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The Nursing Competency Checklist is an essential tool designed to ensure that registered nurses meet the necessary skills and knowledge required in critical care settings. This comprehensive form provides a structured framework for evaluating nursing competencies across various dimensions, including orientation, safety, equipment operation, documentation, and providing care. It allows nursing staff to assess their proficiency in locating vital resources such as manuals, electronic systems, and emergency procedures. Safety protocols and infection control measures are also prioritized within the checklist, ensuring that all staff members are well-prepared for potential health hazards. Furthermore, the checklist evaluates the operation of critical equipment, emphasizing the importance of adhering to manufacturer guidelines. Documentation and communication skills are thoroughly addressed, enabling nurses to manage patient information accurately and effectively. Finally, specific care protocols relevant to the unit are included, ensuring that nurses understand and comply with best practices in patient care. Overall, this checklist not only assists in individual assessments but also contributes to improving the quality of care provided in the healthcare environment.

Nursing Competency Checklist Example

 

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

 

 

Employee Name: ________________

 

 

Unit:

 

 

JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool

Float Cluster: FSC Perianesthesia

 

 

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Instruction Key:

 

Method of Evaluation Key:

 

Self-Assessment by Employee

 

 

 

 

 

Validation of Competency

 

P = Protocol/Procedure Review

 

O = Observation (in clinical setting)

 

 

 

 

 

 

 

 

 

 

 

Method of

 

 

 

 

 

 

 

 

Evaluation

 

 

E = Education Session

 

RD = Return Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never

 

 

Needs

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Method

 

 

S = Self Learning Package

 

T = Written Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review/

 

C

ompetent

 

(Use

 

 

Date

 

 

Initials

 

 

(Use

 

 

 

 

 

Done

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C = Clinical Practice

 

V = Verbal Review

 

 

 

 

Practice

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All Level 1 Competencies reviewed and documented in Central Orientation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. GETTING INTO THE SYSTEM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Locates Hard Copy Manuals / Binders on Unit

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Locates On-Line Manuals (Dept. of Nursing Website)

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

Obtains LCR, email, Pyxis, SIS & Bed Management System Access

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Recalls Proper Call-Out Procedure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifies unit-based orientation plan and timing of evaluations

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

Locates Educational Activity Records Binder / File

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifies Performance Improvement Initiatives

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. SAFETY/INFECTION CONTROL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Completes radiation dosimetry badge request, if desired

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

Places contact information onto disaster call tree

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifies and locates personal protective equipment

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Locates fire alarms, extinguishers and exits

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reviews Safety Plan for unit with Safety Trainer

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

V

 

C. EQUIPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEVEL 1: DEPARTMENTAL COMPETENCIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accesses OneSource for manufacturer equipment information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEVEL 2: CLUSTER SPECIFIC COMPETENCIES – Operates the following according to the operator’s manual

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Defibrillator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Doppler

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Infusion pumps: single- & double-chamber, primary & secondary tubing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 1 of 7

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

 

 

Employee Name: ________________

 

 

Unit:

 

 

JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool

Float Cluster: FSC Perianesthesia

 

 

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Instruction Key:

Method of Evaluation Key:

 

 

Self-Assessment by Employee

 

 

 

 

 

Validation of Competency

P = Protocol/Procedure Review

O = Observation (in clinical setting)

 

 

 

 

 

 

 

 

 

 

 

Method of

 

 

 

 

 

 

 

 

Evaluation

 

E = Education Session

RD = Return Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never

 

 

Needs

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Method

 

S = Self Learning Package

T = Written Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review/

 

C

ompetent

 

 

(Use

 

 

Date

 

 

Initials

 

 

(Use

 

 

 

 

Done

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C = Clinical Practice

V = Verbal Review

 

 

 

 

 

Practice

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Infusion pumps: syringe

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oxygen delivery: cannula, flow meter, mask, re-breather,oxygen flow meter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pulse Oximeter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pyxis Machine(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suction: Continuous/Intermittent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Twelve Lead ECG Machine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEVEL 3: JDH UNIT-SPECIFIC COMPETENCIES - Operates the following according to the operator’s manual:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bair Hugger

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code Cart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hemodynamic monitoring: arterial line

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hemodynamic monitoring: central venous pressure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Intubation Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Latex-free supply box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Malignant Hyperthermia supply boxes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medication Lockboxes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Monitors – GE Carescape B650

