Clinic RN

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Director of Rehab

OT

COTA

PT

PTA

SLP/SLPA

CNA

Director of Nursing

LPN

MDS Coordinator

Medication Aide

LTC RN

Ambulatory RN

Antepartum Postpartum Nursery

Behavioral Health RN

Case Management

Cath Lab RN

Certified Surgical First Assistant

Clinic RN

CVICU RN

CVOR RN

CVOR Surgical Tech

Dialysis RN

Endoscopy RN

Endoscopy Tech

ER RN

High Risk Skills

Home Health RN

Infection Prevention RN

Intensive Care RN

Infusion RN

LDRP RN

LTAC RN

Maternal Fetal/High Risk

Medical Assistant

Medical Surgical / Telemetry

Neonatal Intensive Care

Nurse Manager

OB Tech

Oncology

OR RN

OR/Surg Tech

PACU

Pediatric Emergency Room

Pediatric Intensive Care

Pediatric RN

Rehab RN

Sterile Processing Technologist

Surgical Tech

Tele, PCU, Stepdown RN

Transplant Coordinator RN

Home Health Case Manager

Home Health Clinical Manager

Home Infusion RN

Home Health LPN

Home Health RN

Hospice LPN

Hospice RN

Cath

CT Tech

Dosimetrist

Echo

High Risk Skills

Histotechnologist

Interventional Skills

Mammography Skills

MRI Technologist

Nuclear Medicine Technologist

OR/Surg Tech

Pharmacist

Pharmacy Technician

Radiologic Technologist

Radiation Therapist

Sterile Processing Tech

Ultrasound Tech

Vascular Ultrasound

Cytotechnologist

Histotechnologist

Medical Laboratory Technologist

Medical Technologist

Pathologist Assistant

Phlebotomy

Cath Lab RN

Cath Lab Technologist

Cath EP

Interventional Skills

Anesthesia Tech

Dietician

EKG Tech

Perfusionist

Polysomnographer / RPSGT

Respiratory Therapist

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Marvel Medical Staffing.
- 0 = Not Applicable
- 1 = No Experience
- 2 = Some Experience
- 3 = Intermittent Experience
- 4 = Experienced
- 5 = Very Experienced
*Required Field
CARDIOVASCULAR

0 1 2 3 4 5

Proficiency Rating

Assessment

Auscultation/Irregular Heart Sounds*
Peripheral Edema*
PQRST Assessment*

Interpretation of Labs/Tests

EKG*
Lab Tests (Cardiac Enzymes, Troponin, BNP)*

Equipment & Procedures

Arrhythmia Interpretation*
12-Lead Set Up*
12-Lead Basic Interpretation*
Defibrillation*
External Pacer*

Care of the patient with:

Chest Pain/ACS*
Arrhythmias*
CHF*
AED*
Cardiac Arrest/CPR*

Medications

Nitroglycerin*
Morphine*
Heparin*
ALS (Epinephrine, Atropine, Anti-Arrhythmics)*

PULMONARY

0	1	2	3	4	5

Assessment

Abnormal Breath Sounds (Wheezing, Stridor, Crackles)*
Abnormal Breathing Pattern (Rapid, Labored, Slow)*

Interpretation of Lab/Tests

Pulse Oximetry*
ABGs*

Equipment & Procedures

Oxygen Therapy (Nasal Cannula, Face Mask)*
Manual Resuscitation Bag (MRB, Ambu Bag)*
Metered-Dose Inhaler (MDI)*
Nebulizers*

Care of the patient with:

Aspiration*
Asthma/Reactive Airway Disease*
COPD*
Pneumonia*
Pulmonary Edema*
Pulmonary Embolism*

Medications

Bronchodilators*
Steroids*
Diuretics*

NEUROLOGICAL

0	1	2	3	4	5

Assessment

Signs & Symptoms of Stroke*
Altered LOC*

Equipment & Procedures

Assist with Lumbar Puncture*
Cervical Collar*
Spinal Immobilization*

Care of the patient with:

Head Injury*
Meningitis*
Migraine*
Seizures*
TIA/Stroke*

Medications

Imitrex (Sumatriptan Succinate)*
Phenobarbitol*
Dilantin (Phenytoin)*
Depakote*
Analgesics*

ORTHOPEDICS

0	1	2	3	4	5

Assessment

Range of Motion*
Color, Warmth, Movement, Sensation*
Fracture/Dislocation*

Equipment & Procedures

Apply Splints*
Assist with Casting*
Assist with Reduction of Dislocation*
Spinal Immobilization*
Transfer Boards*

Care of the patient with:

Cast/Splint*
Dislocation*
External Appliance*
Sprain/Fracture*

Medications

Analgesia/Sedation*

GASTROINTESTINAL

0	1	2	3	4	5

Assessment

Bowel Sounds*
Distention*
Fluid Balance*
Nutritional Status*

Equipment & Procedures

Enemas*
Gastric Lavage*
G-Tubes*
NG Tubes*

Care of the patient with:

Colostomy*
Constipation/Impaction*
Diarrhea*
G-Tube (Reinsertion/Replacement)*
Nausea/Vomiting*

Medications

Ipecac*
Charcoal*
Antiemetics*
Antispasmodics*

RENAL/GENITOURINARY

0	1	2	3	4	5

Proficiency Rating

Assessment

Fluid Status*
Shunt/Fistula (Thrill/Bruit)*

Interpretation of Labs

BUN/Creatinine/Electrolytes*

Equipment & Procedures

Urine Dipstick/C&S*
Placement & Management of Bladder Catheters*

Care of the patient with:

