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Emergency Room RN
Emergency Room RN
Name
*
First
Last
Date
*
MM slash DD slash YYYY
Self-Assessment Rating Scale
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Age of Patients Cared For
No Experience
Limited Experience
Experienced
Highly Skilled
Newborn/Neonate (Birth-30 days)
Infant (1 mo-1 yr)
Toddler (1-3 yrs)
Preschooler (3-5 yrs)
School age child (5-12 yrs)
Adolescents (12-18 yrs)
Young adults (18-39 yrs)
Middle adults (39-64 yrs)
Older adults (64-79 yrs)
Elderly adults (79+ yrs)
General Skills
*
No Experience
Limited Experience
Experienced
Highly Skilled
Isolation precautions
Pediatric respiratory/cardiac arrest
Adult respiratory/cardiac arrest
Crash carts
Defibrillators
Care of patient in restraints
Pain management
Automated med dispensing systems
Care planning and discharge planning
Patient/family education
Electronic documentation
Patient head to toe assessment
Peripheral IV insertion, care, and maintenance
Triage procedures
Lab values
Procedur for patient signing AMA
Consent for treatment of minor
Disaster protocols
Crisis intervention
Upholding patient's rights
Reporting procedures for acts of violence
Care of patients with infections diseases
Care of patient with central line
Immunocompromised
No Experience
Limited Experience
Experienced
Highly Skilled
Care of patient with - Cancer
Care of patient with - HIV/AIDS
Care of patient with - Hepatitis
Care of patient with - TB
HEENT Disorders - Care of Patient With:
No Experience
Limited Experience
Experienced
Highly Skilled
Set up for lamp exam
Use of Morgan lens irrigation
Ear irrigations
Eye irrigations
Eye patch application
Epistaxis/nasal packing
Visual acuity
Pulmonary
No Experience
Limited Experience
Experienced
Highly Skilled
Pulmonary edema
Pulmonary embolism
ARDS
Trach
COPD
Aspiration
Tuberculosis
Pneumothorax
Intubation/extubation
T-piece
Obtaining arterial blood gases
Setting up of arterial line
Ventilator
O2 mask and cannula
O2 cylinders
Nebulizer set up
Oropharyngeal suction
Nasotracheal suction
Endotracheal suction
Assisting with chest tube insertion
Use of Pleuravac drainage system
Use of Emerson drainage system
Knowledge and Use of:
No Experience
Limited Experience
Experienced
Highly Skilled
Bronchodilators
Racemic epinephrine
Steroids (IV/PO/Inhaled)
Cardiovascular
No Experience
Limited Experience
Experienced
Highly Skilled
Acute MI/angina
CHF
Abdominal aortic aneurysm
Cardiac monitoring
Recognizing arrhythmias
Obtaining 12 lead EKG's
Cardioversion
Open chest heart massage
Assist with insertion of Pacemakers (temp/perm)
Set up and use of CVP
Interpretation of CVP readings
Interpretation of Swan-Ganz readings
Thrombolytic therapy
Anaphylactic shock
Cardiogenic shock
Septic shock
Hypovolemic shock
Administration of blood and blood products
Knowledge and Use of:
No Experience
Limited Experience
Experienced
Highly Skilled
Heparin
Sodium bicarbonate
Lidocaine
Bretylium
Nipride
Dopamine
Isuprel
Digitalis
Atropine
Epinephrine
Dobutrex
Tridil/nitroglycerine
Neurological
No Experience
Limited Experience
Experienced
Highly Skilled
Spinal precautions
Neuro assessment
Use of Glascow coma scale
Acute head injury
Acute TIA/CVA
Acute spinal cord injury
Seizure precautions
Observing for increased intracranial pressure
Assist with lumbar puncture
Knowledge and Use of:
No Experience
Limited Experience
Experienced
Highly Skilled
Narcan
Dilantin
Phenobarbital
Decadron
Mannitol
Solu-Medrol
Gastrointestinal
No Experience
Limited Experience
Experienced
Highly Skilled
GI Bleed
Abdominal wounds
Acute abdominal disorders
Insertion of nasogastric tube
Gastric lavage
Renal
No Experience
Limited Experience
Experienced
Highly Skilled
Renal failure
Peritoneal dialysis
Renal calculi
Pyelonephritis/UTI
OB/GYN
No Experience
Limited Experience
Experienced
Highly Skilled
HELLP syndrome
Spontaneous abortion
Hemorrhage
Placenta previa
Placental abruption
Pre-eclampsia/eclampsia
Emergency delivery
Fetal heart tones
Sexually transmitted disease
Knowledge and Use of:
No Experience
Limited Experience
Experienced
Highly Skilled
Pitocin
Magnesium sulfate
Psychiatric
No Experience
Limited Experience
Experienced
Highly Skilled
Suicidal patient
Overdose
Emergency police hold
ETOH abuse/DTs
Seclusion
Sexual Assault/Child Abuse
No Experience
Limited Experience
Experienced
Highly Skilled
Sexual assault
Signs of abuse
Orthopedic
No Experience
Limited Experience
Experienced
Highly Skilled
Traction
Cast application
Checking C/M/S
OCL splinting
Pins/wires
Closed fracture/dislocation reduction
Application of orthopedic appliances
Lacerations
No Experience
Limited Experience
Experienced
Highly Skilled
Setting up suture tray
Assist with sutures/staples
Steri strips
Trauma
No Experience
Limited Experience
Experienced
Highly Skilled
Air transport of trauma patient
Major trauma
Minor trauma
MAST suit
Burns
No Experience
Limited Experience
Experienced
Highly Skilled
1st degree
2nd degree
3rd degree
Electrocution
Hazardous materials exposure
Radiation exposure
Pediatric General Skills
No Experience
Limited Experience
Experienced
Highly Skilled
Abuse reporting
Vital sign parameters for pediatric patients
Calculating pediatric medication dosages
Knowledge of normal serum lab values
Pediatric
No Experience
Limited Experience
Experienced
Highly Skilled
Febrile seizure
Epiglottitis
Overdose/poison ingestion
Asthma
Near drowning
Environmental
No Experience
Limited Experience
Experienced
Highly Skilled
Hypothermia
Heat stroke/exhaustion
Snake bite
Administration of antivenom
Animal bite
Poison index
Knowledge and Use of:
No Experience
Limited Experience
Experienced
Highly Skilled
Antibiotics
Analgesics
Antiemetics
Sedatives
Medication titration and calculations
Reversal agents
Charcoal
Miscellaneous Instruments/Trays
No Experience
Limited Experience
Experienced
Highly Skilled
Pelvic tray
Cut down tray
Procto tray
CVP tray
Trach tray
Culdocentesis tray
Thoracentesis tray
Signature
*
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