Name*
First
Last
Age Specific Care
Proficiency Rating
Frequency Rating
Newborn/Neonate (birth - 30 days) *
Newborn/Neonate (birth - 30 days) proficiency* Newborn/Neonate (birth - 30 days) frequency* Infant (30 days - 1 year) *
Infant (30 days - 1 year) proficiency* Infant (30 days - 1 year) frequency* Toddler (1 - 3 years) *
Toddler (1 - 3 years) proficiency* Toddler (1 - 3 years) frequency* Preschooler (3 - 5 years) *
Preschooler (3 - 5 years) proficiency* Preschooler (3 - 5 years) frequency* School Age Child (5 - 12 years) *
School Age Child (5 - 12 years) proficiency* School Age Child (5 - 12 years) frequency* Adolescents (12 - 18 years) *
Adolescents (12 - 18 years) proficiency* Adolescents (12 - 18 years) frequency* Young Adults (18 - 39 years) *
Young Adults (18 - 39 years) proficiency* Young Adults (18 - 39 years) frequency* Middle Adults (39 - 64 years) *
Middle Adults (39 - 64 years) proficiency* Middle Adults (39 - 64 years) frequency* Older Adults (64+ years) *
Older Adults (64+ years) proficiency* Older Adults (64+ years) frequency* Elderly Adults (over 79+ years) *
Elderly Adults (over 79+ years) proficiency* Elderly Adults (over 79+ years) frequency*
General Skills
Proficiency Rating
Frequency Rating
Standard Precautions *
Standard Precautions proficiency* Standard Precautions frequency* Isolation Precautions *
Isolation Precautions proficiency* Isolation Precautions frequency* Pediatric Respiratory / Cardiac Arrest *
Pediatric Respiratory / Cardiac Arrest proficiency* Pediatric Respiratory / Cardiac Arrest frequency* Adult Respiratory / Cardiac Arrest *
Adult Respiratory / Cardiac Arrest proficiency* Adult Respiratory / Cardiac Arrest frequency* Crash Carts *
Crash Carts proficiency* Crash Carts frequency* Defibrillators *
Defibrillators proficiency* Defibrillators frequency* Basic Cardiac Rhythm Recognition *
Basic Cardiac Rhythm Recognition proficiency* Basic Cardiac Rhythm Recognition frequency* Advanced Cardiac Rhythm Recognition *
Advanced Cardiac Rhythm Recognition proficiency* Advanced Cardiac Rhythm Recognition frequency* Pulse Oximetry *
Pulse Oximetry proficiency* Pulse Oximetry frequency* Care of Patient in Restraints *
Care of Patient in Restraints proficiency* Care of Patient in Restraints frequency* Pain Management *
Pain Management proficiency* Pain Management frequency* Automated Med Dispensing Systems *
Automated Med Dispensing Systems proficiency* Automated Med Dispensing Systems frequency* Automated Med Dispensing Systems *
Automated Med Dispensing Systems proficiency* Automated Med Dispensing Systems frequency* Care Planning & Discharge Planning *
Care Planning & Discharge Planning proficiency* Care Planning & Discharge Planning frequency* Patient / Family Education *
Patient / Family Education proficiency* Patient / Family Education frequency* Electronic Documentation *
Electronic Documentation proficiency* Electronic Documentation frequency* Electronic Documentation *
Electronic Documentation proficiency* Electronic Documentation frequency* Cancer Screening and Detection *
Cancer Screening and Detection proficiency* Cancer Screening and Detection frequency*
Gastrointestinal
Proficiency Rating
Frequency Rating
TPN / PPN Administration *
TPN / PPN Administration proficiency* TPN / PPN Administration frequency* G-Tubes / J-Tubes Feeding and Site Care *
G-Tubes / J-Tubes Feeding and Site Care proficiency* G-Tubes / J-Tubes Feeding and Site Care frequency* Enterostomal Care *
Enterostomal Care proficiency* Enterostomal Care frequency* Dobhoff Insertion *
Dobhoff Insertion proficiency* Dobhoff Insertion frequency* NG Tube Insertion *
NG Tube Insertion proficiency* NG Tube Insertion frequency* Colostomy Irrigation *
