Microsoft word - emergency room skills checklist.doc

_________________________________ ________ ______________________________
_______________________________ _______________ ________________________
E-mail Last 4 digits SS# Date
Instructions: Please check the appropriate column that best describes your experience level for each
knowledge competency and skill. Please use the rating scale below to evaluate yourself based on experiences
within the last two years.
1 = No Experience 2 = Minimal Experience 3 = Performs well/competent 4 = Supervise and Teach Skills Continued:

Cardiovascular
1. Assessment
4. Medications
ACLS Drugs:
2. Equipment & Procedures
Assist with Insertion and Setup:
Cardioversion
Interpretation of Waveforms and Values:
Monitoring:
3. Care of the Patient with:
Pulmonary
Assessment:
Skills continued:
Skills Continued:
2. Interpretation of Lab Results:
5. Medications:
3. Equipment and Procedures:
Airway Management Devices/ Suctioning
Neurological:
1. Assessment
Advanced Neuro Assessment:
Care of the patient with a Chest Tube:
2. Equipment and Procedures:
Obtaining Arterial Blood Gasses:
02 Therapy & Medication Delivery Systems:
3. Care of the Patient with:
4. Care of the Patient with:
4. Medications:
Skills Continued:
Skills Continued:
Orthopedics
1. Assessment
4. Care of the Patient with:
2. Equipment and Procedures
Endocrine/ Metabolic
Support Devices:
1. Assessment
2. Equipment & Procedures
Blood Glucose
3. Care of the Patient with
Monitoring:
3. Care of the Patient with:
Gastrointestinal
4. Medications
1. Assessment
Wound Management/ Surgical
1. Equipment and Procedures
2. Interpretation of Blood
Chemistry
3. Equipment and Procedures:
4. Care of the Patient with:
1. Assessment
5. Medications:
2. Equipment and Procedures:
Renal/ Genitourinary (GU)
1. Assessment
2. Interpretation of Lab
Trauma/ Shock
3. Equipment and Procedures:
1. Assessment
Insertion and Care of
Straight and Foley Catheter:
Skills Continued:
Skills Continued:
2. Equipment & Procedures
Assist with Cutdown
Starting IVs:
3. Care of the Patient with
2. Care of the Patient with:
Central line/ Catheter/ Dressing:
Pericardiocentesis
Pain Management
1. Assist with Pain Level/
Dehydration
Tolerance
Electrocution
2. Care of the Patient with:
Gunshot/ Stab wound
Hazardous Material
Exposure
Heat Exhaustion/ Stroke
Hypothermia
Major Trauma
Minor Trauma
1. Assessment
Radiation Exposure
2. Equipment & Procedures
3. Care of the Patient with
Traumatic Amputation
Infectious Diseases
1. Interpretation of Lab
Values – CBC, SMA 7
2. Equipment and Procedures
Miscellaneous
3. Care of the Patient with Aids
Phlebotomy/ IV Therapy/ Invasive Procedures
1. Equipment and Procedures
Administration of Blood/ Blood Products:
Autotransfusion
Skills Continued:
Age Specific Practice Criteria:
Experience with Age Groups:

Certification:
Please check the boxes below and indicate the expiration date for each certificate that you hold. If you do not
know the exact date, please use the last date of the specific month (i.e. 1/31/2007).
Certification:
Expiration Date:

ACLS BCLS CEN CCRN TNCC Computerized charting System Other: I hereby certify all statements and claims as true and that any misrepresentation of the facts on this checklist is sufficient cause for dismissal at any time without prior notice even if I have been already employed. _______________________________________________ ___________________________ Signature ________________________________________________________ Full Name (Print)

Source: http://www.atworkmedical.com/forms/nurse_pdf/emergency_room_skills.pdf