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Skills Checklists

Before you can begin applying for NurseChoice assignments, you need to complete a skills checklist. Required by hospitals, this mandatory form highlights your skills, proficiencies and experience in your specialty. The quickest and easiest way to complete your skills checklist is online. Just select your specialty from the list below, enter the necessary information on the form and click to submit. Once we receive your completed skills checklist you will be one step closer to finding a rewarding travel assignment that meets your needs.


Dialysis Nursing Skills Checklist

*
Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name* Middle Name Last Name*
E-Mail Address* Phone Number*
 
1. No experience, requires education, training and supervision 2. Intermittent experience/may need support or supervision
3. Proficient, consistent experience, independent 4. Expert level; Can teach/supervise others
 
WORK SETTINGS
1 2 3 4
 
Anticoagulation Management
 
Apheresis
 
Bicarbonate Dialysate
 
Cannulating Buttonholes
 
Charge Experience
 
Chronic/Outpatient Dialysis
 
Conductivity Testing
 
Continuous Renal Replacement Therapy
 
Dialysis Home Care
 
Fistula Gortex/Bovine Graft
 
Pediatric Dialysis
 
Peritoneal Dialysis
 
Plasmapheresis
 
Predialysis Nursing Assessment
 
Prep Vascular Access
 
Priming Dialyzer
 
Set Up/Initiate Dialysis Treatment
 
ASSESSMENT DURING DIALYSIS
1 2 3 4
 
Administration of Blood and Blood Products
 
Administration of Mannitol
 
Arterial and Venous Pressures
 
Blood Flow Rate
 
Conductivity
 
Management of Anticoagulation
 
Operation of Myron L. Meter
 
Sequential Ultrafiltration/PUF
 
Ultra Filtration Calculation
 
Vascular Access Function
 
PATIENT MANAGEMENT
1 2 3 4
 
Air Embolus
 
Anticoagulation Emergencies
 
Clotted Access/Poor Blood Flow Rate from Catheter
 
Disequilibrium Syndrome
 
Filter Blood Leak
 
Fluid Overload/Dehydration
 
Hyperkalemia
 
Muscle Cramps
 
Pyrogenic Reaction
 
Seizures
 
DIALYSIS EQUIPMENT
1 2 3 4
 
Baxter
 
Cobe
 
Fresenius H/K
 
Gambro
 
Phoenix
 
T Machine
 
Other: Specify
 
PROFESSIONAL KNOWLEDGE AND SKILLS
1 2 3 4
 
Universal Protocol Procedures (Time Out)
 
Fall Risk Assessment/Prevention
 
Infection Prevention
 
Management of Dialysis Equipment Alarms
 
Proton Charting Experience
 
AMI Charting Experience
 
Ecube Charting Experience
 
Patient/Family Teaching
 
Pressure Ulcer Risk Assessment/Prevention
 
Restraints/Use of Least Restrictive Device
 
AGE SPECIFIC/POPULATION BASED CARE
1 2 3 4
 
Neonate/Infant
 
Toddler/Preschool
 
School Age
 
Adolescents
 
Young/Middle Adults
 
Older Adults/Geriatrics
 
EMR
1 2 3 4
 
Allscripts
 
GE
 
Bar Coding for Medication Administration
 
Cerner
 
Computer Physician Order Entry
 
Eclipsys
 
Epic
 
McKesson
 
Meditech
 
Other: Specify
 
Other: Specify
 
EMR Conversion
 
CERTIFICATIONS* (Current at time of completing this form)
 
BLS
 
CNRN
 
ACLS
 
CCRN
 
Other
Dialysis Nursing Skills Checklist, version 6

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided, will result in being ineligible to travel with AMN. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

© 2013 AMN Healthcare, Inc. All rights reserved. Reproduction and distribution of these materials is prohibited without the expressed written authorization of AMN Healthcare, Inc.