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Nap-clinical-competencies - USM NAP Applicant Clinical Competencies Checklist

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OfficeUseOnly
Initials_______
Nurse Anesthesia Program
Clinical Competency Checklist
Name: ____________________________________________________ Date _____________________
Please select the best choice that describes your clinical experience.
Skills Independent
With
Assistance
Limited None
Physical assessment
ECG monitoring
Arterial line monitoring
Central venous pressure monitoring
Pulmonary artery pressure monitoring
Cardiac output monitoring
Neuromuscular blockade monitoring
Intracranial pressure monitoring
Systemic vascular resistance monitoring
Intra-aortic balloon pump monitoring
Conscious sedation monitoring
Intravenous line insertion
Ventilator management
Code management (ACLS etc)
Agents
Daily
Weekly
Never
Dobutamine infusion
Dopamine infusion
Ephedrine bolus
Epinephrine bolus/infusion
Narcotic bolus/infusion
Neuromuscular blocking agent bolus/infusion
Nitroglycerine infusion
Nitroprusside infusion
Norepinephrine infusion
Phenylephrine bolus/infusion
Precedex bolus/infusion
Propofol bolus/infusion
Sedation agents ______________________
Other agents: _________________________
Type of ICU (Check all that apply) Length of time Position
Level I or II
Trauma Center? (Y or N)
Medical
Surgical
Cardiovascular
Neurosurgical
Pediatric
Other (specify, i.e. trauma, transplant, neonatal level III, etc)
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Nap-clinical-competencies - USM NAP Applicant Clinical Competencies Checklist

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Completed 29 November 2019

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