Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastEmail *Phone No experience: requires education, training and supervision Intermittent experience: may need support or supervise Proficient: consistent experience, independent Expert level: can teach/supervise others. Work settingsICU1234MICU1234CICU1234Neuro ICU1234NICU1234PCU/DOU1234Cardiac Monitoring and Emergency responseCardioversion1234CPR/ Cardiac Arrest1234Defibrillation1234Heart Sounds1234Interpretation of 12 Lead EKG1234Interpretation of dysrhythmias1234Management of dysrhythmias1234Telemetry –on the unit monitoring1234Telemetry- remote monitoring1234Obtain 12 lead EKG1234Use of Rapid Response Teams1234CardiovascularAAA1234Acute Coronary Syndrome1234Carotid Endarterectomy1234Congestive Heart Failure1234Femoral Popliteal Bypass1234Heart Transplant1234Pacemakers/Temporary/Permanent1234Post Cardiac Angiogram1234Post MI1234Post PTCA (Percutaneous transluminal coronary angioplasty)1234Post Vascular Surgery1234Pre/Post Cardiac Cath1234Pre/Post Cardiac Surgery1234Sheath removal1234Endocrine/MetabolicBlood Glucose Monitoring1234Indwelling insulin pumps1234IV insulin protocols1234Management of Hyperglycemia1234Management of Hypoglycemia1234Titration of Insulin drips1234GastrointestinalBariatric surgery1234Bowel obstruction1234Colon resection1234Colostomy1234Feeding tube care and management1234Gastrostomy tube1234GI bleed1234GI surgery1234Ileostomy1234Liver failure1234Liver transplant1234NG tube insertion/ management1234Pancreas transplant1234Pancreatitis1234Whipple1234Genitourinary/RenalBladder suspension1234Continuous bladder irrigation1234Foley catheter insertion female1234Foley catheter insertion male1234Gender reassignment surgery1234Interstim therapy1234Nephrectomy1234Peritoneal dialysis1234Pre/Post Hemodialysis Management1234Pubovaginal sling procedure1234Renal failure1234Renal transplant1234Shunts and Fistula Care1234TURP1234Urogenics1234GynecologyAnterior/Posterior Repair (Colporrhaphy)1234Myomectomy1234Oophorectomy1234Salpingectomy1234Salpingo-oophorectomy1234Total abdominal Hysterectomy1234TVT - Tension Free Vaginal Tape1234TVTO - Trans-Obturator Tape- both procedures for stress urinary incontinence1234Vaginal Hysterectomy1234Vulvectomy1234IV therapy/PhlebotomyAccessing Ports1234Arterial line management1234Blood Product Administration1234Central line blood draw1234Central line care/management1234Monitoring Chemotherapy1234Phlebotomy1234PICC line management1234PICC line management1234TPN/Lipids1234MedicationsAnti-Arrhythmics1234Anticoagulants1234Anti-Hypertensives1234Benzodiazepines1234Emergency Medications1234Epidural analgesia1234Heparin Protocols1234Manage Vasoactive drips-no titration1234Narcotics1234Non-Narcotic analgesics1234PCA1234Procedural Sedation Administration1234Thrombolytic Agents1234Titrate Cardiac drips1234Root Cause Analysis process1234Titrate Vasoactive drips1234Automated Medication Dispensing Systems1234Omnicell1234Pyxis1234Accudose1234Bar Code Medication Administration1234Neurological/PsychiatricAneurysms and repair1234Craniotomy1234CVA1234EED grid/electrode placements1234Intracranial bleeds1234Laminectomy1234Mood Disorders1234Neuromuscular disorders1234Pre/Post neurosurgery1234Post TPA care1234Seizure disorders1234Spinal Cord Injury1234Stroke scale assessment1234Substance Withdrawal1234Traumatic Brain injury1234OncologyBone Marrow Transplant1234Chemotherapy Administration1234Medical Oncology1234Monitoring Chemotherapy1234Radiation Implants1234Surgical Oncology1234OrthopedicsAssessment of peripheral pulses1234Continuous Passive Motion Devices1234Hip Fracture1234Laminectomy1234Ortho trauma1234Total Joint Replacements1234Traction1234PlasticsBreast reconstruction with implants1234Breast reconstruction with tram flap1234Mastectomy1234Skin grafts1234Surgical drains1234RespiratoryAssessment of Breath Sounds1234Chest tubes-Emerson/Pleuravac1234External CPAP/BIPAP1234Interpretation of ABGs1234Intubation/Extubation1234Modes of Ventilation1234Non-invasive airway management1234Pneumonia1234Pre/Post Thoracic Surgery1234Pulmonary Edema1234Pulmonary Embolism1234Pulse Oximetry1234Respiratory distress1234Tracheostomy Management1234Professional Topics and SkillsFall Risk assessment1234Infection Prevention1234Isolation Precautions1234National Patient Safety Goals/Core Measures1234Pain Assessment Management1234SBAR1234Restraint Use1234Wound Care/Wound Vac1234COMPUTERIZED CHARTINGAllscripts1234Cerner1234EPIC1234McKesson1234Meditech1234Other:1234If other, please specifyAge specific competencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234Submit