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Outside Entry Door

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pediatric Anesthesia Cart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pulsatile Anti-embolism Pumps

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pumps - Epidural

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pumps - PCA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Radial Hemostasis Bands

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 2 of 7

 

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

 

 

Employee Name: ________________

 

 

Unit:

 

 

JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool

Float Cluster: FSC Perianesthesia

 

 

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Instruction Key:

 

Method of Evaluation Key:

 

Self-Assessment by Employee

 

 

 

 

 

Validation of Competency

 

P = Protocol/Procedure Review

 

O = Observation (in clinical setting)

 

 

 

 

 

 

 

 

 

 

 

Method of

 

 

 

 

 

 

 

 

Evaluation

 

 

E = Education Session

 

RD = Return Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never

 

 

Needs

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Method

 

 

S = Self Learning Package

 

T = Written Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review/

 

C

ompetent

 

(Use

 

 

Date

 

 

Initials

 

 

(Use

 

 

 

 

 

Done

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C = Clinical Practice

 

V = Verbal Review

 

 

 

 

Practice

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regional Anesthesia Cart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ventilators

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. DOCUMENTATION/COMMUNICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEVEL 1: DEPARTMENTAL COMPETENCIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accesses email account

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accesses patient information in LCR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aware of patient information in eHIMS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Locates link to Patient Safety Net

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adheres to customer service values of UCHC (telephone, interpersonal)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEVEL 2: CLUSTER SPECIFIC COMPETENCIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initiates and documents discharge teaching to patients & families

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

States proper time frames for completion of various documentation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEVEL 3: UNIT SPECIFIC COMPETENCIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accesses information from Physician Postop Note/Orders & Progress Notes

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Completes documentation on-line in SIS application

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Completes forms/requisitions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Completes ISBAR forms (2) appropriately

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explains use of W-10 Clinical Resume’ for PACU discharges

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Generates medication reconciliation forms and report reprints from SIS

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifies correctly completed History & Physical

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identifies correctly completed Informed Consent – Procedure & Transfusion

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 3 of 7

 

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

 

 

Employee Name: ________________

 

 

 

Unit:

 

 

JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool

Float Cluster: FSC Perianesthesia

 

 

 

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Instruction Key:

Method of Evaluation Key:

 

 

Self-Assessment by Employee

 

 

 

 

 

 

Validation of Competency

 

P = Protocol/Procedure Review

O = Observation (in clinical setting)

 

 

 

 

 

 

 

 

 

 

 

Method of

 

 

 

 

 

 

 

 

Evaluation

 

 

E = Education Session

RD = Return Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never

 

 

Needs

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Method

 

 

S = Self Learning Package

T = Written Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review/

 

C

ompetent

 

 

(Use

 

 

Date

 

 

Initials

 

 

(Use

 

 

 

 

 

Done

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C = Clinical Practice

V = Verbal Review

 

 

 

 

 

Practice

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Locates Face Sheet – Locker Assignment Notation

 

 

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Recognizes printed orders / accesses POE orders correctly

 

 

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refers to Patient Belongings Log – Valuables Checklist

 

 

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

States proper time frames for completion of various documentation

 

 

 

 

 

 

 

 

 

 

 

 

 

V / O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. PROVISION OF CARE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOSPITAL ADMINISTRATIVE MANUAL– aware of content and/or provides care according to the following protocols/procedures:

 

 

 

 

 

 

 

 

Consent – Procedural (6-002)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Consent / Refusal of Blood and/or Blood Products (06-002)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

History & Physical (6-017)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Orders (6-019)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Universal Protocol (8-048)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NURSING PRACTICE MANUAL – aware of content and/or provides care according to the following protocols/procedures:

 

 

 

 

 

 

 

 

 

 

 

 

Blanket / Solution Warmers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Central Lines – (Blood Draws, Flush, IV Fluid Administration, & Dressing Care)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chest Tube

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CPAP and BiPAP Units: for use during Hospital Stay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diabetes Mellitus Management: Periprocedural Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hemodynamic Monitoring

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Therapy: Peripheral

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Push Medications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Jewelry: Wearing of Jewelry and Body Piercings during … Procedures

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medications: Double Check

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neurologic Assessment of the Adult Inpatient

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

Initials

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 4 of 7

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

 

 

