RN - Med/Surg - Telemetry 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

  Cardiovascular Assessment         Rating Stars (Click) 1 2 3 4
  Auscultation (Rate/Rhythm)  
  Blood Pressure/Non-Invasive  
  Doppler  
  Heart Sounds/Murmurs  
  Pulses/Circulation Checks  
  Cardiovascular Equipment & Procedures         Rating Stars (Click) 1 2 3 4
  Basic 12 Lead Interpretation  
  Basic Arrhythmia Interpretation  
  Lead Placement  
  Permanent Pacemaker  
  Temporary Pacemaker  
  Care of Patient with Cardiovascular Disease         Rating Stars (Click) 1 2 3 4
  Abdominal Aortic Bypass  
  Aneurysm  
  Angina  
  Cardiac Arrest  
  Cardiomyopathy  
  Carotid Endarterectomy  
  Congestive Heart Failure (CHF)  
  Femoral-Popliteal Bypass  
  Myocarditis  
  Post-Acute Myocardial Infarction (24-48 Hours)  
  Pre/Post Angioplasty  
  Pre/Post Cardiac Catheter  
  Post Cardiac Surgery  
  Cardiovascular Medications         Rating Stars (Click) 1 2 3 4
  Heparin Drip  
  Oral Anticoagulants Oral and IVP  
  Antihypertensives Oral and Topical Nitrates  
  Pulmonary Assessment         Rating Stars (Click) 1 2 3 4
  Breath Sounds  
  Rate and Work of Breathing  
  Interpretation of Pulmonary Laboratory Results         Rating Stars (Click) 1 2 3 4
  Blood Chemistry  
  Arterial Blood Gases  
  Pulmonary Equipment & Procedures         Rating Stars (Click) 1 2 3 4
  EndotrachealTube/Suctioning  
  NasalAirway/Suctioning  
  Oropharyngeal/Suctioning  
  Tracheostomy/Suctioning  
  Sputum Specimen Collection  
  Assist with Intubation  
  Assist with Thoracentesis  
  Assist with Set Up and Insertion of Chest Tube  
  Measuring and Emptying Chest Tube  
  Removal of Chest Tube  
  Chest Physiotherapy  
  Care of Patients with Pulmonary Disease         Rating Stars (Click) 1 2 3 4
  Acute Pneumonia  
  Acute Respiratory Distress Syndrome (ARDS)  
  Chronic Obstructive Pulmonary Disease (COPD)  
  Patient with Mechanical Ventilator  
  Pulmonary Edema/Hypertension  
  Pulmonary Embolism  
  Pulmonary Medications         Rating Stars (Click) 1 2 3 4
  Alupent (Metaproterenol)  
  Aminophylline (Theophylline)  
  Bronkosol (Isoetharine Hydrochloride)  
  Corticosteroids  
  Ventolin (Albuterol)  
  Neurological Assessment         Rating Stars (Click) 1 2 3 4
  Cranial Nerves  
  Glasgow Coma Scale  
  Level of Consciousness  
  Reflex/Motor Deficits  
  Visual/Communication Deficits  
  Neurological Equipment & Procedures         Rating Stars (Click) 1 2 3 4
  Assist with Lumbar Puncture  
  Intracranial Pressure Monitoring  
  Seizure Precautions  
  Spinal Precautions  
  Use of Hyper/Hypothermia Blanket  
  Care of Patients with Neurological Disease         Rating Stars (Click) 1 2 3 4
  Aneurysm Precautions  
  Basal Skull Fracture  
  Closed Head Injury  
  Coma  
  Cerebrovascular Accident (CVA)  
  Delirium Tremens (DTs)  
  Encephalitis  
  Increased ICP  
  Meningitis  
  Neurological Medications         Rating Stars (Click) 1 2 3 4
  Barbiturate  
  Decadron (Dexamethasone)  
  Dilantin (Phenytoin)  
  Phenobarbital  
  Valium (Diazepam)  
  Gastrointestinal Assessments         Rating Stars (Click) 1 2 3 4
  Abdominal/Bowel Sounds  
  Nutritional  
  Fluid Balance  
  Interpretation of Gastrointestinal Laboratory Results         Rating Stars (Click) 1 2 3 4
  Serum Ammonia  
  Serum Amylase  
  Liver Function Tests (LFTs)  
  Gastrointestinal Equipment & Procedures         Rating Stars (Click) 1 2 3 4
  Administration of Tube Feeding  
  Feeding Pump  
  Management of Gastrostomy Tube  
  Management of Jejunostomy Tube  
  T-Tube TPN and Lipids Administration  
  Peripheral Parenteral Nutrition (PPN)  
  Placement of Nasogastric Tube  
  Salem Sump to Suction  
  Care of Patients with Gastrointestinal Disease         Rating Stars (Click) 1 2 3 4
  Bowel Obstruction  
  Colostomy/Ileostomy  
  GI Bleeding  
  GI Surgery  
  Hepatitis  
  Inflammatory Bowel Diseases  
  Liver Failure  
  Parlytic Ileus  
  Gastrointestinal Medications         Rating Stars (Click) 1 2 3 4
  Inderal(Propranolol)  
  Kayexelate  
  Lactulose (Cephulac)  
  Pitressin (Vasopressin)  
  Renal/Genitourinary Assessments         Rating Stars (Click) 1 2 3 4
  Arteriovenous Fistula/Shunt  
  Fluid and Electrolyte Imbalance  
  Interpretation of Renal/Genitourinary Laboratory Results         Rating Stars (Click) 1 2 3 4
  BUN and Creatinine  
  Serum Electrolytes  
  Renal/Genitourinary Equipment and Procedures         Rating Stars (Click) 1 2 3 4
  Bladder Irrigation  
  Insertion and Care of 3-Way Foley - Female  
  Insertion and Care of 3-Way Foley - Male  
  Routine Specimen Collection  
  24-Hour Specimen Collection  
  Care of Patients with Renal/Genitourinary Disease         Rating Stars (Click) 1 2 3 4
  Hemodialysis  
  Nephrectomy  
  Peritoneal Dialysis  
  Renal Failure  
  Transurethral Resection of the Prostate (TURP)  
  Urinary Tract Infection  
  Endocrine/Metabolic Assessment         Rating Stars (Click) 1 2 3 4
  S/S Diabetic Coma  
  S/S Insulin Reaction  
  Endocrine/Metabolic Equipment and Procedures         Rating Stars (Click) 1 2 3 4
  Blood Glucose Measuring  
  Performing Finger Stick  
  Care of Patients with Endocrine/Metabolic Disease         Rating Stars (Click) 1 2 3 4
  Diabetes Mellitus  
  Diabetic Ketoacidosis  
  Disorders of Adrenal Gland (e.g.  