Colostomy Irrigation proficiency* Colostomy Irrigation frequency* Colostomy Patient Teaching *
Colostomy Patient Teaching proficiency* Colostomy Patient Teaching frequency* Tube Feeding Assessments *
Tube Feeding Assessments proficiency* Tube Feeding Assessments frequency*
Additional Skills
Proficiency Rating
Frequency Rating
Management of Sudden Wound Dehiscence *
Management of Sudden Wound Dehiscence proficiency* Management of Sudden Wound Dehiscence frequency* Wound Debridement *
Wound Debridement proficiency* Wound Debridement frequency* Wet to Dry Dressing Changes *
Wet to Dry Dressing Changes proficiency* Wet to Dry Dressing Changes frequency* Care of Drains and Tubes *
Care of Drains and Tubes proficiency* Care of Drains and Tubes frequency* Wound Vac *
Wound Vac proficiency* Wound Vac frequency*
Pain Management
Proficiency Rating
Frequency Rating
Pain Assessment *
Pain Assessment proficiency* Pain Assessment frequency* Nonpharmacologic / Alternative Strategies *
Nonpharmacologic / Alternative Strategies proficiency* Nonpharmacologic / Alternative Strategies frequency* Adjuvant Medications for Pain *
Adjuvant Medications for Pain proficiency* Adjuvant Medications for Pain frequency* Oral Pain Medication Administration *
Oral Pain Medication Administration proficiency* Oral Pain Medication Administration frequency* Use of Narcotic Pain Patches *
Use of Narcotic Pain Patches proficiency* Use of Narcotic Pain Patches frequency* IV Push Narcotics *
IV Push Narcotics proficiency* IV Push Narcotics frequency* Use of PCA Pump *
Use of PCA Pump proficiency* Use of PCA Pump frequency* Continuous Narcotic Infusion *
Continuous Narcotic Infusion proficiency* Continuous Narcotic Infusion frequency* Continuous Epidural Infusion *
Continuous Epidural Infusion proficiency* Continuous Epidural Infusion frequency*
Medication Knowledge and Use of
Proficiency Rating
Frequency Rating
Solu - Cortef *
Solu - Cortef proficiency* Solu - Cortef frequency* Prednisone *
Prednisone proficiency* Prednisone frequency* Decadron *
Decadron proficiency* Decadron frequency* Antiemetics *
Antiemetics proficiency* Antiemetics frequency* Benadryl *
Benadryl proficiency* Benadryl frequency*
Blood Draw & IV Therapy
Proficiency Rating
Frequency Rating
Peripheral IV Insertion, Maintenance and Discontinuation *
Peripheral IV Insertion, Maintenance and Discontinuation proficiency* Peripheral IV Insertion, Maintenance and Discontinuation frequency* Peripheral Venous Blood Draw *
Peripheral Venous Blood Draw proficiency* Peripheral Venous Blood Draw frequency* Central Venous Catheters *
Central Venous Catheters proficiency* Central Venous Catheters frequency* Hickman *
Hickman proficiency* Hickman frequency* Obtaining Peripheal Blood Cultures *
Obtaining Peripheal Blood Cultures proficiency* Obtaining Peripheal Blood Cultures frequency* Port - A - Cath Care & Maintenance *
Port - A - Cath Care & Maintenance proficiency* Port - A - Cath Care & Maintenance frequency* Obtaining CVC Blood Cultures *
Obtaining CVC Blood Cultures proficiency* Obtaining CVC Blood Cultures frequency* PICC Line Insertion *
PICC Line Insertion proficiency* PICC Line Insertion frequency* PICC Line Care and Maintenance *
PICC Line Care and Maintenance proficiency* PICC Line Care and Maintenance frequency* IJ Care & Maintenance *
IJ Care & Maintenance proficiency* IJ Care & Maintenance frequency* Groshong Care & Maintenance *
Groshong Care & Maintenance proficiency* Groshong Care & Maintenance frequency* Administration of IV Fluids *
Administration of IV Fluids proficiency* Administration of IV Fluids frequency* Administration of Antibiotics *
Administration of Antibiotics proficiency* Administration of Antibiotics frequency* Administration of Blood and Blood Products *
