Emergency Room Skills Checklist

Name*

Telephone*

Who is your recruiter?*

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

CARDIOVASCULAR


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assess Heart Sounds
Acute MI

Abdominal Aortic Aneurysm

Angina, unstable

Cardiac Monitoring

Congestive Heart Failure (CHF)

Arrhythmia Intrepretation

Obtaining 12-Lead EKG

Cardiopulmonary Arrest/CPR

Cardioversion

Defibrillation

Assist with Insertion of Pacemaker

Application of External Pacemaker

Transthoracic Pacemaker

CVP - set up

CVP - interpretation of readings

Swan Ganz - Set up/assist with insert

Swan Ganz - interpretation of readings

Thrombolytic Therapy

Anaphylactic Shock

Cardiogenic Shock

Hypovolemic Shock

Septic Shock

RESPIRATORY


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assess Breath Sounds
Pulmonary Edema

Pulmonary Emboli

COPD

Pneumonia

Pneumothorax

Hemopneumothorax

Tension Pneumothorax

Status Asthmaticus

Anaphylactic Reactions

Near Drowning

Thoracentesis/Paracentesis - assist with

Chest tube & drainage system

a. Set up

b. Assist with insertion

c. Care & maintenance

d. Troubleshooting

Intubation - assist with

Extubation - assist with

Emergency Tracheotomy - assist with

Trach Tube

T-piece

Obtain Arterial Blood Gases

a. Radial artery

b. Femoral artery

c. From arterial line (A-line)

Interpretation of Blood Gases

Oxygen Therapy Administration

a. Ambu bag

b. Bag & mask

c. BiPAP

d. Face mask

e. Nasal cannula

f. Trach collar

Nebulizer Set-up/Administration

Oropharyngeal Suctioning

Nasotracheal Suctioning

Endotracheal Suctioning

Tracheostomy Suctioning

NEUROLOGICAL


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Neuro Assessments
Glascow Coma Scale

Neuro Signs

Acute Head Injuries

Acute Spinal Cord Injuries

C-Spine Precautions

Application of Cervical Collars

Acute CVA/TIA

Seizures

Seizure precautions

Increase ICP - monitor/observe for

Lumbar Puncture - assist with

Migraine Headache

Syncope

GASTROINTESTINAL


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Abdominal Pain
Appendicitis

Cholecystitis

Gastritis

GI Bleed

Esophageal Varices

Abdominal Wounds

Bowel Obstruction

Acute Pancreatitis

Diabetic Ketoacidosis (DKA)

Hernia

Insertion of NG tube

Insertion of Ewald tube

Gastric Lavage

BURNS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Calculation of BSA
First Degree

Second Degree

Third Degree

Electrocution

Radiation Exposure/Reporting

Hazardous Material Exposure/Reporting

RENAL


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Acute Renal Failure
Chronic Renal Failure

Peritoneal Dialysis

Renal Calculi/Kidney Stones

Insertion of Foley Catheter

EENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Ear Irrigations
Eye Irrigations

Nasal Packing

Removal of Nasal Foreign Body

Remove Contact Lenses

Visual Acuity Assessment

Eye Patch Application

Fluorescein/Woods Lamp

Use of Morgan Lens Irrigation

Epiglottitis

ORTHOPEDIC


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assess Extremity Circulation
Set up/assist cast application

Set up/assist cast application

Closed Fracture Reductions - assist with

Dislocation Reductions - assist with

Orthopedic Appliance Application

Orthopedic Appliance Patient Teaching

Set up Steinman Pin/K-wires insertion

OBSTETRICS/GYNECOLOGY


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pelvic Exam/Obtain Cultures-assist with
Doppler Fetal Heart Tones (FHT)

Emergency Delivery

Hemorrhage

Ectopic Pregnancy

Spontaneous Abortion

Preeclampsia/Eclampsia

Placentia Previa

Aburptio Placenta

Communicable Diseases

PEDIATRICS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pediatric Assessments/VS
Medication Dosage Calculation

Lab Value Interpretation

Overdose/Poison ingestion

Pediatric Arrest/Resuscitation

Near Drowning

Child Abuse/Reporting

Epiglottitis

PYSCHIATRIC


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Overdose
ETOH Withdrawl/Delirium Tremens

Suicidal Patients

Crisis Intervention

Restraints

Maintaining Patient Rights

Emergency 72 Hour Hold

TRAUMA


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Level 1 Trauma experience
Level 2 Trauma experience

Blood Warmer

Peritoneal Lavage

Open Chest Massage

Hypovolemic Shock

AutoTransfuser

MAST Suit

ENVIRONMENTAL


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Hypothermia
Heat Stroke/Exhaustion

Heat Exhaustion

Snake Bite

Antivenom Administration

Animal/Human Bite

MISCELLANEOUS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Triage Procedures
Isolation Procedures

Intrepretation of Critical Lab Values

Insertion of Adult IV's

Insertion of Pediatric IV's

Assist with Cut Down

Setup/Assist with Central Line Insertion

Setup/Assist with Arterial Line Insertion

Procedure for Patient Signing AMA

Consent for Treatment of a Minor

Conscious Sedation

COBRA Criteria/Transfering Patients

Computer Charting Systems

SEXUAL ASSAULT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Rape Kit
Reporting Procedure for Violent Acts

LACERATIONS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Suture Tray set up
Suture/Staple - assist with

Suture/Staple Removal

Steri Strip Application

MEDICATIONS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Adenosine
Atropine

Bretylium

Cardizem

Decadron

Dextrose

Digoxin

Dobutamine/Dobutrex

Dopamine

Epinephrine

Heparin

Insulin

Isuprel

Lidocaine

Mannitol

Narcan

Nipride

Nitroglycerine/Tridil

Paralytic Agents

Penobarbital

Procainamide

Romazicon

Sodium Bicarbonate

Solu-Medrol

Thrombolytics

Verapamil

Do you speak any languages other than English?

Yes

No

If yes, which language(s)?

Age Specific Skills

Check the box under EACH age group that you have experience with and are comfortable with for each skill below.

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different communication needs for the age group & changes communication methods and terminology accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different safety risks for the age group and alters the environment accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the normal growth and development for the age group and adapts care accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

*

I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.