Intensive Care Unit RN Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

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Email(Required)

Date(Required)

Send to(Required)

TYPE OF FACILITY EXPERIENCE

Acute Hospital Level 1

Acute Hospital Level 2

Acute Hospital Level 3

CAH (Critical Access Hospital)

Unknown or No Trauma Designation

Long-Term Acute Care (LTAC)

Rehab

Skilled Nursing Facility (SNF)

TYPES OF ICU EXPERIENCE

ICU (General ICU)(Required)

MICU (Medical Intensive Care Unit)(Required)

SICU (Surgical Intensive Care Unit)(Required)

CCU (Cardiac Care Unit)(Required)

CVICU (Cardiovascular Intensive Care Unit)(Required)

TICU (Trauma Intensive Care Unit)(Required)

Neurosurgical ICU(Required)

Burn ICU(Required)

AGE OF PATIENTS CARED FOR

Newborn/ Neonate (birth to 30 days)(Required)

Infant (31 days to 12 months)(Required)

Toddler/Preschool (13 months to 5 years)(Required)

School Age Child/adolescent (6 years to 18 years)(Required)

Young Adults Middle Adult (19 years to 64 years)(Required)

Older Adults/Elderly (65+ years)(Required)

GENERAL SKILLS

Care of Patient in Restraints(Required)

Automated Med Dispensing Systems

Accudose

Metro

Omnicell

Promanager Rx

Pyxis

N/A

Other Automated Med Dispensing Systems:

Electronic Documentation

MEDICATION ADMINISTRATION

Moderate/Conscious Sedation(Required)

Sedation Reversal Agents(Required)

Antibiotics IM/IV(Required)

Antiemetics(Required)

Adenosine(Required)

Aminophylline(Theophylline)(Required)

Atropine(Required)

Anticoagulants(Required)

Anticonvulsants(Required)

Antihypertensives(Required)

Barbituate Induced Coma(Required)

Charcoal(Required)

Cardizem(Required)

Cordarone(Required)

Decadron(Required)

Dopamine(Required)

Diuretics(Required)

Epinephrine(Required)

Heparin Drip protocol(Required)

Inotropes (Digoxin,Dobutamine,Primacor)(Required)

Inocor(Required)

Insulin Infusions(Required)

Intrathecal Medication(Required)

Isuprel(Required)

Kayexelate(Required)

Lidocaine(Required)

Mannitol(Required)

Nitroglycerin(Required)

Nipride(Required)

Steroids(Required)

Thrombolytic Therapy(Required)

Vasopressin(Required)

Ventolin (Albuterol)(Required)

CARDIOVASCULAR

Care of the Patient With:

Adult ECMO(Required)

Continuous Cardiac Monitoring(Required)

Femoral-Arterial Sheath/Removal(Required)

Intra Aortic Balloon Pump(Required)

Abdominal Aortic Aneurysm/Bypass(Required)

Acute MI(Required)

Angioplasty(Required)

Bacterial Endocarditis(Required)

Pericarditis(Required)

Carotid Endarterectomy(Required)

Fem-Pop Bypass(Required)

Cardiac Arrest(Required)

CHF(Required)

Fresh Open Heart Surgery(Required)

Open Heart Surgery (more than 6 hrs. post-op)(Required)

Heart Transplant(Required)

Myocardial Contusion(Required)

Mediastinal Tube(Required)

Vascular Surgeries(Required)

Cardiac Tamponade(Required)

EP Study and Ablation(Required)

POST Pacemaker/AICD Insertion(Required)

Pre/Post Cardiac Cath(Required)

Post Artherectomy (DCA)(Required)

Hyperthermia Blanket(Required)

Hypothermia protocol (post arrest)(Required)

Shock:

Anaphylactic(Required)

Cardiogenic(Required)

Hypovolemic(Required)

Neurogenic(Required)

Septic(Required)

Pacemaker:

External(Required)

Permanent(Required)

Temporary(Required)

Transthoracic(Required)

Ventricular Assist Device (RVAD,LVAD, BIVAD)(Required)

Hemodynamic Monitoring:

Set up, use and Interpreation of Reading of CVP(Required)

Set up, use and Interpretation of Reading of PA/Swan-Ganz(Required)

Transducer Setup and Monitoring(Required)

Cardiac Output(Required)

Cardiac Index(Required)

Wedge Pressures(Required)

SVO2(Required)

Set up and use of Arterial Line(Required)

PULMONARY

Care of the Patient With:

Ventilator/Weaning

Other Ventilator/Weaning:

CPAP/BIPAP(Required)

Asphyxiation (Near Drowning)(Required)

Oral Airway(Required)

Endotracheal Tube(Required)

Laryngeal Spasm(Required)

Tracheostomy(Required)

Lung Transplant(Required)

Epistaxis(Required)

Aspiration(Required)

ARDS(Required)

COPD(Required)

Lobectomy(Required)

Pneumonectomy(Required)

