Skills Checklist

Skills Checklist - Ambulatory RN

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

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AGE*

	0	1	2	3	4	5
Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64+ years)

GENERAL SKILLS*

	0	1	2	3	4	5
Standard Precautions
Isolation Precautions
Adult Respiratory/ Cardiac Arrest
Pediatric Respiratory/Cardiac Arrest
Crash Carts
Defibrillators
Patient/ Family Education
Admit and Assess Patients
Automated Med Dispensing Systems
Electronic Documentation
Obtaining Cultures (Blood, Sputum, Swab, Urine)
Advance Directives
Collect Appropriate Data
Discharge Teaching
Preoperative Teaching
Patient Prep

CARDIOVASCULAR*

PULMONARY*

NEUROLOGY*

GI*

	0	1	2	3	4	5
Insertion/ Monitoring NG Tubes
Assessment
Flexible Sigmoidoscopy
Hemorrhoid Banding
Liver Biopsy
Paracentesis
Lap Band Surgery

GU*

	0	1	2	3	4	5
Bladder Biopsy
Cystoscopy
Urethral Dilation
Nephrostomy
Kidney Biopsy
Suprapubic Catheter
Prostate Biopsy

ENDOCRINE*

	0	1	2	3	4	5
Care of Diabetic Patient
Diabetic Teaching
Blood Glucose Testing

ENT AND MOUTH*

	0	1	2	3	4	5
Prosthodontics -Restorative Dentistry
Mouth Biopsy
Myringotomy
Maxillofacial Prosthetics
Nose Biopsy
Thyroid Aspirate Biopsy
Fiberoptic Laryngoscopy
Tonsillectomy

WOUNDS/ INTEGUMENT*

OB/ GYN*

	0	1	2	3	4	5
Electrodesiccation and Curettage (ED7C)
Assist with In-Office Procedures

ORTHO*

PLASTICS*

GENERAL MEDICATIONS/ THERAPEUTIC INTERVENTIONS*

IV THERAPY*

OXYGEN ADMINISTRATION*

NUTRITIONAL THERAPY*

PAIN MANAGEMENT/ ANESTHESIA*

	0	1	2	3	4	5
Implantable Narcotic Pump
Moderate Sedation
Epidural
Spinal
Local
General
Axillary Block
Bier Block

GENERAL PROCEDURES/ EQUIPMENT*

	0	1	2	3	4	5
Apply Immobilizers (clavicle, knee, etc.)
Assist with Code Resuscitation
Assist with Lumbar Puncture
Laser
Dermabrasion
Drain Removal
Incision and Drainage
NGT Insertion
Patch Test
Punch Biopsy
Shave Biopsy
Procedure Set Up
Remove External Fixators with Pin
Scrub
Screw-Hardware Removal
Set-Up/ Assist Suturing
Staple Removal
Suture Removal
Foley/ Straight Catheter - Male
Foley/ Straight Catheter - Female
TENS Unit
Use of Doppler

SPECIMEN COLLECTIONS*

	0	1	2	3	4	5
Venipuncture
Clean Catch Urine
Sterile Urine Collection
Stool
Sputum
Butterfly Stick
Central Line Draw

CLINICAL SETTINGS*

Position Category*

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Total Years of Experience*

First Name*

Last Name*

Social Security #*

Date of Birth*

Email*

Phone*

Attestation*

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

Please verify that you are human*

Signature*

Assess Heart Tones

Bedside Tele Monitoring

Interpretation of Coagulation Studies

Perform Pulse/ Circulation Checks

Pre-Post Op Pacemaker Care