Telemetry Skills Checklist
Name: Date:
In order to provide suitable assignments for you, this checklist is intended as a method of assessing your professional proficiency. Please rate your skill
level as accurately as possible by placing a check (√) in the appropriate box.
1 = No experience; Theory/observed only 2 = Limited competency; < 5 times per year; Needs supervision 3 =
Acceptable competency; > 5 times per year 4 = Competent; Performs on a daily or weekly basis; Proficient
Skill Level 1 2 3 4 Skill Level 1 2 3 4
Cardiac Gastrointestinal cont…
Acute Coronary Syndrome Liver Failure
Congestive Heart Failure Pancreatitis
Post Open Heart (12-24 hours) Liver Transplant
Carotid Endarterectomy Pancreas Transplant
Post Vascular Surgery Renal/Genitourinary
Heart Transplant Renal Failure
Pacemaker - Temporary / Permanent Renal Surgery
Pacemaker - Epicardial Renal Transplant
Sheath Removal Arteriovenous Fistula/Shunt
Heart Sounds Nephrostomy Tubes
Pulmonary Peritoneal Dialysis
Pneumonia Endocrine Metabolic
Respiratory Distress Diabetes - Hypo/Hyperglycemic Crisis
COPD Pituitary Disorders
Breath Sounds IV Insulin Protocols
Post Thoracic Surgery Indwelling Insulin Pumps
Chest Tube Placement & Management Medications
Trach Management Anti-Arrhythmias
Modes of Ventilation
Anticoagulants (IV, oral, & injection)
(AC/PC/SIMV/CPAP)
Intubation/Extubation Anti-Hypertensives
External CPAP/BiPAP Anti-Psychotics
Interpretation of Arterial Blood Gases Anti-Seizure Medications
Neurologic & Psychiatric Benzodiazepines
Stroke Scale Assessment Procedural Sedation
CVA Diuretics
Brain Injury Emergency Medications
Post Craniotomy Inhaled Medications
Spinal Cord Injury Insulin
Seizure Disorders Titrate Vasoactive Drips
ETOH/Drug Withdrawal Manage Vasoactive Drips - No Titration
Narcotics/Opioid Analgesics (IV, oral, &
Gastrointestinal Injection)
GI Bleeding Nitrates (Oral & Topical)
Non-Opioid Analgesics (IV, Oral &
GI Surgery
Injection)
1
Medications cont…
Reversal Agents
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e.
Pyxis, Omincell)
IV Therapy
Starting IVs
Central Line Blood Draws
Central Line / Implanted Line Care
Arterial Line Management
TPN & Lipids
Blood Product Administration
Administration of Chemotherapy
Cardiac Monitoring & Emerg
Response
Dysrhythmia Interpretation
Dysrhythmia Management
Obtain 12 Lead EKG
Interpret 12 Lead EKG
Cardioversion
Defibrillation
Malignant Hyperthermia
EMR
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication
Administration
2
Professional
Knowledge and Skills
National Patient Safety Goals/Core
Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of least restrictive device
Patient/Family Teaching
Age Specific / Population-Based Care
Isolation Precautions
Infection Prevention
Pain Assessment & Management
Charge Experience
Interpretation and Communication of
Lab Values
Specialty Beds
Age Specific Practice Criteria
Newborn/Neonate (birth - 30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Please list any areas of expertise below:
I hereby certify that ALL information I have provided to Insigma Healthcare on this
skills checklist is true and accurate. I understand and acknowledge that any
misrepresentation or omission may result in disqualification from employment and/or
immediate termination.
Nurse Signature: Date: