Skills Checklist – Critical Care

CARE OF PATIENTS WITH*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Abdominal Aortic Aneurysm
Acute MI
Cardiac Tamponade
Cardiac Transplant
Congestive Heart Failure
Intracoronary Stent Placement
ARDS
COPD
Lung Transplant
Pulmonary Edema/Hypertension
Pulmonary Embolism
Status Asthmaticus
Tension Pneumothorax
Tuberculosis
Cerebral Aneurysm
CVA/TIA
Seizures
Skull Fracture
Spinal Cord Injuries
VP Shunt
Acute Renal Failure
Renal Transplant
Hepatic Failure
Hepatitis
Liver Transplant
Diabetes Insipidus
Diabetes Mellitus
Diabetic Ketoacidosis
Insulin Shock
GI Bleed
Pancreatitis
TURP
Urinary Tract Infection
DIC
Hypothermia
Amputation
Orthopedic Injuries
Osteomyelitis
Cardiogenic Shock
Hypovolemic Shock
Neurogenic Shock
Septic Shock
First Degree Burns
Second Degree Burns
Third Degree Burns
Drug Overdose
Delirium Tremens
Near Drowning
Renal Trauma
GI Surgery
Neurosurgery
Vascular Surgery
Transfusion Reaction

MEDICATION ADMINISTRATION*

PROCEDURES/SKILLS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
A-V Fistula Care
Brace/Splint Application
Bronchoscopy (assist with)
Foley/Straight Cath insertion & care
Chest tube & drainage system
EKG Intrepretation
Gastric Suction
Glascow Coma Scale
Halo Traction/Cervical Tongs
Hemodialysis - Care during/post
Hemodynamic Monitoring, Invasive
Hemodynamic Monitoring, Non-invasive
Interpretation of Lab Results
Intestinal Tract Tube Insertion/Care
T-tubes (care only)
Intraaortic Balloon Pump
Intracranial Pressure Monitoring
Intravenous Infusions
Blood & Blood Products
Central line care
Peripheral IV insertion & care
Pacemaker
Peritoneal Dialysis
Specimen Collection
Suctioning
Temperature
Wound/Ostomy Care
Pressure ulcers
Pain Management

EQUIPMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Pneumatic Stockings
Cardiac Monitor
Defibrillator
Glucometer
Specialty Beds
Ventilator
Infusion Pumps (specific brands)
Infusion Pump Brand #1
Infusion Pump Brand #2
Infusion Pump Brand #3
Infusion Pump Brand expertise
Rarely Some Experience Proficient Trainer / Preceptor N/A
Infusion Pump Brand #1
Infusion Pump Brand #2
Infusion Pump Brand #3
Do you speak any languages other than English?*
- No
If yes, enter languages above, separated by commas.

Age Group Experience*

Confirmation*
- I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
Signature
Date
MM slash DD slash YYYY

Origin Travel Nurses has earned the Joint Commission's Gold Seal of Approval

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Pneumatic Stockings
Cardiac Monitor
Defibrillator
Glucometer
Specialty Beds
Ventilator
Infusion Pumps (specific brands)