Area |
Not Applicable |
Inexperienced |
Limited |
Experienced |
Highly Experienced |
Cardiovascular |
Basic 12 lead EKG interpretation |
N/A
|
1
|
2
|
3
|
4
|
Use of Cardiac Monitor |
N/A
|
1
|
2
|
3
|
4
|
Assessment of heart sounds (normal vs. abnormal) |
N/A
|
1
|
2
|
3
|
4
|
Cardiac arrest/CPR |
N/A
|
1
|
2
|
3
|
4
|
Heparin drip (Precautions and maintenance) |
N/A
|
1
|
2
|
3
|
4
|
Peripheral Pulses |
N/A
|
1
|
2
|
3
|
4
|
Use and administration of |
N/A
|
1
|
2
|
3
|
4
|
Anticoagulants |
N/A
|
1
|
2
|
3
|
4
|
Antihypertensives |
N/A
|
1
|
2
|
3
|
4
|
Digoxin |
N/A
|
1
|
2
|
3
|
4
|
Nitroglycerine |
N/A
|
1
|
2
|
3
|
4
|
Permanent pacemaker |
N/A
|
1
|
2
|
3
|
4
|
Cardiac surgery |
N/A
|
1
|
2
|
3
|
4
|
Post acute MI |
N/A
|
1
|
2
|
3
|
4
|
Congestive heart failure (CHF) |
N/A
|
1
|
2
|
3
|
4
|
Femoral popliteal bypass/Vascular Procedures |
N/A
|
1
|
2
|
3
|
4
|
Abdominal aortic aneurysm |
N/A
|
1
|
2
|
3
|
4
|
Carotid endarterectomy |
N/A
|
1
|
2
|
3
|
4
|
Thrombophlebitis |
N/A
|
1
|
2
|
3
|
4
|
|
Pulmonary |
Assessment of breath sounds |
N/A
|
1
|
2
|
3
|
4
|
Chest Physiotherapy |
N/A
|
1
|
2
|
3
|
4
|
Oral suctioning |
N/A
|
1
|
2
|
3
|
4
|
Nasotracheal suctioning |
N/A
|
1
|
2
|
3
|
4
|
Chest tube (care and maintenance) |
N/A
|
1
|
2
|
3
|
4
|
Oxygen Therapy Administration: |
N/A
|
1
|
2
|
3
|
4
|
Bag and Mask |
N/A
|
1
|
2
|
3
|
4
|
Nasal cannula |
N/A
|
1
|
2
|
3
|
4
|
Facemask |
N/A
|
1
|
2
|
3
|
4
|
Albuterol (Ventolin) |
N/A
|
1
|
2
|
3
|
4
|
Corticosteroids |
N/A
|
1
|
2
|
3
|
4
|
Tracheostomy |
N/A
|
1
|
2
|
3
|
4
|
Mechanical ventilator |
N/A
|
1
|
2
|
3
|
4
|
COPD |
N/A
|
1
|
2
|
3
|
4
|
Emphysema |
N/A
|
1
|
2
|
3
|
4
|
Pneumonia |
N/A
|
1
|
2
|
3
|
4
|
Pulmonary edema |
N/A
|
1
|
2
|
3
|
4
|
|
Neurology |
Assessment of neurological status |
N/A
|
1
|
2
|
3
|
4
|
Use of Glasgow Coma Scale |
N/A
|
1
|
2
|
3
|
4
|
Halo traction |
N/A
|
1
|
2
|
3
|
4
|
Assist with Lumbar Puncture |
N/A
|
1
|
2
|
3
|
4
|
Post craniotomy |
N/A
|
1
|
2
|
3
|
4
|
Shunts (i.e. ventriculoperitoneal) |
N/A
|
1
|
2
|
3
|
4
|
CVA |
N/A
|
1
|
2
|
3
|
4
|
Seizure activity |
N/A
|
1
|
2
|
3
|
4
|
Head injury/trauma |
N/A
|
1
|
2
|
3
|
4
|
Spinal cord injury |
N/A
|
1
|
2
|
3
|
4
|
Parkinson’s |
N/A
|
1
|
2
|
3
|
4
|
Multiple Sclerosis |
N/A
|
1
|
2
|
3
|
4
|
DTs/ Impending Delirium Tremens |
N/A
|
1
|
2
|
3
|
4
|
|
Orthopedic |
Total hip replacement |
N/A
|
1
|
2
|
3
|
4
|
Total knee replacement |
N/A
|
1
|
2
|
3
|
4
|
CPM (Constant Passive Motion) |
N/A
|
1
|
2
|
3
|
4
|
Arthroscopic surgery |
N/A
|
1
|
2
|
3
|
4
|
Amputation/stump care |
N/A
|
1
|
2
|
3
|
4
|
Ortho trauma |
N/A
|
1
|
2
|
3
|
4
|
Skeletal traction |
N/A
|
1
|
2
|
3
|
4
|
Spika cast/body cast |
N/A
|
1
|
2
|
3
|
4
|
Cast care |
N/A
|
1
|
2
|
3
|
4
|
K-wires/Steinman pins |
N/A
|
1
|
2
|
3
|
4
|
|
Gastrointestinal |
NG tube placement |
N/A
|
1
|
2
|
3
|
4
|
Assessment of abdomen |
N/A
|
1
|
2
|
3
|
4
|
Administration of tube feeding |
N/A
|
1
|
2
|
3
|
4
|
Gastrostomy tube |
N/A
|
1
|
2
|
3
|
4
|
Jejunostomy tube (J-tube) |
