SunbeltStaffing.com Skills Self Assessment

Telemetry / Step Down
Skills Self Assessment

This skills assessment is designed to determine your level of competency in the areas listed below. By completing this checklist to the best of your ability, you will help us match your skills and areas of interest with our available assignments. Please indicate your appropriate level for each category as well as the date last performed.

Traveler Name:
Traveler Email:
Recruiter Name:
Date:

COMPETENCY LEVELS	DATE LAST PERFORMED
1 = Functionally Independent	Within 6 Months
2 = Some Experience	6 mo. - 12 mo. ago
3 = Minor or No Experience	Over 1 year ago
	Not Performed / Never Worked

Skills	Competency Level	Date Last Performed
CARDIOVASCULAR
Assessment of Auscultation
Assessment of Heart Sounds/Murmurs
Assessment of Pulse/Circulation
Cardiac Dysrhythmias
Sinus Dysrhythmias
Atrial Dysrhythmias
Junctional Dysrhythmias
Heart Blocks
Pacemaker Rhythms
Ventricular Dysrhythmias
Interpretation of Cardiac Enzymes
Interpretation of Coagulation Studies
Interpretation/EKG
12 Lead
Arrhythmia
Lead Placement
Lead Placement - 5 Electrode
Lead Placement - I, II, V Leads
Lead II & MCL
Interpretation/ABG
Pacemaker (Permanent)
Pacemaker (Temporary)
Epicardial Wires
External Pacing
Transvenous
Arterial Lind Insertion/Assist
Central Line Insertion/Assist
Hemodynamic Monitoring/Invasive
A-Line (Radial)
CVP
Femoral Artery
Swan-Ganz
Hemodynamic Monitoring/Non-Invasive
Auscultation
Doppler
Electronic
Palpation
Abdominal Aortic Bypass
Aneurysm
Angina
Cardiac Arrest
Cardiomyopathy
Cartoid Endarterectomy
Cellulitis
CHF
Deep Vein Thrombosis
Femoral - Popliteal Bypass
Pre/Post Care
Acute MI
Angioplasty
CABG
Cardiac Catheter
Stent Placement
Septic Shock
Sickle Cell Anemia
COMPUTERIZED CHARTING
Cerner
CPRS
CPSI
EPIC
HMS
Meditech
Other:

GASTROINTESTINAL
Administration/Feeding
Pump (Continuous)
Gravity Drainage (Bolus)
Appendicitis
Bowel Sounds Assessment
Bowel Obstruction
Colostomy
ERCP
Esophageal Bleeding
Intestinal Tract Tubes
Gastrostomy
Jejunostomy
Nasogastric
Orogastric
T-Tube
GI Bleed
GI Surgery
Hepatitis
Illeostomy
Inflammatory Bowel
Liver Failure
Pancreatitis
Paralytic Ileus
GYNECOLOGY
Abdominalplasty
Cyst Removal
Ectopic Pregnancy
Hysterectomy
Mastectomy
Reconstructive Breast Surgery
Thyroidectomy
INFECTIOUS DISEASE
AIDS
Fever Management
Hepatitis
HIV Infection
Isolation Techniques
MEDICATION ADMINISTRATION/IV THERAPY
Eye/Ear Instillations
Intramuscular Injections
Intradermal Injections
Subcutaneous Injections
Administer Blood Products
Albumin/Plasma
Cryoprecipitate
Packed Red Blood Cells
Whole Blood
Peripheral IV
Angiocath
Butterfly
Heparin Lock
IV Drip
Calculations
Titrations
Central Line Catheter
Broviac
Groshong
Hickman
Peripheral Arterial Line
PICC
Portacath
Quinton
Unit Dose
Chemotherapy Admin
Nutritional Infusions
Hyperalimentation
Intralipids
Nebulizer
NATIONAL PATIENT SAFETY GOALS
Accurate Patient Identification
Effective Communication
Infection Control
Universal Precautions
Patients In Isolation
Minimize Risk For All
Please list any additional skills:

Please list any additional training:

Please list any additional equipment:

Age Specific Competency

Please indicate the appropriate level for each category. When evaluating your competency level, please focus on the following guidelines:

Ability to ensure a safe and caring environment for the specific age groups indicated below.
Ability to communicate and instruct patients in the designated age groups.
Ability to evaluate age-appropriate behavior and skills.

Age Group	Competency Level	Date Last Performed
Newborn (birth-30 days)
Infant (30 days-1 yrs)
Toddler (1-3 yrs)
Preschooler (3-5 yrs)
School Age (5-12 yrs)
Adolescents (12-18 yrs)
Young Adults (18-39 yrs)
Middle Adults (39-64 yrs)
Older Adults (64 yrs +)

To the best of my knowledge, the information represented above is an accurate reflection of my skills and abilities, and I authorize Sunbelt Staffing to share the above skills checklist with its clients.