Competency Checklist, Emergency by tcoady


First Name: _______________                   Last Name: ________________                 Date: ______________________

Age – Specific Practice
Please list your TOTAL years experience in caring for the following age groups:

A. Newborn (Up to 30 days)                  D. Preschooler (4-5 yrs.)                      G. Young Adults (18-39 yrs.)
B. Infant (30 days to 1 yr.)                E. School Age (5-12 yrs.)                      H. Middle Aged Adults (39-64 yrs.)
C. Toddler (1-3 yrs.)                       F. Adolescents (12-18 yrs.)                    I. Older Adults (64 yrs. And older)

Please indicate your experience with the above-listed age groups: (Check the appropriate boxes)

                                                                                             A    B    C    D    E     F   G     H   I
Able to adapt care to incorporate normal growth and development
Able to adapt method and terminology of patient instructions to their age,
comprehension and maturity level
Can ensure a safe environment reflecting specific needs of various age groups

Please indicate your level of experience in the following areas. Rank each skill using the following
numbers to indicate your level of proficiency:

1. Clinical Observation or didactic learning: No experience

2. Limited or infrequent experience

3. Experienced. May occasionally need resource assistance

4. Proficient: Can perform/teach without assistance

                  GENERAL SKILLS                              EXP.                        GENERAL SKILLS                         EXP.
Admission assessment to ICU/CCU                                         Isolation precautions
Air Transfers                                                           Isolation procedures
Ambulance Transfers                                                     Application of steri-strips
Eye irrigations                                                         Pain management
Assessment of pain tolerance                                            Patient education
Charge Nurse duties                                                     Preceptor new staff
Code Team                                                               Restraints and proper use/documentation
Death and Dying                                                         Specimen collection
Discharge teaching                                                      Sterile technique
Fall Risk Assessment                                                    Transfer to intermediate care
Family intervention skills                                              Wound/skin care/dressing changes
HIPAA policies/documentation                                            Assist with staples/sutures; set up suture trays

                                         developed by Beth Nash, RN from
Interpretation of lab values                                   Staple/suture removal
Set up exam lamps                                              Ear irrigations
AMA procedures                                                 Suicide precautions
Eye patch application                                          Morgan lens irrigations
Nasal packing                                                  Removal of contact lenses
Fever management                                               Consents to treat: adults and minors
Child abuse: recognition/reporting                             Rape kit: Use of
Pelvic exam: assist                                            Abuse: Recognition/reporting

          CARDIOVASCULAR KNOWLEDGE                     EXP.              CARDIOVASCULAR KNOWLEDGE            EXP.
12 lead EKG interpretation                                     Lead placement
ABG Interpretation                                             Monitor Malfunction: Troubleshooting alarms
Arrhythmia interpretation: (A-Fib, V-Fib, PVC, etc.)           Monitor pulse oximetry
Assess heart sounds                                            Pediatric cardiac arrest
Assist intubation or extubation                                Monitor Setup
Assist with arterial/central line/Swanz Ganz                   Removal of Swan Ganz or SD
Assist with pacemaker insertion                                Resuscitation team member
Cardioversion: Understand/perform                              Resuscitation: team leader
Defibrillation: Understand/perform                             Swan Ganz hemodynamic monitoring
Heart sounds interpretation                                    Use of Doppler
Hemodynamic monitoring: Cardiac index, cardiac
output, CVP monitoring, etc.)

            ENDOCRINE/METABOLIC                        EXP.                ENDOCRINE/METABOLIC               EXP.
Assessment: S/S Diabetic coma                                  Blood glucose monitoring: Measuring device
Assessment: S/S Insulin reaction                               Blood glucose monitoring: finger stick

          GASTROINTESTINAL SKILLS                      EXP.                GASTROINTESTINAL SKILLS           EXP.
Assessment: abdominal                                          Placement of nasogastric tube
Assessment: bowel sounds                                       Salem sump to suction
Assessment: fluid balance                                      Saline lavage
Assessment: nutritional status

            CARE OF THE PATIENT WITH:                  EXP.                CARE OF THE PATIENT WITH:         EXP.
Abdominal trauma                                               Hepatitis
Abruptio placenta                                              HIV/AIDS
Acute MI                                                       IV conscious sedation
Acute renal failure                                            Knee immobilizer
Aneurysm                                                       Laryngospasm
Angina                                                         Liver failure
Angiography                                                    Myocarditis
Ankle brace/splint                                             Near-drowning: Pediatric/adult
Aspiration                                                     Overdose/poison ingestion: Pediatric/adult
Asthma                                                         Pericardiocentesis
Bowel obstruction                                              Peritoneal lavage
Cardiac arrest                                                 Pinned fractures
Cast                                                           Placenta previa
Central line catheter                                          Precipitous delivery of infant
Congestive heart failure                                       Pre-eclampsia/eclampsia
COPD                                                           Pulmonary edema

