Gastroenterology/Endoscopy Skills Checklist

Please enter your full legal name as it appears on your Social Security Card.

* - Required Fields

* First Name:      * Last Name:      * Date:   (mm/dd/yyyy)

Job Description: Gastroenterology/Endoscopy Registered Nurse Provides professional nursing care activities in the gastroenterology/endoscopy unit for assigned patients. May assist with medical procedures. Ensures that all equipment is functioning properly. Performs assessments, evaluation and documents the nursing process as needed. Education requires a minimum of an associate's degree and is licensed as a registered nurse with at least 2 years of clinical experience. Must be familiar with standard concepts, practices, and procedures within the critical care nursing field as it applies to pediatric population. Performs a variety of tasks and demonstrates critical thinking skills and scientific judgment. Works under general supervision; typically reports to a supervisor and/or manager. A certain degree of creativity and latitude is required.

KEY: For each criteria Score 1: Two plus years Expert Experience Score 2: One-Two Years Current Experience Score 3: Less than one year or Intermittent Experience Score 4: Theory, no experience

CRITERIA	SCORE
	1 2 3 4
Procedures, Assist or Knowledge of
Anoscopy
Bronchoscopy
Colonoscopy
EGD
ERCP
Flexible Sigmoidoscopy
Proper Assessment and Documentation of Conscious Sedation Record
Rigid Protoscopy
Sphincterotomy
Assessory Equipment
Cytology Brushes
Decompression Tubes
Dilators
Baloon
Maloney
Savory
Forceps
Foreign Body Equipment
Polyp Snares
Valley Lab BX
Bleeder Cart Equipment
Bicap Unit
Code Blue Lavage Kit
Endo Pump
Esophageal Banding
Gold Probe/Injector Needle
Scero Needles and Meds
ERCP
Equipment and Stock
Papillatomy
Som Procedure
Stent Placement
Specimen Collection
Biopsies
Cytology
Immuno Supressed Protocol
Manometry and Diagnostic Testing
24 Hour PH Ambulatory Study
Esophogeal Manometry
Liver BX
Paracentesis
Pediatric Procedures
Pediatric Peg Cart
Proper EGD Scopes According to Age
Specific Equipment for Pediatric Scopes
Cleaning
Proper Scope Cleaning
Proper Use of Scope Washers
Storing Scopes
Use of Leak Tester
Age of Patients Cared For
Infants and Toddlers (ages 0-3 years)
Young Children (ages 4-6 years)
Older Children (ages 7-12 years)
Adolescents (ages 13-20 years)
Young Adults (ages 21-39 years)
Middle Adults (ages 40-64 years)
Older Adults (ages 65+ years)
Units Worked
Outpatient Department
Freestanding Clinic
Total Number of Years
Certifications
ACLS
BCLS
IV Certification
NALS
NPR
PALS
Other
Equipment
Please list any equipment not already listed:

AGE SPECIFIC CARE
Please indicate the frequency with which you provide care for each age group inthis specialty area.	1	2	3	4
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)

JCAHO: I acknowledge and understand JCAHO's list of "Do Not Use Abbreviations" : Yes No

The information I have given is true and accurate to the best of my knowledge. I have read and fully understand the job description. By signing below or submitting electronically, I attest that the information provided within this skills checklist represents a full and complete disclosure of information, and is true and correct to the best of my knowledge and belief. I hereby authorize Sagent Healthstaff to release this skills checklist to client facilities for employment purposes.

* I agree with the above statements. : Yes

* Signature: (please type your full name) :

* Date: (mm/dd/yyyy) :