Pneumothorax/Tension Pneumothorax(Required)

Hemothorax(Required)

Pneumonia(Required)

Assist with Emergency Tracheostomy(Required)

Thoracentesis(Required)

Inhalation Injuries(Required)

Pulmonary Edema(Required)

Pulmonary Embolism(Required)

Status Asthmaticus(Required)

Tuberculosis(Required)

Chest Tube (pleurevac/Thoraclex)(Required)

Assist with Intubation(Required)

Assist with Extubation(Required)

Assist with Chest Tube Insertion(Required)

ABG Interpretation(Required)

NEUROLOGICAL

Intracranial Pressure Monitoring(Required)

Ventriculostomy Drain(Required)

Increased ICP(Required)

Closed Head Injuries(Required)

Heat Exhaustion(Required)

Multiple Sclerosis(Required)

Psychiatric Disorders(Required)

Aneurysm Precautions(Required)

Basal Skull Fracture(Required)

Coma(Required)

CVA(Required)

Encephalitis(Required)

Craniotomy(Required)

Delirium Tremors(Required)

Meningitis(Required)

Seizures(Required)

Status Epilepticus(Required)

Spinal Cord Injury(Required)

Halo Traction/Cervical Tongs(Required)

Intracranial Tumor Resection(Required)

Cranial Nerve Assessment(Required)

Reflex/Motor Deficits(Required)

Assist with Lumbar Puncture(Required)

Stryker Frame(Required)

Overdose(Required)

ORTHOPEDICS

Multiple Long Bone Fractures(Required)

Pelvic Fracture(Required)

Open Book Pelvic Fracture(Required)

Fracture/Dislocation(Required)

Traumatic Amputation(Required)

Osteoporosis(Required)

Pined Fractures(Required)

Total Joint Replacements(Required)

Brace/Splint Application(Required)

Fractured Ribs/Sternum(Required)

Traction Devices(Required)

GASTROINTESTINAL

Gastric Lavage(Required)

Gastrostomy Tube(Required)

Jejunostomy Tube(Required)

Nasogastric Tube(Required)

Salem Sump(Required)

PEG Tube(Required)

Acute Cholecystitis(Required)

Bowel Obstruction(Required)

Cirrhosis(Required)

GI Bleed(Required)

Paralytic Ileus(Required)

GI Surgery(Required)

Pancreatitis(Required)

Liver Failure(Required)

Liver Transplant(Required)

Acute Abdominal Pain(Required)

Blunt Abdominal Trauma(Required)

Penetrating Abdominal Trauma(Required)

Ostomies(Required)

Esophageal Bleeding(Required)

Whipple(Required)

RENAL/GENITOURINARY

AV Fistula(Required)

Suprapubic Catheter(Required)

Hemodialysis(Required)

Peritoneal Dialysis(Required)

Nephrostomy Tube(Required)

Peritoneal Lavage(Required)

Acute Renal Failure(Required)

Renal Transplant(Required)

Renal Rejection Syndrome(Required)

Nephrectomy(Required)

TURP(Required)

Bladder Irrigation(Required)

CRRT (continuous Renal Replacement Therapy)(Required)

ENDOCRINE/METABOLIC

Adrenal Disorders (Addison's Disease)(Required)

Diabetic Ketoacidosis(Required)

Diabetes Mellitus(Required)

Insulin Shock(Required)

Hypothyroidism(Required)

Hyperthyroidism (Graves Disease)(Required)

Pituitary Disorders(Required)

Thyroidectomy(Required)

INFECTIOUS DISEASE

Hepatitis(Required)

HIV(Required)

MRSA (Methicillin Resistant Staphylococcus)(Required)

VRE ( Vancomycin Resistant Enterococci)(Required)

CRE (Carbapenem Resistant Enterobacteriaceae)(Required)

C Difficile(Required)

Tuberculosis(Required)

Isolation Precautions/Procedures(Required)

ONCOLOGY

Chemotherapy(Required)

Bone Marrow Transplants(Required)

Leukemia(Required)

Lymphoma(Required)

Radiation Implants(Required)

WOUND MANAGEMENT

Multiple Abdominal Wounds and Drains(Required)

Gunshot Wound(Required)

Stab Wound(Required)

Lacerations(Required)

Hazardous Material Exposure(Required)

Radiation Exposure(Required)

Stasis Ulcers(Required)

Surgical Wound Healing(Required)

Traumatic Wounds(Required)

Multi System Organ Failure(Required)

DIC(Required)

Organ/Tissue Donation(Required)

Burns:

First Degree(Required)

Second Degree(Required)

Third Degree(Required)

Rule of Nines(Required)

Fluid Resuscitation Burn Formula(Required)

Electrical Burns(Required)

CARDIAC MONITORS

Hewlett-Packard(Required)

Spacelab(Required)

Siemens(Required)

Marquette(Required)

Mennen(Required)

Lifecare(Required)

Nihon-Koder(Required)

Other Cardiac Monitors Please List: