EMERGENCY ROOM SKILLS COMPETENCY CHECKLIST Registered Nurse (RN)

Name: ______________________________________________________ Date: _____________________________

Total Years of Emergency ROOM Nursing Experience:

My primary experience has been in: Level I Level II Level III Triage PEDS Burn Please rate your Skill Level: 0 - NO Experience. Theory Only 2 - Acceptable competency/proficiency 1 - Limited competency/proficiency. 3 - Competent/proficient. Performed frequently and

Supervision Required. independently during the past 2 years. SKILL 0 1 2 3 SKILL 0 1 2 3

Respiratory: Neurology: Assessment of Breath Sounds Neuro Assessment / Vital Signs

Administer of O2 (NC, Mask) Glasgow Coma Scale Pulse Oximetry Assist with Lumbar Puncture Nebulizer Set-up Identify Neuro Complications Re-Breather Mask Seizure Precautions Venturi Mask Aneurysm Precautions Ventilate with Ambu-bag Care of Patients With: Assist with Intubation Open / Closed Head Injury Rapid Sequence iinduction Acute CVA Care of Intubated Patient Acute Spinal Injury Suctioning Increased ICP Assist Needle Thoracostomy Halo Traction / Cervical Tongs Troubleshoot Ventilator Problems CNS Infections Draw Blood from Arterial Line MUSCULOSKELETAL Interpret Arterial Blood Gases Immobilization & Splinting Assist with Emergency Trach Ice Bag Application Assist with Emergency Cric Fit / Instruct Crutch Walking Assist with Thoracentisis Assist with Cast Application Assist with Bronchoscopy Cast Removal Care of Patient With: Assist w/ External fixation pins Asthma Assist w/ Nerve Blocks Pulmonary Edema Application & Assistance: Chest Injury Ace Wraps Chest Tubes / Pleurevac Posterior Splints Assess Resp Complications Clavicle Strap Shoulder Immobilizer Gastrointestinal: Knee Immobilizer Assess Abd & Bowel Sounds Identification of Abnormalities Urogenital: Insert / Maintain NG Tubes Insertion of Male Catheter Gastric Lavage Insertion of Female Catheter NG Meds ( ie: Activated Charcoal) Set-up/ Assist with Vaginal Exams Care of Patient With: Assist with Sexual Assault Exams Drug Overdose / DTs Evidence Collection / Documentation Gastrostomy / Jejunostomy tube Knowledge of Procedure: GI Bleed Eval of Abd Pain Acute Pancreatitis GYN History / Prenatal Assess Open Abd Wound / Incision Precipitous Delivery Abdominal Aortic Aneurysm Spontaneous AB Assist with Suction Curettage

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SKILL 0 1 2 3 SKILL 0 1 2 3 Renal: Infusion Therapy: Care of Patient with: Infusion Pump Acute Renal Failure Syringe Pump Chronic Renal Failure Blood / Blood Products Administration Hemodialysis Insert Peripheral IV Heplock Peritoneal Dialysis Discontinue Peripheral IV Heplock Renal Transplant Access / Care / Blood Draws: Venipuncture Cardiac: Hickman / Broviac Assessment of Heart Sounds Groshong Place Cardiac Monitor / Telemetry Implanted Ports Troubleshoot Monitor / Telemetry PICC / Midline Identify Lethal Dysrhythmias Assist With Insertion and Setup: Perform 12-Lead EKG Cutdown Basic 12-Lead Interpretation Arterial Lines Assist with Arrest / Resusc. Central Venous Catheter Defibrillation / Cardioversion Pulmonary Artery Catheter Automatic External Defib ( AED) External Pacemaker Care of Patient With: Temporary Transvenous Pacer Angina Pericardiocentesis Acute MI Intraosseous Infusions Congestive Heart Failure Autotransfuser Aneurysm Permanent Pacemaker Trauma Care: Temporary Pacemaker Trauma Assessment Automatic Implanted Defibrillator Primary Survey Heart Transplant Secondary Survey Septic Shock Trauma Score Hypovolemic Shock Pediatric Trauma Score Cardiogenic Shock Principles of Fluid Resuscit. Anaphylactic Shock Principles of C-Spine Immob. Emergency Medication Administration: Use of Philadelphia Collar Epinepherine Use of Backboard Atropine Principles of Fluid Resuscit. Bicarbonite Use of Rapid / Pressure Infuser Lidocaine Principles of Fluid Resuscit. Streptokinase ( Indication / Manage) Gunshot Wound TPA ( Indication / Manage) Stab Wound Infusion Med Administration: Blunt Chest Trauma Bretylium Blunt Abdominal Trauma Dopamine MAST Suit Insulin Hypothermia Pronestyl Frostbite Care of Patient With: Integumentary: Chemical Burn Wound Assess & Dressings Electrical Burn Wound Cultures Thermal Burn Wound Irrigation Assist With: Suture Set-up and Assist Diagnostic Peritoneal Lavage Local Anesthetics Chest Tube Insertion Tetanus Prophylactics Thoracotomy Venomous Stings / Bites

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Name____________________________________________ Page 2 of 3

SKILL 0 1 2 3 SKILL 0 1 2 3 Pediatrics: Ear-Nose-Throat (ENT) Principles of Growth and Development Eye Irrigations Vital Signs / Normal Values for Age Ear Irrigations Care of Febrile Patient Visual Acuity Legal Principles re: Child Abuse Remove Contact Lens Care of a Newborn Epitaxis Other: Isolation Techniques Advance Directives Care of Patient With: Postmortem Care Psychiatric Issues Emergency Pre-Operative Prep Oncology Triage Procedure Chemotherapy Aware of Cobra Legislation AIDS Aware of Consent Procedures Ketoacidosis Aware of Contact Isolation Precations Bone Marrow Transplant Crisis Intervention Liver Transplant Resus Room Do you speak any other language(s) besides English? Yes / No If YES, please list other language(s):____________ ______________________________________________________________________________________________

Are you familiar with computer charting? Yes / No If YES, what system(s) have you used: _____________________ ______________________________________________________________________________________________ Comments:_____________________________________________________________________________________ ______________________________________________________________________________________________ I hereby certify that all information I have provided to AZ Nurses Choice on this skills checklist is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. Nurse Signature _______________________________________________ Date _________________________

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