N/A
|
1
|
2
|
3
|
4
|
Colostomy/ileostomy |
N/A
|
1
|
2
|
3
|
4
|
GI bleed |
N/A
|
1
|
2
|
3
|
4
|
GI surgery |
N/A
|
1
|
2
|
3
|
4
|
Hepatitis |
N/A
|
1
|
2
|
3
|
4
|
Inflammatory bowel disease |
N/A
|
1
|
2
|
3
|
4
|
|
Renal/Genitourinary |
Foley catheter insertion |
N/A
|
1
|
2
|
3
|
4
|
Care of three-way Foley Catheter |
N/A
|
1
|
2
|
3
|
4
|
Bladder irrigations |
N/A
|
1
|
2
|
3
|
4
|
Care of supra-pubic catheter |
N/A
|
1
|
2
|
3
|
4
|
Nephrectomy |
N/A
|
1
|
2
|
3
|
4
|
Renal failure |
N/A
|
1
|
2
|
3
|
4
|
Renal transplant |
N/A
|
1
|
2
|
3
|
4
|
Peritoneal dialysis |
N/A
|
1
|
2
|
3
|
4
|
Fistula/shunt |
N/A
|
1
|
2
|
3
|
4
|
T.U.R.P. |
N/A
|
1
|
2
|
3
|
4
|
UTI (Urinary Tract Infection) |
N/A
|
1
|
2
|
3
|
4
|
|
Gynecology |
GYN exam/PAP (assist) |
N/A
|
1
|
2
|
3
|
4
|
Hysterectomy |
N/A
|
1
|
2
|
3
|
4
|
Ectopic pregnancy |
N/A
|
1
|
2
|
3
|
4
|
Mastectomy |
N/A
|
1
|
2
|
3
|
4
|
Repair of cystocele/rectocele |
N/A
|
1
|
2
|
3
|
4
|
|
Endocrine |
Diabetic teaching |
N/A
|
1
|
2
|
3
|
4
|
Insulin administration |
N/A
|
1
|
2
|
3
|
4
|
Use and Administration of Oral Hypoglycemics |
N/A
|
1
|
2
|
3
|
4
|
Blood glucose testing |
N/A
|
1
|
2
|
3
|
4
|
|
Oncology |
Chemotherapy administration (precautions and side effects) |
N/A
|
1
|
2
|
3
|
4
|
Isolation/reverse isolation |
N/A
|
1
|
2
|
3
|
4
|
IV hydration |
N/A
|
1
|
2
|
3
|
4
|
Nutritional requirements |
N/A
|
1
|
2
|
3
|
4
|
Care of bone marrow transplant patient |
N/A
|
1
|
2
|
3
|
4
|
Hickman catheter |
N/A
|
1
|
2
|
3
|
4
|
Groshong Catheter |
N/A
|
1
|
2
|
3
|
4
|
Infusa-port |
N/A
|
1
|
2
|
3
|
4
|
Broviac |
N/A
|
1
|
2
|
3
|
4
|
Chemotherapy Certification |
N/A
|
1
|
2
|
3
|
4
|
|
IV Therapy |
Drawing venous blood |
N/A
|
1
|
2
|
3
|
4
|
Administration of blood and blood products (precautions, recognizing transfusion reactions and taking appropriate actions) |
N/A
|
1
|
2
|
3
|
4
|
Start peripheral IV’s |
N/A
|
1
|
2
|
3
|
4
|
Maintenance of IV’s |
N/A
|
1
|
2
|
3
|
4
|
Administration/mixing IV meds |
N/A
|
1
|
2
|
3
|
4
|
Calculate doses |
N/A
|
1
|
2
|
3
|
4
|
Calculate rates |
N/A
|
1
|
2
|
3
|
4
|
Hanging IV piggybacks |
N/A
|
1
|
2
|
3
|
4
|
Insertion of heparin lock |
N/A
|
1
|
2
|
3
|
4
|
Maintenance of heparin lock |
N/A
|
1
|
2
|
3
|
4
|
Care/maintenance of Central lines |
N/A
|
1
|
2
|
3
|
4
|
Nutritional Infusions /Hyperalimentation |
N/A
|
1
|
2
|
3
|
4
|
|
Wound and Skin Care |
Sterile dressing changes |
N/A
|
1
|
2
|
3
|
4
|
Wound irrigations |
N/A
|
1
|
2
|
3
|
4
|
Wound culture |
N/A
|
1
|
2
|
3
|
4
|
Care of surgical incisions with drains (i.e. JP drain) |
N/A
|
1
|
2
|
3
|
4
|
Assessment and care of pressure sores |
N/A
|
1
|
2
|
3
|
4
|
Assessment and care of decubitus ulcers |
N/A
|
1
|
2
|
3
|
4
|
|
Other Nursing Responsibilities |
Physical assessment |
N/A
|
1
|
2
|
3
|
4
|
Use of restraints |
N/A
|
1
|
2
|
3
|
4
|
Care of the patient with: HIV/AIDS |
N/A
|
1
|
2
|
3
|
4
|
Knowledge of Normal Serum Lab Values |
N/A
|
1
|
2
|
3
|
4
|
Charge Nurse Responsibilities |
N/A
|
1
|
2
|
3
|
4
|
|