Administrative Registered Nurse Skills Checklist

Polysomnographer/Sleep Tech Skills Checklist

Fill Out and Submit your Skills Checklist

(Polysomnographer/Sleep Tech Skills Checklist)

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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

Age of Patients Cared For

Newborn/Neonate (birth–30 days):

★★★★

Infant (1 month–1 year):

★★★★

Toddler (1–3 years):

★★★★

Preschooler (3–5 years):

★★★★

School Age Child (5–12 years):

★★★★

Adolescents (12–18 years):

★★★★

Young Adults (18–39 years):

★★★★

Middle Adults (39–64 years):

★★★★

Older Adults (64–79 years):

★★★★

Elderly Adults (over 79+ years):

★★★★

GENERAL SKILLS

Standard Precautions:

★★★★

Isolation Precautions:

★★★★

Pediatric Respiratory/Cardiac Arrest:

★★★★

Adult Respiratory/Cardiac Arrest:

★★★★

Crash Carts:

★★★★

Defibrillators:

★★★★

Electronic Documentation:

★★★★

List Types (Electronic Documentation):

Automated Med Dispensing Systems:

★★★★

List Types (Med Dispensing Systems):

SETTING

Hospital:

★★★★

Independent Lab:

★★★★

Patient Home:

★★★★

DIAGNOSTIC STUDIES / PROCEDURES

Multiple Sleep Latency Test (MSLT):

★★★★

Maintenance of Wakefulness Test (MWT):

★★★★

Nocturnal Penile Tumescence:

★★★★

Seizure Study:

★★★★

Portable Sleep Study:

★★★★

Split-Night Polysomnogram:

★★★★

EKG Electrode Placement:

★★★★

EEG Electrode Placement:

★★★★

Seizure Hook-Up:

★★★★

Calibration:

★★★★

Drawing Arterial Blood Gases (ABGs):

★★★★

MONITORING / SCORING

Periodic Limb Movements:

★★★★

Snores:

★★★★

Respiratory Events:

★★★★

Respiratory Disturbance Index (RDI):

★★★★

Apnea-Hypopnea Index (AHI):

★★★★

Periodic Breathing:

★★★★

Complex Sleep Apnea:

★★★★

Cheyne-Stokes:

★★★★

Obstructive Sleep Apnea:

★★★★

Hypopnea:

★★★★

Sleep Log:

★★★★

Seizure Recognition and Precaution:

★★★★

Transient Arousal Scoring Rules/Procedures:

★★★★

EQUIPMENT

Oximeters:

★★★★

Nasal Cannula:

★★★★

Humidified O2:

★★★★

Nasal Mask:

★★★★

BiPAP:

★★★★

CPAP:

★★★★

Portable Set-Up:

★★★★

Position Sensor:

★★★★

Actimeter:

★★★★

Thermistor:

★★★★

Phillips Respironics:

★★★★

Nihon Kohden:

★★★★

Grass Technologies:

★★★★

Natus:

★★★★

ResMed:

★★★★

CleveMed:

★★★★

CareFusion BD:

★★★★

Compumedics:

★★★★

Cadwell:

★★★★

Somnomedics:

★★★★

Other:

★★★★

List Types (Other Equipment):

CREDENTIALS

CPSGT:

★★★★

RST:

★★★★

RPSGT:

★★★★

SDS:

★★★★

Please List (CREDENTIALS):

Polysomnographer/Sleep Tech Skills Checklist

Fill Out and Submit your Skills Checklist

(Polysomnographer/Sleep Tech Skills Checklist)

Proficiency Scale:

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