  Addisons Disease)  
  Disorders of Pituitary Gland (e.g.  
  Diabetes Insipidus)  
  Orthopedic Assessment         Rating Stars (Click) 1 2 3 4
  Circulation Checks  
  Gait  
  Range in Motion  
  Skin  
  Orthopedic Equipment and Procedures         Rating Stars (Click) 1 2 3 4
  Continuous Passive Motion Devices  
  Cane  
  Cervical Collar  
  Gait Belt  
  Prosthetic  
  Transfer Boards  
  Walker  
  Wound Assessment         Rating Stars (Click) 1 2 3 4
  Skin for Impending Breakdown  
  Stasis Ulcers  
  Surgical Wound Healing  
  Wound Equipment and Procedures         Rating Stars (Click) 1 2 3 4
  Application of Steristrips  
  Air Fluidized  
  Low Air Loss Beds  
  Sterile Dressing Changes  
  Wound Care/Irrigations  
  Care of Patient with Wound         Rating Stars (Click) 1 2 3 4
  Pressure Sores  
  Staged Decubitus Ulcers  
  Surgical Wounds with Drain(s)  
  Traumatic Wounds  
  Interpretation of Infectious Diseases Laboratory Results         Rating Stars (Click) 1 2 3 4
  CBC  
  SMA7  
  Infectious Diseases Equipment and Procedures         Rating Stars (Click) 1 2 3 4
  Fever Management  
  Isolation  
  Phlebotomy/IV Therapy Equipment and Procedures         Rating Stars (Click) 1 2 3 4
  Auto Transfusion  
  Administration of Cryoprecipitate  
  Administration of Packed Red Blood Cells  
  Administration of Plasma/Albumin  
  Administration of Whole Blood  
  Drawing Venous Blood  
  Starting Angiocath IVs  
  Starting Butterfly IVs  
  Starting Heparin Lock  
  Care of Patient with IVs         Rating Stars (Click) 1 2 3 4
  Angiography  
  Broviac/Hickman  
  Groshong  
  PICC  
  Pericardiocentesis  
  Pain Assessment         Rating Stars (Click) 1 2 3 4
  Pain Level/Tolerance  
  Care of Patient with Pain         Rating Stars (Click) 1 2 3 4
  Epidural Anesthesia/Analgesia  
  IV Conscious Sedation  
  Patient Controlled Analgesia (PCA pump)  
  Care of Patient with Trauma/Shock         Rating Stars (Click) 1 2 3 4
  Suicide Precautions  
  Disaster Protocols  
  Charge Experience  
  Dehydration  
  Electrocution  
  Gun Shot/Stab Wounds  
  Hazardous Material Exposure  
  Radiation Exposure  
  Anaphylactic Shock  
  Cardiogenic  
  Hypovolemic Shock  
  Neurogenic Shock  
  Septic Shock  
  Burns: Rule of Nines  
  Automated Medication Dispensing Systems         Rating Stars (Click) 1 2 3 4
  Accudose  
  Metro  
  Omnicell  
  Promanager Rx  
  Pyxis  
  eMAR  
  Electronic Documentation         Rating Stars (Click) 1 2 3 4
  AllScripts  
  Care360  
  Cerner  
  CPSI  
  eClinicalWorks  
  Eclipsys  
  EPIC  
  MACLAB  
  McKesson/Paragon  
  Meditech  
  PACS  
  Quadramed  
  Soarian  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Newborn/Neonate (birth to 30 days)  
  Infant (30 days - 1 year)  
  Toddler (1 year to 3 years)  
  Preschooler (3 years to 5 years)  
  School age children (5years 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 to 79 years)  
  Elderly Adults (over 79+ years)