Med Surg RN Skills Assessment

Medical Surgical RN Skills Assessment

Congrats on taking the necessary step to applying for a travel nursing position with us! Before we can offer you an amazing nursing assignment, the following skills assessment must be completed. Take your time and review your information before submitting. We look forward to seeing your results!

Instructions:

This checklist is for assessing your experience in specific clinical areas. It will not be a determining factor in accepting your application to become an employee of Trusted Nurse Staffing LLC.

Please rate your experience using the following scale (check the appropriate boxes below):

0 = No Experience / Observed Only
1 = Less than 1 year experience
2 = 1 - 2 years of experience
3 = Over 2 years of experience

Your Information: *This question is required.

Today's Date: This question requires a valid date format of MM/DD/YYYY.

calendar

First Name

Last Name

Email Address

Phone Number

MEDS/IV THERAPY *This question is required.

Space Cell	0	1	2	3
Administer PO Medications	Administer PO Medications: 0	Administer PO Medications: 1	Administer PO Medications: 2	Administer PO Medications: 3
Administer NG / GT Meds	Administer NG / GT Meds: 0	Administer NG / GT Meds: 1	Administer NG / GT Meds: 2	Administer NG / GT Meds: 3
Administer IM & SQ Meds	Administer IM & SQ Meds: 0	Administer IM & SQ Meds: 1	Administer IM & SQ Meds: 2	Administer IM & SQ Meds: 3
Peripheral IV Insertion	Peripheral IV Insertion: 0	Peripheral IV Insertion: 1	Peripheral IV Insertion: 2	Peripheral IV Insertion: 3
Mix IV Infusion w/ Additives	Mix IV Infusion w/ Additives: 0	Mix IV Infusion w/ Additives: 1	Mix IV Infusion w/ Additives: 2	Mix IV Infusion w/ Additives: 3
Administer IV Medications	Administer IV Medications: 0	Administer IV Medications: 1	Administer IV Medications: 2	Administer IV Medications: 3
Heparin/Saline Locks	Heparin/Saline Locks: 0	Heparin/Saline Locks: 1	Heparin/Saline Locks: 2	Heparin/Saline Locks: 3
Needle-less Systems	Needle-less Systems: 0	Needle-less Systems: 1	Needle-less Systems: 2	Needle-less Systems: 3
Infusion Pumps	Infusion Pumps: 0	Infusion Pumps: 1	Infusion Pumps: 2	Infusion Pumps: 3
Discontinue Peripheral IVs	Discontinue Peripheral IVs: 0	Discontinue Peripheral IVs: 1	Discontinue Peripheral IVs: 2	Discontinue Peripheral IVs: 3
Pain Assessment/Management	Pain Assessment/Management: 0	Pain Assessment/Management: 1	Pain Assessment/Management: 2	Pain Assessment/Management: 3
IV Rate Calculation	IV Rate Calculation: 0	IV Rate Calculation: 1	IV Rate Calculation: 2	IV Rate Calculation: 3
Antibiotics	Antibiotics: 0	Antibiotics: 1	Antibiotics: 2	Antibiotics: 3
Antihypertensives	Antihypertensives: 0	Antihypertensives: 1	Antihypertensives: 2	Antihypertensives: 3
Anticoagulants	Anticoagulants: 0	Anticoagulants: 1	Anticoagulants: 2	Anticoagulants: 3
Anticonvulsants	Anticonvulsants: 0	Anticonvulsants: 1	Anticonvulsants: 2	Anticonvulsants: 3
Diuretics	Diuretics: 0	Diuretics: 1	Diuretics: 2	Diuretics: 3
IV Conscious Sedation	IV Conscious Sedation: 0	IV Conscious Sedation: 1	IV Conscious Sedation: 2	IV Conscious Sedation: 3

VASCULAR *This question is required.

Space Cell	0	1	2	3
Draw Blood for Lab Studies	Draw Blood for Lab Studies: 0	Draw Blood for Lab Studies: 1	Draw Blood for Lab Studies: 2	Draw Blood for Lab Studies: 3
Administer Blood	Administer Blood: 0	Administer Blood: 1	Administer Blood: 2	Administer Blood: 3
Administer Blood Products	Administer Blood Products: 0	Administer Blood Products: 1	Administer Blood Products: 2	Administer Blood Products: 3
Hyperalimentation / TPN	Hyperalimentation / TPN: 0	Hyperalimentation / TPN: 1	Hyperalimentation / TPN: 2	Hyperalimentation / TPN: 3
Central Venous Lines (CVL)	Central Venous Lines (CVL): 0	Central Venous Lines (CVL): 1	Central Venous Lines (CVL): 2	Central Venous Lines (CVL): 3
CVLs Dressing Change	CVLs Dressing Change: 0	CVLs Dressing Change: 1	CVLs Dressing Change: 2	CVLs Dressing Change: 3
Hickman/Broviac Catheters	Hickman/Broviac Catheters: 0	Hickman/Broviac Catheters: 1	Hickman/Broviac Catheters: 2	Hickman/Broviac Catheters: 3
Intake and Output	Intake and Output: 0	Intake and Output: 1	Intake and Output: 2	Intake and Output: 3
Assess for Edema/Fluid Overload	Assess for Edema/Fluid Overload: 0	Assess for Edema/Fluid Overload: 1	Assess for Edema/Fluid Overload: 2	Assess for Edema/Fluid Overload: 3
Peripheral Pulses	Peripheral Pulses: 0	Peripheral Pulses: 1	Peripheral Pulses: 2	Peripheral Pulses: 3
Ultrasonic Doppler	Ultrasonic Doppler: 0	Ultrasonic Doppler: 1	Ultrasonic Doppler: 2	Ultrasonic Doppler: 3

GENITOURINARY *This question is required.

Space Cell	0	1	2	3
Straight/Foley Cath	Straight/Foley Cath: 0	Straight/Foley Cath: 1	Straight/Foley Cath: 2	Straight/Foley Cath: 3
Obtain/Instruct Clean Catch Urine	Obtain/Instruct Clean Catch Urine: 0	Obtain/Instruct Clean Catch Urine: 1	Obtain/Instruct Clean Catch Urine: 2	Obtain/Instruct Clean Catch Urine: 3
Suprapubic Tube	Suprapubic Tube: 0	Suprapubic Tube: 1	Suprapubic Tube: 2	Suprapubic Tube: 3
Nephrostomy Tube	Nephrostomy Tube: 0	Nephrostomy Tube: 1	Nephrostomy Tube: 2	Nephrostomy Tube: 3
GU Irrigations	GU Irrigations: 0	GU Irrigations: 1	GU Irrigations: 2	GU Irrigations: 3