Employee Name: ________________

 

 

Unit:

 

 

JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool

Float Cluster: FSC Perianesthesia

 

 

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Instruction Key:

Method of Evaluation Key:

 

 

Self-Assessment by Employee

 

 

 

 

 

Validation of Competency

P = Protocol/Procedure Review

O = Observation (in clinical setting)

 

 

 

 

 

 

 

 

 

 

 

Method of

 

 

 

 

 

 

 

 

Evaluation

 

E = Education Session

RD = Return Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never

 

 

Needs

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Method

 

S = Self Learning Package

T = Written Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review/

 

C

ompetent

 

 

(Use

 

 

Date

 

 

Initials

 

 

(Use

 

 

 

 

Done

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C = Clinical Practice

V = Verbal Review

 

 

 

 

 

Practice

 

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pain: Care of the Adult

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pain: Continuous Narcotic Infusion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pain: Epidural Narcotic Infusion and Patient Controlled Epidural Analgesia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pain: Narcotics via PCA Pump

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Post-Mortem Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Restraints: Acute Medical/Surgical (Non-behavioral)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transportation: Inpatients

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNIT PRACTICE MANUAL - aware of content and/or provides care according to the following protocols/procedures:

 

 

 

 

 

 

 

 

 

 

 

Anesthesia, Spinal & Epidural: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cardiovascular Monitoring: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOC Patients in Perioperative Area

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discharge from PACU: Ambulatory Patients (Phase 2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discharge from PACU: Inpatients (Phase 1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Documentation: Perioperative Electronic and Back-up

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Extended PACU Stay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Falls: Perioperative Risk Identification

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Flolan: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hysteroscopy: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Implanted Electronic Cardiac Devices

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Catheter Removal: MA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Catheters: Problem Insertion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Push Medications: Perianesthetic Approved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Latex Allergy Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Malignant Hyperthermia: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

Initials

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 5 of 7

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

 

Employee Name: ________________

 

Unit:

 

 

JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool

Float Cluster: FSC Perianesthesia

 

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Method of Instruction Key:

 

Method of Evaluation Key:

 

Self-Assessment by Employee

 

 

 

 

Validation of Competency

P = Protocol/Procedure Review

 

O = Observation (in clinical setting)

 

 

 

 

 

 

 

 

 

 

Method of

 

 

 

 

 

 

 

 

Evaluation

 

E = Education Session

 

RD = Return Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never

 

 

Needs

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Method

 

S = Self Learning Package

 

T = Written Test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review/

 

C

ompetent

 

(Use

 

 

Date

 

 

Initials

 

 

(Use

 

 

 

 

Done

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C = Clinical Practice

 

V = Verbal Review

 

 

 

 

Practice

 

 

 

 

Instruction

 

 

 

 

 

 

 

 

Evaluation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D = Demonstration

 

 

 

 

 

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

Key on Left)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nausea & Vomiting: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nerve Blockade, Regional and Peripheral

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PACU Admission

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pain and Comfort Management: Perioperative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Respiratory Compromise Management: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Skin Care: Perioperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thermoregulation and Prevention of Unplanned Hypothermia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tonsillectomy: Postoperative Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Visitors & Observers in the Perioperative Area

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRACTICUMS & SKILL VALIDATIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Anesthesia Observation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Arrhythmia Course (or passing exam in GNO)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICU Rotation (inexperienced staff)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phlebotomy practicum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preoperative Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Insertion #1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Insertion #2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Insertion #3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JDH PACU to FSC PACU Float Experience

B. SAFETY/INFECTION CONTROL

Initials Signature

Initials Signature

Initials Signature

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 6 of 7

UCHC Competency Checklist: ORIENTATION: RN

 

 

 

 

 

 

Position Title: Registered Nurse, JDH

Employee Name: ________________

Unit: JDH PACU

 

 

 

 

 

 

 

 

 

 

 

 

Cluster Area: Critical Care: ICU, CSDU, ED, PACU & ICU Float Pool Float Cluster: FSC Perianesthesia

Start Date: _________________

 

 

 

 

 

 

 

 

 

 

Identifies and locates personal protective equipment

 

 

 

 

E

 

 

 

 

Locates fire alarms, extinguishers and exits

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. EQUIPMENT

 

 

 

 

 

 

 

 

 

 

Code Cart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV Cart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Latex-free supply box

