Med-Surg 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
  Angina  
  Post Acute MI  
  Congestive Heart Failure  
  Post Cardiac Cath  
  Post Cardiac Surgery  
  Aneurysm  
  Carotid Endarterectomy  
  Post Vascular Surgery  
  Post Cardiac Transplant  
  PULMONARY         Rating Stars (Click) 1 2 3 4
  neumonia  
  COPD  
  Tuberculosis  
  Pulmonary Embolism  
  Tracheostomy Management  
  CPAP/BiPAP  
  Interpretation of Arterial Blood Gases  
  Post Lung Transplant  
  NEUROLOGICAL & PSYCHIATRIC         Rating Stars (Click) 1 2 3 4
  Stroke Scale Assessment  
  Traumatic Brain Injury  
  CVA  
  Post Craniotomy  
  Seizure Disorders  
  Spinal Cord Injuries  
  Mood Disorders  
  Substance Withdrawal  
  ORTHOPEDICS         Rating Stars (Click) 1 2 3 4
  Circulation/Skin Checks  
  Continuous Passive Motion Devices  
  Ambulation Assistive Devices  
  Prosthetics  
  Cast Care  
  Pin Care  
  Traction  
  Total Joint Replacement  
  Amputation  
  GASTROINTESTINAL         Rating Stars (Click) 1 2 3 4
  Bariatrics  
  Feeding Tubes  
  GI Bleeding  
  Bowel Obstruction  
  GI Surgery  
  Liver Disease  
  Pancreatitis  
  Post Liver Transplant  
  Post Pancreas Transplant  
  RENAL/GENITOURINARY         Rating Stars (Click) 1 2 3 4
  Arteriovenous Fistula/Shunt  
  3 Way Catheter & Bladder Irrigation  
  Suprapubic Catheter  
  Renal Failure  
  Peritoneal Dialysis  
  GU Surgery  
  Nephrostomy Tubes  
  Renal Transplant  
  Management Pre/Post Hemodialysis  
  Gyn Surgery  
  ENDOCRINE METABOLIC         Rating Stars (Click) 1 2 3 4
  Diabetes Type I  
  Diabetes Type II  
  Blood Glucose Monitoring  
  IV Insulin Protocols  
  Management of Hypoglycemia  
  Indwelling Insulin Pumps  
  Pituitary Disorders  
  ONCOLOGY         Rating Stars (Click) 1 2 3 4
  Chemotherapy Administration  
  Radiation Therapy  
  Medical Oncology  
  Surgical Oncology  
  Radiation Implants  
  Bone Marrow Transplant  
  MEDICATIONS         Rating Stars (Click) 1 2 3 4
  Antiarrhythmics  
  Anticoagulants (IV  
  oral  
  & injection)  
  Anti-Depressants  
  Anti-Hypertensives  
  Anti-Psychotics  
  Benzodiazepines  
  Emergency Medications  
  Epidural Analgesia  
  Inhaled Medications  
  Insulin  
  Narcotics/Opioid Analgesics (IV  
  oral  
  & injection)  
  Nitrates (Oral & Topical)  
  Non-Opioid Analgesics (IV  
  Oral  
  & Injection)  
  Oral Hypoglycemics  
  IV THERAPY         Rating Stars (Click) 1 2 3 4
  Starting IVs  
  Central Line Blood Draws  
  Central Line/Implanted Line Care  
  TPN & Lipids  
  Blood Product Administration  
  Monitoring of Chemotherapy  
  CARDIAC MONITORING & EMERG. RESPONSE         Rating Stars (Click) 1 2 3 4
  Placement of Telemetry Leads  
  Rhythm Interpretation  
  Dysrhythmia Management  
  Obtain 12 Lead EKG  
  Use of Rapid Response Teams  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals/Core Measures  
  Fall Risk Assessment/Prevention  
  Pressure Ulcer Risk Assessment/Prevention  
  Restraints/Use of Least Restrictive Device  
  Patient/Family Teaching  
  Age Specific/Population-Based Care  
  Isolation Precautions  
  Infection Prevention  
  Pain Assessment & Management  
  Charge Experience  
  Interpretation and Communication of Lab Values  
  Wound Care /Wound Vac  
  Specialty Beds  
  EMR         Rating Stars (Click) 1 2 3 4
  Epic  
  Cerner  
  Eclipsys  
  McKesson  
  Meditech  
  Other Computerized System  
  Computerized Physician Order Entry  
  Bar Coding for Medication Administration  
  EMR Conversion