ADEX Medical Staffing - MedSurg Skills Checklist

MedSurg Skills Checklist

This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment with ADEX Medical Staffing, LLC.

Proficency Scale:

1 = No Experience - Theory only

2 = Limited Experience - Infrequent

3 = Moderate Experience - Able to perform independently

4 = Proficient - Able to perform proficiently and instruct

Frequency Scale:

1 = Never Observed

2 = Less than 6 times a year

3 = 1 or 2 Times a Month

4 = Daily or Weekly

Personal Information
Name:
Email:
City:
Country:
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	Proficiency				Frequency
Basic Skills	1	2	3	4	1	2	3	4
Physical assessment
Breath sounds
Heart sounds
Neurological assessment
GI assessment
General physical assessment
Blood sampling
Venipuncture
Central line
Implanted ports
Intravenous Fluid Administration
Peripheral access: Angiocath, Butterfly, and I.V. lock
Administration/maintenance: Peripheral, Central, TPN, and Lipids
Tubing changes: Peripheral and Central
Site care: Peripheral and Central
Blood/Blood Products Administration
Urinary Catheterization
Placement: Single and three-way
CBI (Continuous / Intermittent Bladder Irrigation)
Enteral Feedings: Continuous and Intermittent
Tubes/Drains
Nasogastric/Salem Sump Tube
Insertion, maintenance (including anti-reflux valve), and removal
Feeding tube: Insertion, maintenance, and removal
Levine tube: Insertion, maintenance, and removal
Jackson-Pratt drain
Wound/Sterile Dressing Care
Oxygen Delivery: Set-Up/Maintenance
Nasal cannula
Ventimask
Partial and non-rebreather masks
Adjunctive Airway Management
Bag valve mask (Ambu bag)
Tracheostomy care
Suctioning: Oral, nasal, and tracheal
Use of Medical Equip: I.V. and PCA pump
Use of Medical Equip: Enteral feeding pump.
Use of Medical Equip: Oxygen tank and regulator
Use of Medical Equip: Finger-stick glucose monitor
Use of Medical Equip: Suction apparatus: Wall and portable
Use of Medical Equip: K-pad
Use of Medical Equip: Hypo/hyperthermia blanket
Use of Medical Equip: Sequential compression device
Use of Medical Equip: Specialty bed/overlay mattresses
Use of Medical Equip: Portable Hepafilter
Use of Medical Equip: Pulse oximeter
Use of Medical Equip: Overhead trapeze
Use of Medical Equip: Incentive spirometer
Use of Medical Equip: Defibrillator
Use of Medical Equip: ECG machine
Reports defective equipment

	Proficiency				Frequency
Legal Aspects	1	2	3	4	1	2	3	4
Knowledge of patients rights
Confidentiality
Voluntary & Involuntary Commitment
Discharge AMA from hospital setting

	Proficiency				Frequency
Documentation	1	2	3	4	1	2	3	4
Familiar with Problem oriented charting
Use of Nursing diagnosis
Initiating treatment plans
Defining goals and objectives
Assessment including biological, psychological, spiritual & intellectual functions

	Proficiency				Frequency
Milieu	1	2	3	4	1	2	3	4
Use of milieu to enhance patient care
Familiarity with group process
Use of milieu to dec. confusion & tension
Use of community meetings

	Proficiency				Frequency
Gerontological Psy. Nursing	1	2	3	4	1	2	3	4
Differentiating depression from dementia
Factors contributing to Sundown Syndrome
Effectiveness of Nursing actions / interventions with agitated or confused elderly
Preventive measures for disoriented elderly
Mental status assessment
Factors that contribute to withdrawal of the elderly

	Proficiency				Frequency
General Adult Psy. Nursing	1	2	3	4	1	2	3	4
Knowledge of responses, dev. of impressions, planning & implementation
Knowledge of Somatic therapies

	Proficiency				Frequency
Substance Abuse Nursing	1	2	3	4	1	2	3	4
Knowledge of major categories of abused substances
Stressors and behaviors observed
Knowledge of common themes and appropriate nursing intervention

	Proficiency				Frequency
Isolation Precautions	1	2	3	4	1	2	3	4
Regular Isolation
Reverse Isolation
Enteric Isolation
Respiratory Isolation
Wound and Skin Isolation
Sterile Dressing Changes

	Proficiency				Frequency
Age Specific Skills	1	2	3	4	1	2	3	4
Newborn birth-30 days
Infant 30 days-1 year
Toddler 1-3 years
Preschooler 3-5 years
School Age 5-12 years
Adolescents 12-18 years
Young Adults 18-39 years
Middle Adults 39-64 years
Older Adults 64+ years

Signature
The information represented above is true and correct to the best of my knowledge. I authorize ADEX Medical Staffing, LLC to share this skills checklist with its clients.
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Form Reviewed by ADEX Clinician - 11/16/2010