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ICU RN
Intensive Care RN
Name
*
Full Name
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
Cardiovascular
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Ausculation (rate, rhythm, volume)
Assessment - Blood Pressure/Invasive (A-Line)
Assessment - Heart Sounds/Murmurs
Assessment - Perfusion
Assist with Arterial Line Insertion
Assist with Setup/Insertion of Cardioversion
Assist with Setup/Insertion of PA Catheter/Swan - Ganz
Assist with Setup/Insertion of Pacemaker
Care of Patient - Abdominal Aortic Bypass
Care of Patient - Acute MI
Care of Patient - Cardiac Arrest
Care of Patient - Cardiac Tamponade
Interpret - Cardiac Enzymes
Interpret - Coagulation Studies
Medications - Heparin Drip
Medications - Thrombolytic Therapy
Monitoring - A - Line (radial)
Monitoring - Arrhythmia Interpretation
Monitoring - Cardiac Index
Monitoring - Cardiac Output
Monitoring - CVP
Monitoring - Intra Aortic Balloon Pump
Monitoring - MAP
Monitoring - Pulmonary Artery/Capillary Wedge
Monitoring - PVR
Monitoring - Right Arterial/Left Arterial
Monitoring - Swan-Ganz
Pacemaker - External
Pacemaker - Permanent
Perform - CAVH - D
Perform - Controlled Cardioversion
Perform - Emergency Defibrillation
Perform - Setup and Run 12-Lead EKG
Pulmonary
No Experience
Limited Experience
Experienced
Highly Skilled
Airway Management - Endotracheal/Suctioning
Airway Management - Nasal/Suctioning
Airway Management - Tracheostomy/Suctioning
Assessment - Breath Sounds
Assessment - Rate and Work of Breathing
Assist with Emergency Tracheostomy
Assist with Intubation
Assist with Removal of Chest Tube
Assist with Setup/Insertion of Chest Tube
Assist with Thoracentisis
Care of Patient - Lobectomy
Care of Patient - On Ventilator
Care of Patient - Pneumonectomy
Care of Patient - Pneumothorax
Care of Patient - Pulmonary Embolism
Chest Tube - Use of Pleurevac or Thoraclex
Chest Tube - Use of Water Seal Drainage System
Establishing an Airway
Interpret - Arterial Blood Gases
Perform - Chest Physiotherapy
Perform - Obtain Sputum Specimen
Teach and Understand Incentive Spirometry
Ventilator - Pressure Support
Ventilator Care - CPAP/PEEP
Ventilator Care - High Frequency Jet Ventillator
Ventilator Care - IMV
Ventilator Care - Oscillating
Ventilator Care - Pressure Ventilator
Ventilator Care - Volume Ventilator
Ventilator Care - Weaning
Neurological
No Experience
Limited Expeirence
Experienced
Highly Skilled
Assessment - Cranial Nerves
Assessment - Glascow Coma Scale
Assessment - Reflex/Motor Deficits
Assessment - Visual or Communication Deficits
Assist with Lumbar Puncture
Care of Patient - Coma
Care of Patient - CVA
Equipment - Hyper/Hypothermia Blanket
ICP Management - Medications
ICP Management - Monitoring
ICP Management - Regulation of ICP
ICP Management - Temperature Control
Medications - Barbituate Induced Coma
Medications - Epidural Administration
Gastrointestinal
No Expeirence
Limited Experience
Experienced
Highly Skilled
Assessment - Abdominal/Bowel Sounds
Assessment - Nutrition
Care of Patient - Colostomy
Care of Patient - GI Bleeding
Care of Patient - Liver Failure
Care of Patient - Balloon Tamponade
Equipment - Feeding Pump
Equipment - Flexible Feeding Tube (e.g. Corpak)
Interpret - Blood Chemistry
Monitoring - Gastrostomy Tube
Monitoring - Penrose Drain
Perform - Administer Tube Feeding
Perform - Placement of NG Tube
Interpret - Blood Chemistry
Perform - Setup and Administer TPN/Lipids
Perform - Test for Occult Blood
Perform - Wound Irrigation/Dressing Change
Renal/Genitorinary
No Experience
Limited Expeirence
Experienced
Highly Skilled
Assessment - A-V Fistula
Assessment - Fluid Status
Assessment - Renal/GU System
Care of Patient - A-V Fistula/A-V Graft
Care of Patient - Chronic Renal Failure
Care of Patient - Nephrectomy
Insert and Care for Supra-Pubic Catheter
Interpret - BUN and Creatine
Interpret - Serum Electrolytes
Interpret - Urinalysis
Perform - Insert and Care for Foley
Perform - Manual CAPD Administration
Perform - Peritoneal Dialysis via Automatic Cycler
Endocrine/Metabolic
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Finnegan
Assessment - Fluid and Electrolyte Balance
Assessment - S/S Diabetic Coma
Assessment - S/S Insulin Reaction
Care of Patient - Indwelling Insulin Pump
Interpret - Blood Glucose
Interpret - Thyroid Studies
Medications - Insulin
Medications - Insulin Administration - IV Drip
Medications - Insulin Pump
Pain Management
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Pain Level/Tolerance
Care of Patient - Epidural Anesthesia/Analgesia
Care of Patient - IV Concscious Sedation
Care of Patient - Narcotic Analgesia
Care of Patient - Patient Controlled Analgesia (PCA)
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