Pyelonephritis/UTI*
Obstruction*
Renal Calculi*
Renal Trauma*
Testicular Torsion*
Priapism*

Medications

Antibiotics*

ENDOCRINE/METABOLIC

0	1	2	3	4	5

Proficiency Rating

Assessment

Hypo/Hyperglycemia*

Interpretation of Labs

Blood Glucose*
Urine Ketones*

Equipment & Procedures

Bedside Blood Glucose Monitoring*

Care of patient with:

Hypoglycemia/Insulin Shock*
Hyperglycemia/DKA*

Medications

Dextrose*
Insulin*
Oral Hypoglycemics*

EENT

0	1	2	3	4	5

Proficiency Rating

Assessment

Visual Acuity*
Foreign Body*
Enlarged Tonsils*

Equipment & Procedures

Ear Irrigation/Removal Foreign Body*
Eye Injury/Foreign Body/Detached Retina*
Assist with Removal of Nasal Foreign Body*
Epistaxis*
Set Up/Assist Cautery*
Set Up Slit Lamp*

Medications

Silver Nitrate*
Liquid Cocaine*
Anti-Hypertensives*

INFECTIOUS DISEASE

0	1	2	3	4	5

Proficiency Rating

Assessment

Communicable Disease*
Interpret Culture Results*

Equipment & Procedures

Obtain Cultures*
Fever Management*
Isolation*
Reverse Isolation/Hepa Filter*
Use of Personal Protective Equipment*

Care of the patient with:

Communicable Disease*
Infectious Disease*
Immunosuppression/Neutropenia*

Medications

Antibiotics*
Antivirals*

WOUND MANAGEMENT

0	1	2	3	4	5

Proficiency Rating

Burn Care*
Dressing Change*
Ostomy Care*
Wound Repair (Staples/Sutures, etc.)*

PAIN MANAGEMENT

0	1	2	3	4	5

Proficiency Rating

Assessment of Pain Level/Use of Pain Scale*
Assessment of Response to Pain Management Interventions*
Monitoring of Patients after Pain Medication*
Comfort Care*
Moderate Sedation*

PSYCHIATRIC

0	1	2	3	4	5

Proficiency Rating

Assessment

Behavior*
Drug/ETOH*
Risk for Violence*

Equipment & Procedures

Managing Threatening/Violent Behavior*
Psychiatric Hold*

Care of the patient with:

Drug OD*
ETOH OD*
Depression/Anxiety*
Restraints*
Suicide Risk*

Medications

Antipsychotics/Antidepressants*
Reversal Agents*

WOMEN'S HEALTH

0	1	2	3	4	5

Proficiency Rating

Assessment

Vaginal Bleeding*
Doppler/Fetal Heart Tones*
Ectopic Pregnancy*

Equipment & Procedures

Obtain Cultures*
Pelvic Tray*

Care of the patient with:

Ectopic Pregnancy*
Hemorrhage*
Pelvic Inflammatory Disease*
Placenta Abruptio/Previa*
Precipitous Delivery*
Pregnancy-Induced Hypertension*
Spontaneous Abortion*

PEDIATRICS

0	1	2	3	4	5

Child Abuse Recognition/Reporting*
Shaken Baby Syndrome*
Obtaining Consent to Treat*

Assessment

Normal VS for age groups*
Use of Dynamap/Doppler Leg Cuffs for B/P*
Failure to Thrive*

Equipment & Procedures

Assist with Fracture Stabilization*
Cooling/Warming Measures*
Draw Labs (Venous/Butterfly)*
Ear Care-Assist with Cleaning/Wash, Insert Ear Drops*
IM/SQ Medications in Pediatric Patients*
Obtain RSV Culture*
Obtain Urine Culture (Cath/Bag)*
Lumbar Puncture*
Papoose Board/Therapeutic Hold*
Start IV in Pediatric Patient*

Care of the pediatric patient with:

Abdominal Pain*
Aspiration*
Asthma/Reactive Airway Disease*
Burns*
Dehydration*
Epiglottitis*
Fever*
Foreign Object*
Fracture*
Head Injury*
Hypo/Hyperglycemia*
Hypo/Hyperthermia*
Lacerations*
Near Drowning*
Nursemaid's Elbow*

Medications

Ipecac/Charcoal*
Bronchodilators/Nebulizers*
Fluid Replacement*

AGE SPECIFIC COMPETENCIES

0	1	2	3	4	5

Infant (Birth - 1 year)*
Preschooler (ages 2-5 years)*
Childhood (ages 6-12 years)*
Adolescents (ages 13-21 years)*
Young Adults (ages 22-39 years)*
Adults (ages 40-64 years)*
Older Adults (ages 65-79 years)*
Elderly (ages 80+ years)*

MISCELLANEOUS

0	1	2	3	4	5

Intake and Triage*
National Patient Safety Goals*
AMA procedures*
Disaster Management*
Computerized Charting*

Care of the patient with:

Bites*
Hazardous Materials Exposure*
Victims of Acts of Violence*
Application Agreement*
- I certify that the test was filled out to the best of my knowledge.
Signature*
Date*
First Name*
Last Name*
Applicant Email*
Applicant Phone*

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clinic-rn

Clinic RN