
1
2
3
4
5
Bowel Obstruction
*
0
1
2
3
4
5
Pancreatitis
*
0
1
2
3
4
5
Post Abdominal Surgery
*
0
1
2
3
4
5
Ileostomy
*
0
1
2
3
4
5
Colostomy
*
0
1
2
3
4
5
Inflammatory Bowel Disease
*
0
1
2
3
4
5
Obstruction
*
0
1
2
3
4
5
Hepatitis
*
0
1
2
3
4
5
Gastrointestinal - Knowledge and Use Of
Total Parenteral Nutrition (TPN)
*
0
1
2
3
4
5
Peripheral Parenteral Nutrition (PPN)
*
0
1
2
3
4
5
Antiemetics
*
0
1
2
3
4
5
Proton Pump Inhibitors
*
0
1
2
3
4
5
Renal/GU Problems General Skills
Insertion of Catheter Straight
*
0
1
2
3
4
5
Insertion of Catheter Foley
*
0
1
2
3
4
5
Bladder Irrigation Continuous
*
0
1
2
3
4
5
Bladder Irrigation Intermittent
*
0
1
2
3
4
5
Peritoneal Dialysis
*
0
1
2
3
4
5
Automatic Cycler Machine
*
0
1
2
3
4
5
Collection of Urine Specimens
*
0
1
2
3
4
5
Hemodialysis
*
0
1
2
3
4
5
A-V Fistula/Shunt Care
*
0
1
2
3
4
5
Pre/Post-Dialysis Care
*
0
1
2
3
4
5
Suprapubic Catheter
*
0
1
2
3
4
5
Nephrostomy Tube
*
0
1
2
3
4
5
Renal/GU - Care of Patient With
Urinary Tract Infection
*
0
1
2
3
4
5
Pyelonephritis
*
0
1
2
3
4
5
Renal Calculi
*
0
1
2
3
4
5
Urinary Retention/Incontinence
*
0
1
2
3
4
5
Endocrine General Skills
Performing Fingersticks
*
0
1
2
3
4
5
Use of Blood Glucose Meter Device
*
0
1
2
3
4
5
Use of Visual Blood Glucose Strips
*
0
1
2
3
4
5
Endocrine - Care of Patient With
Hyper/Hypoglycemia
*
0
1
2
3
4
5
DKA
*
0
1
2
3
4
5
Thyroid Disorders
*
0
1
2
3
4
5
Endocrine - Knowledge and Use of Insulin
Single Type
*
0
1
2
3
4
5
Dextrose
*
0
1
2
3
4
5
Mixed Insulins
*
0
1
2
3
4
5
Insulin Infusion
*
0
1
2
3
4
5
Orthopedic General Skills
Cast Care
*
0
1
2
3
4
5
C.M.S. Checks
*
0
1
2
3
4
5
Traction - Skin
*
0
1
2
3
4
5
Traction - Skeletal
*
0
1
2
3
4
5
Range of Motion
*
0
1
2
3
4
5
Use of Assistive Devices
*
0
1
2
3
4
5
Applications of Splints Extremities
*
0
1
2
3
4
5
Continuous Passive Motion Machine (CPM)
*
0
1
2
3
4
5
Orthopedic - Care of Patient With
Total Joint Replacement
*
0
1
2
3
4
5
Rheumatic/Arthritic Disease
*
0
1
2
3
4
5
Amputation
*
0
1
2
3
4
5
Wound/Skin Care
Dressing Changes
*
0
1
2
3
4
5
Air Fluidized, Low Airloss Beds
*
0
1
2
3
4
5
Pressure Relief Mattress/Seat Cushion
*
0
1
2
3
4
5
Pressure Sores
*
0
1
2
3
4
5
Leg Ulcers
*
0
1
2
3
4
5
Burns
*
0
1
2
3
4
5
Wound Vacs
Hemovacs
*
0
1
2
3
4
5
Jackson-Pratt Tubes
*
0
1
2
3
4
5
Penrose Drains
*
0
1
2
3
4
5
T-Tubes
*
0
1
2
3
4
5
Surgical Wound Irrigations & Dressings
*
0
1
2
3
4
5
Vascular
Discontinue PICC
*
0
1
2
3
4
5
Care of Patient with DVT
*
0
1
2
3
4
5
Draw Blood from Arterial Line
*
0
1
2
3
4
5
Draw Blood from Central Line
*
0
1
2
3
4
5
Peripheral IV Insertion, Care and Maintenance
*
0
1
2
3
4
5
Discontinue Peripheral IV
*
0
1
2
3
4
5
IV Infusion Pumps
*
0
1
2
3
4
5
CVP Lines - Measurement of CVP
*
0
1
2
3
4
5
Central Line Care and Maintenance (including dressing changes)
*
0
1
2
3
4
5
Blood/Blood Product Administration
*
0
1
2
3
4
5
Multi-Lumen Central Catheters
*
0
1
2
3
4
5
Port-A-Caths (Infusa-Ports)
*
0
1
2
3
4
5
Continuous Subcutaneous Infusion Pumps
*
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
*