                                      developed by Beth Nash, RN from
Diabetic ketoacidosis                                            Pulmonary embolism
DIC                                                              Renal trauma
Epidural anesthesia                                              Spontaneous abortion
Epiglottitis: pediatric                                          Tension pneumothorax
Epilepsy                                                         Tuberculosis
GI bleeding                                                      Urinary tract infection
Hemo-pneumothorax                                                Wrist splint

               ORTHOPEDIC SKILLS                         EXP.                     ORTHOPEDIC SKILLS                    EXP.
Assessments: circulation                                         Canes/ crutches
Assessments: gaits                                               Cervical collars
Assessments: range of motion                                     Slings
Assessments: skin integrity                                      Transfer boards
Assistance with casting

             PULMONARY CARE                              EXP.                      PULMONARY CARE                      EXP.
Acute pneumonia                                                  Interpretation of ABGs
Airway management devices/suctioning                             O2 therapy/med delivery systems: bag and mask,
                                                                 ET tube, CPAP, face mask, nasal cannula, T piece,
                                                                 trach collar
Assess breath sounds                                             Obtain Arterial blood gases: Arterial line, femoral
                                                                 artery, radial artery
Assist with chest tube insertion, bronchoscopy,                  Pulmonary edema/hypertension
tracheotomy, thoracentesis, intubation
Chest trauma                                                     Pulmonary embolism
Establishment of airway via oral airway                          Ventilator management
Identify/intervene respiratory complications
(aspiration, tension pneumothorax, etc)

                   RENAL SKILLS                          EXP.                       RENAL SKILLS                       EXP.
Assessment: fluid balance                                        Insertion/care of catheters: female
Interpret lab values: BUN, creatinine                            Insertion/care of catheters: male
Interpret lab values: Electrolytes                               Urine specimen collections

       PHLEBOTOMY/INTRAVENOUS SKILLS                     EXP.           PHLEBOTOMY/INTRAVENOUS SKILLS                  EXP.
Administer blood/blood products: plasma,
cryoprecipitate, PRBC’s, whole blood                             Change IV dressings
Administer continuous infusions                                  Hyperalimentation
Administer IV antibiotics/piggybacks                             Infusion pumps
Administer IV push                                               Monitor central lines
Broviac, Groshong, Hickman, Portacath, Quinton,                  Peripheral Line
Central line/catheter/dressing:                                  Starting IV's

                NEUROLOGICAL SKILLS                      EXP.                  NEUROLOGICAL SKILLS                     EXP.
  Basal skull fracture: care                                       Meningitis: care
  Closed head injury: care                                         Neuromuscular disease: care
  Coma: care                                                       Overdose: care
  CVA/TIA: care                                                    Reflex/motor deficits
  Encephalitis: care                                               Seizures: care

                                        developed by Beth Nash, RN from
 Externalized VP shunts: care                                  Spinal cord injury: care
 Increased ICP management: Medications,
                                                               Spinal cord injury: care
 positioning, temperature control, ventilation
 Intracranial pressure monitoring                              Use of Glascow Coma scale
 LOC: Assessment                                               Visual or communications deficits
 Lumbar puncture: Assist

               SHOCK/TRAUMA SKILLS                   EXP.                  SHOCK/TRAUMA SKILLS          EXP.
Air transport: trauma patient                                Heat exhaustion or stroke
Application: Mast suit                                       Hypothermia
Bites: animal                                                Major/minor trauma
Bites: human                                                 Poison index
Bites: venomous snake                                        Radiation exposure
Bites: venomous spider                                       Shock: Anaphylactic
Burns: First, second, third degree                           Shock: Cardiogenic
Burns: Rule of Nines                                         Shock: Hypovolemic
Champion trauma score                                        Shock: Neurogenic
Dehydration                                                  Shock: Septic
Exposure: hazardous materials                                Stab wounds
Ground transport: trauma patient                             Traumatic Amputation
Gunshot wounds                                               Triage

                                                     EXP.                                               EXP.
                                                                       MEDICATION ADMINISTRATION
 Adenosine (Adenocard)                                         Insulin
 Aminophylline (Theophylline)                                  Ipecac
 Amiodarone (Cordarone)                                        Isuprel (Isoproterenol hydrochloride)
 Antiemetics                                                   Lasix (Furosemide)
 Antispasmodics                                                Lidocaine (Xylocaine)
 Atropine                                                      Mannitol (Osmitrol)
 Bretylium (Bretylol)                                          Nitroglycerin (Tridil)
 Bronkosol (Isoetharine hydrochloride)                         Nitroprusside (Nipride)
 Charcoal                                                      Oral hypoglycemics
 Decadron (Dexamethasone)                                      Phenobarbital
 Digoxin (Lanoxin)                                             Procainamide (Pronestyl)
 Dilantin (Phenytoin)                                          Sodium bicarbonate
                                                               Solu-Medrol (Methylprednisolone sodium
 Diltiazem (Cardizem)
 Dobutamine (Dobutex)                                          Steroids
 Dopamine (Intropin)                                           Terbutaline
 Epinephrine (Adrenalin)                                       Thrombolytic therapy
 Epinephrine (Adrenalin)                                       Use of nebulizer
 Esmolol (Brevibloc)

                                    developed by Beth Nash, RN from

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