 

 

 

 

 

 

 

 

 

 

Monitors – Dash

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Narcotics Security System

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nurse Call System

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regional Block Cart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scale - electronic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials Signature

Initials Signature

Initials Signature

Revised 4/07, 5/07, 3/10, 3/11, 11/12

Page 7 of 7
Get Nursing Competency Checklist PDF Form

Form Characteristics

Fact Name Description
Purpose The Nursing Competency Checklist is designed to assess and validate essential skills and knowledge for Registered Nurses in a clinical setting.
Orientation Requirement Completion of the checklist is a mandatory part of the orientation process for all new Registered Nurses (RNs) employed at JDH.
Instruction Methods Various instructional methods include self-assessment, observation, education sessions, and return demonstrations.
Evaluation Methods The checklist utilizes different evaluation methods, including written tests, verbal reviews, and clinical practice assessments.
Compliance Tracking All Level 1 competencies must be reviewed and documented in Central Orientation for compliance tracking.
Safety Protocols The checklist emphasizes safety and infection control, requiring nurses to complete safety-related tasks and training.
Equipment Competencies Nurses are required to demonstrate competency in operating crucial medical equipment, including defibrillators and infusion pumps.
State Governing Laws Specific laws governing nursing practices vary by state and can impact training and competency requirements; refer to local regulations for details.

Guidelines on Utilizing Nursing Competency Checklist

Completing the Nursing Competency Checklist form is essential for ensuring that all required competencies are assessed and validated for new Registered Nurses. The form should be filled out carefully to provide a comprehensive overview of each competency. The steps below guide you through the process of accurately completing this document.

  1. Gather Information: Before starting, collect your personal details, including your name, start date, and unit information.
  2. Enter Personal Details: Fill in your name, position title (Registered Nurse), unit (JDH PACU), and start date in the designated fields at the top of the form.
  3. Select Method of Instruction and Evaluation: Familiarize yourself with the key provided for the methods of instruction and evaluation. Mark the appropriate boxes corresponding to each competency being assessed.
  4. Complete Each Competency Section: Go through the sections: A (Getting Into the System), B (Safety/Infection Control), C (Equipment), D (Documentation/Communication), and E (Provision of Care). Mark the appropriate columns as you complete each competency based on your assessment and validation.
  5. Initial and Sign: For each competency you complete, provide your initials in the appropriate space provided. Ensure that the evaluation is clear and indicates whether you are competent or need further instruction.
  6. Submit the Checklist: Once all sections are filled out, submit the completed checklist to your supervisor or the designated personnel for review and recording.

Completing the Nursing Competency Checklist serves to validate and document knowledge and skills essential for safe nursing practice. Keeping a clear record is beneficial for both personal growth and compliance with institutional requirements.

What You Should Know About This Form

What is the Nursing Competency Checklist form?

The Nursing Competency Checklist form is a structured tool designed to assess the skills and competencies of registered nurses during their orientation process. It ensures that new hires demonstrate the necessary knowledge and abilities required to perform in their roles effectively. The checklist covers various competencies, including safety protocols, equipment operation, documentation, and patient care standards.

Who needs to complete this checklist?

All newly hired registered nurses (RNs) in the JDH PACU, Critical Care Units, or other designated clusters are required to complete the Nursing Competency Checklist. This form is crucial for ensuring that each nurse meets the specific expectations and standards of practice within their respective unit.

What are the key components of the checklist?

The checklist encompasses several key areas, including orientation procedures, safety and infection control protocols, equipment competencies, documentation practices, and provision of care. Each section assesses specific skills and knowledge, helping to validate that the nurse is prepared to deliver safe and effective patient care.

How is competency evaluated using this checklist?

Competency evaluation occurs through multiple methods outlined in the checklist. Nurses undergo self-assessments, direct observations, and demonstrations of skills in a clinical setting. In addition, completion of educational sessions and return demonstrations may be required to show proficiency with equipment and procedures.

What happens if a nurse does not meet the competency requirements?

If a nurse does not meet the required competencies outlined in the checklist, a plan for additional training or remediation will be developed. This may include further education sessions, practice opportunities, or one-on-one guidance. The aim is to ensure that the nurse achieves the necessary skills to fulfill their role before they assume full responsibilities.

How often is the checklist updated?