Administration of Blood and Blood Products proficiency* Administration of Blood and Blood Products frequency*
Chemotherapy / Biotherapy Administration
Proficiency Rating
Frequency Rating
Knowledge of Normal Lab Values *
Knowledge of Normal Lab Values proficiency* Knowledge of Normal Lab Values frequency* Calculate Body Surface Area *
Calculate Body Surface Area proficiency* Calculate Body Surface Area frequency* Care of Patients with Extravasation *
Care of Patients with Extravasation proficiency* Care of Patients with Extravasation frequency* Manage Cytotoxic Spills *
Manage Cytotoxic Spills proficiency* Manage Cytotoxic Spills frequency* Safe Handling of Cytotoxic Agents *
Safe Handling of Cytotoxic Agents proficiency* Safe Handling of Cytotoxic Agents frequency* Handle Body Fluids Post Chemo *
Handle Body Fluids Post Chemo proficiency* Handle Body Fluids Post Chemo frequency* METHODS OF CHEMOTHERAPY / BIOTHERAPY ADMINISTRATION
Oral *
Oral proficiency* Oral frequency* Subcutaneous *
Subcutaneous proficiency* Subcutaneous frequency* IV Push *
IV Push proficiency* IV Push frequency* IVPB & Continuous Infusion *
IVPB & Continuous Infusion proficiency* IVPB & Continuous Infusion frequency* Intrathecal *
Intrathecal proficiency* Intrathecal frequency* Intraperitoneal *
Intraperitoneal proficiency* Intraperitoneal frequency* Intravesicular *
Intravesicular proficiency* Intravesicular frequency* Intrapleural *
Intrapleural proficiency* Intrapleural frequency* KNOWLEDGE AND ADMINISTRATION
Immune Therapy *
Immune Therapy proficiency* Immune Therapy frequency* Growth Factors *
Growth Factors proficiency* Growth Factors frequency* Monoclonal Antibodies *
Monoclonal Antibodies proficiency* Monoclonal Antibodies frequency* CHEMOTHERAPY HORMONAL ANTINEPLASTICS
Antineoplastic Antibiotics *
Antineoplastic Antibiotics proficiency* Antineoplastic Antibiotics frequency* Antimetabolites *
Antimetabolites proficiency* Antimetabolites frequency* Plant Alkaloids *
Plant Alkaloids proficiency* Plant Alkaloids frequency* Alkylating Agents *
Alkylating Agents proficiency* Alkylating Agents frequency*
Education and Care of Patient with following Effects of Chemotherapy / Biotherapy
Proficiency Rating
Frequency Rating
Allergic Reactions - Hives, Itching *
Allergic Reactions - Hives, Itching proficiency* Allergic Reactions - Hives, Itching frequency* Weakness / Dizziness *
Weakness / Dizziness proficiency* Weakness / Dizziness frequency* Fever / Chills *
Fever / Chills proficiency* Fever / Chills frequency* Low Blood Pressure *
Low Blood Pressure proficiency* Low Blood Pressure frequency* Abnormal Lab Values (Neutropenia, Pancytopenia, etc.) *
Abnormal Lab Values (Neutropenia, Pancytopenia, etc.) proficiency* Abnormal Lab Values (Neutropenia, Pancytopenia, etc.) frequency* Fatigue *
Fatigue proficiency* Fatigue frequency* Nausea / Vomiting *
Nausea / Vomiting proficiency* Nausea / Vomiting frequency* Anorexia *
Anorexia proficiency* Anorexia frequency* Constipation / Diarrhea *
Constipation / Diarrhea proficiency* Constipation / Diarrhea frequency* Mucositis / Stomatitis *
Mucositis / Stomatitis proficiency* Mucositis / Stomatitis frequency* Renal or Hepatic Toxicity *
Renal or Hepatic Toxicity proficiency* Renal or Hepatic Toxicity frequency* Cardiac Toxicity *
Cardiac Toxicity proficiency* Cardiac Toxicity frequency* Alopecia *
Alopecia proficiency* Alopecia frequency* Dermatitis *
Dermatitis proficiency* Dermatitis frequency* Cystitis *
Cystitis proficiency* Cystitis frequency* Neurotoxicity *
Neurotoxicity proficiency* Neurotoxicity frequency* Pneumonitis *
Pneumonitis proficiency* Pneumonitis frequency* Infertility *
Infertility proficiency* Infertility frequency* Depression / Anxiety *
Depression / Anxiety proficiency* Depression / Anxiety frequency* Neuropathy *
