Ambulatory Skills Checklist

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(Ambulatory)

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I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

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.

Proficiency Scale:

1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

General Patient Care

Admit and Assess Patients:

★★★★

Advance Directives:

★★★★

Collect Appropriate Data:

★★★★

Discharge Teaching:

★★★★

Preoperative Teaching:

★★★★

Patient Prep:

★★★★

Computerized Documentation:

★★★★

Cardiovascular

Assess Heart Tones:

★★★★

Bedside Tele Monitoring:

★★★★

Interpretation of Coagulation Studies:

★★★★

Perform Pulses/Circulation Checks:

★★★★

Pre/Post Op Care Pacemaker:

★★★★

Pulmonary

Assess Breath Sounds:

★★★★

Apply Oxygen:

★★★★

Interpret ABGs:

★★★★

Thoracentesis:

★★★★

Oximetry:

★★★★

Neurology

Assess Neurological Signs:

★★★★

Epidurals:

★★★★

Selective Nerve Root Blocks:

★★★★

Level of Consciousness:

★★★★

Insertion/Monitoring NG Tubes:

★★★★

Assessment/Patient Care Continued:

★★★★

Flexible Sigmoidoscopy:

★★★★

Hemorrhoid Banding:

★★★★

Liver Biopsy:

★★★★

Paracentesis:

★★★★

Lap Band Surgery:

★★★★

Bladder Biopsy:

★★★★

Cystoscopy:

★★★★

Urethral Dilation:

★★★★

Nephrostomy:

★★★★

Kidney Biopsy:

★★★★

Suprapubic Catheter:

★★★★

Prostate Biopsy:

★★★★

Endocrine

Care of Diabetic Patient:

★★★★

Diabetic Teaching:

★★★★

ENT and Mouth

Prosthondontics – Restorative Dentistry:

★★★★

Mouth Biopsy:

★★★★

Myringotomy:

★★★★

Maxillofacial Prosthetics:

★★★★

Nose Biopsy:

★★★★

Thyroid Aspirate Biopsy:

★★★★

Fiberoptic Laryngoscopy:

★★★★

Tonsilectomy:

★★★★

Rhinoplasty:

★★★★

Wounds/Integument

Application of Burn Dressings:

★★★★

Application of Dressing:

★★★★

Debridement of Wound:

★★★★

Wound Care:

★★★★

Additional Wound Care Item 1:

★★★★

Additional Wound Care Item 2:

★★★★

OB/GYN

Electrodesiccation and Curettage (ED&C):

★★★★

Nipple Reconstruction:

★★★★

Musculoskeletal

Arthrocentesis:

★★★★

External Hardware and Pin Care:

★★★★

Arthroscopy:

★★★★

Open Reduction and Internal Fixation:

★★★★

Closed Reduction and Internal Fixation:

★★★★

Trigger Point Injections:

★★★★

Plastics

Liposuction:

★★★★

Plastic Surgery:

★★★★

Cosmetic:

★★★★

General Medications/Therapeutic Interventions

Administer IM and SQ Meds:

★★★★

Administer Inhalation Medications:

★★★★

Administer PO Medications:

★★★★

Bladder Irrigation and Instillation:

★★★★

Needleless Systems:

★★★★

Chemotherapy:

★★★★

IV Therapy

Infusion Pumps:

★★★★

Peripheral IV Insertion:

★★★★

Syringe Pumps:

★★★★

Vascular Access Devices Care/Maintenance:

★★★★

Administer IV Medications:

★★★★

Oxygen Administration

Ambu-Bug:

★★★★

Nasal Cannula:

★★★★

Non-ReBreather Mask:

★★★★

Pulse Oximetry:

★★★★

Venti Mask:

★★★★

Face Mask:

★★★★

Nutritional Therapy

Lipids:

★★★★

TPN:

★★★★

Procalamine:

★★★★

Enteral Administration:

★★★★

Pain Management/Anesthesia

Implantable Narcotic Pump Refill:

★★★★

Moderate Sedation:

★★★★

Epidural:

★★★★

Spinal:

★★★★

Local:

★★★★

General:

★★★★

Axillary Block:

★★★★

Bier Block:

★★★★

Blood

Blood and Blood Products:

★★★★

Albumin:

★★★★

General Procedures/Equipment

Apply Immobilizers (clavicle, knee, etc.):

★★★★

Assist with Code Resuscitation:

★★★★

Assist with Lumbar Puncture:

★★★★

Laser:

★★★★

Dermabrasion:

★★★★

Drain Removal:

★★★★

Incision and Drainage:

★★★★

NGT Insertion:

★★★★

Patch Test:

★★★★

Punch Biopsy:

★★★★

Procedure Set Up:

★★★★

Procedures/Equipment Continued:

★★★★

Remove External Fixators With Pin:

★★★★

Scissor Biopsy:

★★★★

Scrub:

★★★★

Screw-Hardware Removal:

★★★★

Set-up Assist Suturing:

★★★★

Staple Removal:

★★★★

Straight/Foley Cath Female:

★★★★

Straight/Foley Cath Male:

★★★★

Suture Removal:

★★★★

TENS (Transcutaneous Elec. Nerve Stimulator):

★★★★

Use of Doppler:

★★★★

Specimen Collections

Venipuncture:

★★★★

Clean Catch Urine:

★★★★

Sterile Urine Collection:

★★★★

Stool:

★★★★

Sputum:

★★★★

Butterfly Stick:

★★★★

Central Line Draw:

★★★★

Clinical Settings

Surgi-Center:

★★★★

Out Patient Clinic:

★★★★

Age Group Experience Continued:

★★★★

Physician Office:

★★★★

Ambulatory Surgery Clinic:

★★★★

Joint Commission

National Safety Goals:

★★★★

"Do Not Use" Abbreviations and Terms:

★★★★

Age Specific Competencies

Infant (Birth - 1 year):

★★★★

Preschooler (ages 2-5 years):

★★★★

Childhood (ages 6-12 years):

★★★★

Adolescents (ages 13-21 years):

★★★★

Young Adults (ages 22-39 years):

★★★★

Adults (ages 40-64 years):

★★★★

Older Adults (ages 65-79 years):

★★★★

Elderly (ages 80+ years):

★★★★