The Nursing Competency Checklist is periodically reviewed and updated to reflect current best practices, regulatory standards, and any changes in equipment or protocols. This ensures that the checklist remains a relevant and effective tool for assessing nursing competencies.

Where can nurses access or submit their completed checklist?

Nurses can access the Nursing Competency Checklist typically from their unit's educational resources or the Department of Nursing website. Upon completion, the checklist should be submitted to the designated individual within their unit, such as the nurse educator or manager, for review and documentation in the nurse's personnel file.

Common mistakes

When filling out the Nursing Competency Checklist form, there are common mistakes that individuals often make. Awareness of these errors can streamline the process and ensure that competencies are accurately documented.

Firstly, many people neglect to complete the Employee Name and Start Date sections. Omitting these critical details can lead to confusion and delays in processing the documentation. Without this information, it becomes challenging to track who is being evaluated and when they started their role.

Secondly, failing to specify the method of instruction or evaluation is another common oversight. Each competency should be assessed with a clearly defined method, such as observation or written tests. Not indicating this can compromise the validity of the evaluation, making it difficult to ascertain how skills were measured.

Additionally, some individuals make the mistake of not initialing once they have completed each section. Missing initials fail to provide verification that the task has been completed. Each section should not only be checked off but also initialed to show personal accountability.

Another frequent error is overlooking the need for periodic reviews of competencies. Some may assume that once they have filled out the checklist, no further action is required. Regular reviews ensure continued adherence to standards, especially as procedures and protocols evolve.

Poor documentation is also a prevalent issue. Some nurses may write vague notes or leave fields incomplete, which can mislead evaluators. Each competency should be documented clearly, providing specific examples when possible.

Furthermore, without a solid understanding of the relevant policies and procedures, applicants might inaccurately assess their competencies. Familiarity with the Nursing Practice Manual and Hospital Administrative Manual is vital. A lack of knowledge can cause individuals to overlook important competencies.

Some individuals also misunderstand the meaning of terms used in the checklist. Using 'never needs instruction' when a competency is only partially understood can misrepresent their capabilities. It is important to evaluate honestly and accurately.

When accessing documents or resources, delays in finding the necessary manuals can hinder completion. Failing to prepare in advance by knowing where resources are located can lead to unnecessary wait times and missed evaluations.

Finally, not engaging with mentors or trainers during the checklist process can serve as a barrier. Seeking guidance often leads to a better understanding of competencies and enhances one's overall preparedness for evaluations. Building a collaborative approach can significantly improve the quality of submissions.

Documents used along the form

The Nursing Competency Checklist form is an essential document for assessing the skills and competencies of registered nurses during their orientation. However, several other forms and documents are commonly used alongside it to ensure comprehensive evaluation and compliance with healthcare standards. Here are some of those additional documents.

  • Performance Improvement Plans: These documents outline specific areas where a nurse's performance may need enhancement. They establish goals, strategies, and timelines for improvement.
  • Clinical Practice Guidelines: Written protocols provide evidence-based practices for various procedures and patient care scenarios. They serve as a reference for nurses to follow in their daily practice.
  • Patient Safety Reports: Documenting incidents related to patient safety helps identify trends and areas for improvement. These reports can be vital for training and accountability.
  • Accreditation Standards: These guidelines from accrediting bodies ensure facilities meet established healthcare standards. Familiarization with these standards is essential for nurses in clinical settings.
  • Self-Assessment Tools: Used by nurses to evaluate their own strengths and weaknesses, these tools help promote personal growth and professional development.
  • Documentation Policies: These outlines detail how nurses should maintain and document patient care records. They ensure clarity, compliance with legal standards, and proper communication.
  • Training Manuals: Comprehensive guides that include protocols, equipment usage, and organizational policies. They provide in-depth knowledge essential for effective patient care.

Utilizing these documents in conjunction with the Nursing Competency Checklist helps create a thorough orientation process. This thoroughness ultimately supports high-quality patient care and elevates the overall performance of nursing staff.