Neuropathy proficiency* Neuropathy frequency* Altered Skin Integrity *
Altered Skin Integrity proficiency* Altered Skin Integrity frequency*
Psychosocial Care
Proficiency Rating
Frequency Rating
Kubler - Ross Stages of Grieving *
Kubler - Ross Stages of Grieving proficiency* Kubler - Ross Stages of Grieving frequency* Identify Support Groups for Patients / Family *
Identify Support Groups for Patients / Family proficiency* Identify Support Groups for Patients / Family frequency* Self - Care and Coping Skills *
Self - Care and Coping Skills proficiency* Self - Care and Coping Skills frequency* Goal Setting *
Goal Setting proficiency* Goal Setting frequency* Advance Directives *
Advance Directives proficiency* Advance Directives frequency* Quality of Life Issues *
Quality of Life Issues proficiency* Quality of Life Issues frequency* Palliative and Hospice Care *
Palliative and Hospice Care proficiency* Palliative and Hospice Care frequency*
Radiation Therapy
Proficiency Rating
Frequency Rating
Provide Radiation Therapy Teaching *
Provide Radiation Therapy Teaching proficiency* Provide Radiation Therapy Teaching frequency* Provide Skin Care Post - Radiation *
Provide Skin Care Post - Radiation proficiency* Provide Skin Care Post - Radiation frequency*
Assess for S/S of Radiation Therapy Complications / Side Effects
Proficiency Rating
Frequency Rating
External Radiotherapy *
External Radiotherapy proficiency* External Radiotherapy frequency* Total Body Irradiation (TBI) *
Total Body Irradiation (TBI) proficiency* Total Body Irradiation (TBI) frequency* Non-sealed Radioactive Therapy Intraoperative Radiotherapy (IORT) *
Non-sealed Radioactive Therapy Intraoperative Radiotherapy (IORT) proficiency* Non-sealed Radioactive Therapy Intraoperative Radiotherapy (IORT) frequency* Brachytherapy *
Brachytherapy proficiency* Brachytherapy frequency* Radioembolization *
Radioembolization proficiency* Radioembolization frequency* Radiation Safety Precautions *
Radiation Safety Precautions proficiency* Radiation Safety Precautions frequency*
Bone Marrow Transplant
Proficiency Rating
Frequency Rating
Adult BMT *
Adult BMT proficiency* Adult BMT frequency* Pediatric BMT *
Pediatric BMT proficiency* Pediatric BMT frequency* Stem Cell Transplant *
Stem Cell Transplant proficiency* Stem Cell Transplant frequency* Graft Rejection *
Graft Rejection proficiency* Graft Rejection frequency* Veno-occlusive Disease / Graft - Versus - Host Disease (GVHD) *
Veno-occlusive Disease / Graft - Versus - Host Disease (GVHD) proficiency* Veno-occlusive Disease / Graft - Versus - Host Disease (GVHD) frequency* Administration of Interferons *
Administration of Interferons proficiency* Administration of Interferons frequency*
Care of Patients with following Crisis
Proficiency Rating
Frequency Rating
Anaphylaxis *
Anaphylaxis proficiency* Anaphylaxis frequency* S.I.A.D.H. *
S.I.A.D.H. proficiency* S.I.A.D.H. frequency* Superior Vena Cava Syndrome *
Superior Vena Cava Syndrome proficiency* Superior Vena Cava Syndrome frequency* Organ Obstruction *
Organ Obstruction proficiency* Organ Obstruction frequency* Spinal Cord Compression *
Spinal Cord Compression proficiency* Spinal Cord Compression frequency* Tumor Lysis Syndrome *
Tumor Lysis Syndrome proficiency* Tumor Lysis Syndrome frequency* DIC *
DIC proficiency* DIC frequency* Septicemia *
Septicemia proficiency* Septicemia frequency* Tamponade *
Tamponade proficiency* Tamponade frequency* Hypercalcemia *
Hypercalcemia proficiency* Hypercalcemia frequency* Certify your information* I certify that I have provided true and accurate information about my skills and experience to the best of my ability
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