ICU Checklist


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.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  Cardiac         Rating Stars (Click) 1 2 3 4
  Defibrillation/Cardioversion  
  Assisting with Insertion of Central Lines  
  Pacemakers?External  
  Permanent or Temporary Pacemaker  
  Cardiac Arrest/CPR  
  A?Line (Transducer setup?D/C)  
  Swan Ganz (Transducer setup?D/C)  
  Balloon Pump (IABP)  
  SVO2 Monitoring  
  Automatic Internal Cardioverter Defib  
  Care of patient with         Rating Stars (Click) 1 2 3 4
  Aneurysm  
  Acute MI/Unstable Angina  
  Cardiogenic/Hypovolemic Shock  
  Pre/Post Cardiac Surgery  
  Heart Transplant  
  PTCA  
  COPD  
  ARDS  
  Pulmonary Embolism  
  Pulmonary Edema  
  Pneumonia  
  Inhalation Injuries  
  CVA  
  Seizure Disorder  
  Overdose  
  Neuro Injury/Trauma  
  Pre/Post Neuro Surgery  
  Cranial Hemorrhage  
  Aphasia  
  Multiple Sclerosis  
  Pancreatitis  
  GI Bleed  
  Esophageal Bleeding  
  Bowel Obstruction  
  Liver Transplant  
  Paralitic Ileus  
  TURP  
  Shunts and Fistulas  
  Nephrectomy  
  Renal Transplant  
  Renal Trauma  
  Use and Administration of the following         Rating Stars (Click) 1 2 3 4
  Atropine  
  Bretylol  
  Bumex  
  Digoxin  
  Dopamine  
  Dobutrex  
  Inderal  
  Inocor  
  Isupre  
  Lidocaine  
  Neosynephrine/Nipride  
  NTG  
  Pronestyl  
  Titrate Morphine  
  Verapamil  
  Thrombolitic Agents  
  Prep/Titration of Emergency Drugs  
  Aminophylline  
  Corticosteroids  
  Bronkosol  
  Ventolin  
  Alupent  
  Decadron  
  Dilantin  
  Magnesium Sulfate  
  Phenobarbital  
  Steroids  
  Valium  
  Versed  
  Respiratory         Rating Stars (Click) 1 2 3 4
  Lung Transplant  
  Establishing an Airway  
  Pulse Oximetry  
  Interpretation of ABG  
  Drawing ABG Blood Sample from A?Line  
  Incentive Spirometer  
  Neurology         Rating Stars (Click) 1 2 3 4
  Assessment of Neuro Signs  
  Use of Glascow Coma Scale  
  Seizure Precautions  
  Assist with Lumbar Puncture  
  ICP Monitoring  
  Crutchfield Tongs  
  Halo Traction  
  Stryker Frame  
  Assessment of Sensory?Motor Function  
  Cervical Traction  
  Cranial Nerve Assessment  
  LOC Assessment  
  Pre/Post Neuro Surgical Care  
  Visual Acuity Measurement  
  Vascular         Rating Stars (Click) 1 2 3 4
  Peripheral Pulses  
  Fluid Overload  
  Starting IV\'s  
  Subcutaneous Central Line  
  Hickman/Broviac/Groshong Catheters  
  Mainenance of Heparin Lock  
  TPN/Hyperalimentation  
  Air Occlusive Dressing  
  Infusion Pump  
  Peritoneal Dialysis  
  Hemodialysis  
  Heparin Drip ? Precautions and Maintenance  
  Gastrointestinal         Rating Stars (Click) 1 2 3 4
  NG Tube Insertion  
  Gastronomy Tube  
  Jejunoostomy Tube  
  Enterostomal Care  
  Genito Urinary/Renal         Rating Stars (Click) 1 2 3 4
  Foley Catheter Insertion  
  GU Irrigations  
  Nephrostomy Tube  
  Suprapubic Tube  
  Electrolyte Imbalance/Replacement  
  Other         Rating Stars (Click) 1 2 3 4
  Oncology  
  Chemotherapy  
  Isolation Techniques  
  Hyperbaric Oxygenation  
  Fingerstick Blood Glucose monitoring  
  Equipment         Rating Stars (Click) 1 2 3 4
  Bear I  
  Bear II  
  Bear V  
  Bennett 7200  
  CPAP  
  Emerson  
  EMV  
  MA?I  
  MA?II  
  Monihan  
  Ohio 560  
  PEEP  
  Pressure Pre?Set  
  Servo 900b  
  Servo 900c  
  Servo 900e  
  Siemens  
  Hewlett?Packard  
  Spacelab  
  Marquette  
  Mennen  
  Lifecare  
  Nihon?Koder  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Infant (Birth - 1 year)  
  Preschooler (ages 2-5 years)  
  Childhood (ages 6-12 years)  
  Adolescents (ages 13-21 years)  
  Young Adults (ages 22-39 years)  
  Adults (ages 40-64 years)  
  Older Adults (ages 65-79 years)  
  Elderly (ages 80+ years)