Similar forms

  • Skills Competency Checklist: Similar to the Nursing Competency Checklist, this document outlines essential skills and procedures a healthcare worker must demonstrate proficiency in, focusing on clinical skills and practices.
  • Employee Orientation Checklist: This checklist ensures that new employees complete all necessary trainings and orientation sessions, documenting each item and providing a record similar to the competency evaluation.
  • Clinical Practice Evaluation Form: This form captures data on clinical performance, aligning closely with competency validation by tracking specific actions and decisions made in patient care.
  • Medication Administration Record (MAR): The MAR serves as a formal log for tracking medication administration, similar to how the Nursing Competency Checklist tracks specific competencies and actions for nurses.
  • Patient Care Plan Template: This document outlines expected nursing interventions and outcomes for patients, much like how competences are defined and measured in the checklist.
  • Quality Improvement Audit Tool: Both tools measure competency and compliance in specific practices. This audit tool assesses adherence to established protocols, similar to a competency checklist.
  • Nursing Competency Validation Tool: This form provides a means to assess nursing skills and knowledge according to established standards, closely mirroring the purpose of the Nursing Competency Checklist.
  • Infection Control Practices Checklist: This document audits compliance with infection control policies, akin to how the Nursing Competency Checklist assesses adherence to safety and infection protocols.
  • Staff Development Plan: Like the Nursing Competency Checklist, this plan identifies needed training and development for staff to ensure they meet competency standards within their roles.
  • Patient Safety Incident Report: Both documents document potential safety issues and provide data on nursing performance. Investigation and analysis of incidents can involve similar methodologies as the competencies outlined in the checklist.

Dos and Don'ts

Here are ten things to consider when filling out the Nursing Competency Checklist form:

  • Ensure all personal information, including your name and start date, is accurate and complete.
  • Read each competency carefully before marking it, as this helps in understanding expectations.
  • Utilize the provided method of evaluation key to appropriately assess your competencies.
  • Consult available resources, such as manuals and training guides, when unsure about specific competencies.
  • Document any completed competencies immediately to maintain current records.

Here are five things to avoid when completing the form:

  • Do not leave any sections of the checklist blank unless specified; it may lead to confusion regarding your competencies.
  • Avoid marking a competency as "Done" or "Competent" without sufficient practice or confidence.
  • Do not rush through the evaluation process; take your time to ensure accuracy.
  • Refrain from using abbreviations or unclear terminology that may not be widely understood.
  • Do not submit the form without a thorough review to catch potential errors and confirm completeness.

Misconceptions

Here are some common misconceptions about the Nursing Competency Checklist form:

  1. It only addresses basic nursing tasks. Many believe that the checklist only covers foundational skills. In reality, it includes advanced competencies relevant to various clinical situations, ensuring that nurses are well-prepared for complex care.
  2. Completing the checklist guarantees competency. While the checklist is a valuable tool for evaluation, completing it does not automatically mean that a nurse is competent. Ongoing assessment and practical application of skills are essential for true competency.
  3. Self-assessment is less important than observation. Some think that observation is the only valid way to assess skills. However, self-assessment also plays a crucial role in understanding personal strengths and areas for improvement in nursing practice.
  4. All competencies are assessed at the same time. Many believe that the checklist requires all competencies to be completed in one session. In fact, it allows for flexibility and can be completed over time, accommodating individual learning paces.
  5. The checklist is only for new hires. There is a misconception that only new employees should use the checklist. Existing staff also benefit from regularly reviewing and updating their competencies, ensuring ongoing professional development.

Key takeaways

  • Understand the purpose of the Nursing Competency Checklist. It serves as a tool to verify skills and knowledge for a Registered Nurse.
  • The checklist is structured by unit-specific and departmental competencies to ensure that all relevant skills are covered.
  • Access the Hard Copy and Online Manuals which contain important information related to procedures and protocols.
  • Use various methods of evaluation, such as observation and self-assessment, to gauge competencies effectively.
  • Ensure completion of required documentation on skills acquired during orientation. It is essential for future validations.
  • Engage in safety and infection control practices according to the outlined protocols, as patient safety is paramount.
  • Familiarize yourself with the equipment that you will be using, and ensure proficiency before operating these devices.
  • Prioritize communication skills. Access patient information and document interactions according to established protocols.
  • Participate actively in educational sessions and seek guidance from peers if uncertainty arises during practice.
  • Regularly review and update your competency skills to stay aligned with best practices and institutional changes.

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Form W-8ben-e - Providing this form helps confirm your foreign income status.

Ohio State Tax Forms - Vendor license information is crucial to properly identify the seller on the form.

New York Sales Tax Rate - Privacy notice alerts you that personal information collected will be used for tax administration purposes.