Medical Surgical / Telemetry

Show us what you got

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

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 Surgical / Telemetry

Neonatal Intensive Care

Nurse Manager

OB Tech

Oncology

OR RN

OR/Surg Tech

PACU

Pediatric Emergency Room

Pediatric Intensive Care

Pediatric 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
AGE

0 1 2 3 4 5

0 1 2 3 4 5

Proficiency Rating Frequency Rating
Newborn (birth - 30 days)*
Infant (30 days - 1 year)*
Toddler (1 - 3 years)*
Preschooler (3 - 5 years)*
School Age (5 - 12 years)*
Adolescents (12 - 18 years)*
Young Adults (18 - 39 years)*
Middle Adults (39 - 64 years)*
Older Adults (64+ years)*

GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Standard Precautions*
Isolation Precautions*
Discontinue PIV*
Initiate Peripheral IV*
Lift / Transfer Devices*
Pediatric Respiratory / Cardiac Arrest*
Adult Respiratory / Cardiac Arrest*
Crash Carts*
Defibrillators*
Care of Patients in Restraints*
Pain Management*
Automated Med Dispensing Systems*
List Types:
Care Planning & Discharge Planning*
Patient / Family Education*
Electronic Documentation*
List Types:
Patient Head to Toe Assessment*
Knowledge of Normal Serum Lab Values*
Obtaining Cultures (Blood, Sputum, Swab, Urine)*
Calculate mcg / min and mcg / Kg / min*
Titrating Medications*

PSYCHOLOGICAL

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Overdose / Withdrawl*
Suicidal Precautions*
Manic Disorder / Behavior*
De-escalation techniques*
Depression*

Knowledge and Use of:

Anti-depressants*
Anti-anxiety Medications*
Psych Medications*

MEDICATIONS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Anticoagulants*
Narcotics*
PCA for Pain Control*
Epidural for Pain Control*
Non-narcotic Analgesics*
Topical Medications*
IM Medications*
SQ Medications*
Oral Medications*
IV Push Medications*
IV Drip Medications*
Antibiotics*
Chemotherapy*

NEURO GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Assessing Levels of Consciousness*
Pupil Checks*
Seizure Precautions*
Aneurysm Precautions*
Assisting with Lumbar Puncture*
Use of Hyper / Hypothermia Blanket*

NEURO - CARE OF PATIENTS WITH:

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Stroke*
Spinal Cord Injury - Acute*
Spinal Cord Injury – Long Term*
Neuromuscular Disease*
Alzheimers Disease*

Knowledge and Use of:

Anticonvulsants*
IV Drip Steroids*

CARDIAC GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Cardiac Monitors*
Auscultation of Cardiac Sounds*
EKG - 12 Lead*
Recognizing Basic & Life-Threatening Dysrhythmias*
Cardioversion / Defibrillation*
Pulse Checks*
Interpretation of Cardiac Enzymes*
Use of Doppler*
Use of Automatic BP Cuff (ie Dinamap)*

CARDIAC - CARE OF PATIENTS WITH:

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Angina*
CHF*
Chest Pain*
Post MI*

Knowledge and Use of:

Nitrates (Oral, Topical)*
Antiarrhythmics (Oral)*
Antihypertensives (Oral)*
Heparin Drip*

RESPIRATORY GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

O2 Cannulas / Masks*
Nebulizer Set-up / Use*
Incentive Spirometry*
Chest PT*
Pulse Oximetry*

Suctioning:

Oral*
Tracheostomy Tube*

RESPIRATORY - CARE OF PATIENT WITH:

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

SOB*
Pulmonary Embolism*
Tracheostomy Tube*
COPD*
Asthma Exacerbation*
Pneumonia*
Pre / Post Thoracic Surgery*
Chest Tubes*
Tuberculosis*

Knowledge and Use of:

O2 Therapy*
Bronchodilators*
Oral Steroids*
IV Steroids*
Inhaler*

GASTROINTESTINAL GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Insertion, Care & Maintenance of Nasogastric Tubes (ie Salem Pump, Levine)*
Nasointestinal Tubes (ie Cantor, Miller-Abbot)*
Jejunostomy, Gastrostomy, Cecostomy Tubes*

Tube Feedings via Flexible Tubes:

by Gravity Infusion*
by Feeding Pump*
Collection of Stool Specimens*
Bowel Preparation & Cleansing Procedures*

GASTROINTESTINAL - CARE OF PATIENTS WITH:

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Stoma*
Bowel Obstruction*
Pancreatitis*
Post Abdominal Surgery*
Ileostomy*
Colostomy*
Inflammatory Bowel Disease*
Obstruction*
Hepatitis*

Knowledge and Use of:

Total Parenteral Nutrition (TPN)*
Peripheral Parenteral Nutrition (PPN)*
Antiemetics*
Proton Pump Inhibitors*

RENAL / GU PROBLEMS GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Insertion of Catheter Straight*
Insertion of Catheter Foley*
Bladder Irrigation Continuous*
Bladder Irrigation Intermittent*
Peritoneal Dialysis*
Automatic Cycler Machine*
Collection of Urine Specimens*
Hemodialysis*
A-V Fistula / Shunt Care*
Pre - & Post - Dialysis Care*
Suprapubic Catheter*
Nephrostomy Tube*

RENAL / GU - CARE OF PATIENT WITH:

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Urinary Tract Infection*
Pyelonephritis*
Renal Calculi*
Urinary Retention / Incontinence*

ENDOCRINE GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Performing Fingersticks*
Use of Blood Glucose Meter Device*
Use of Visual Blood Glucose Strips*

Endocrine - Care of Patient With:

Hyper / Hypoglycemia*
DKA*
Thyroid Disorders*

Knowledge and Use of Insulin:

Single Type*
Dextrose*
Mixed Insulins*
Insulin Infusion*

ORTHOPEDIC GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Cast Care*
C.M.S. Checks*
Traction – Skin*
Traction – Skeletal*
Range of Motion*
Use of Assistive Devices*
Applications of Splints Extremities*
Continuous Passive Motion Machine (CPM)*

ORTHOPEDIC - CARE OF PATIENTS WITH:

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Total Joint Replacement*
Rheumatic / Arthritic Disease*
Amputation*

WOUND / SKIN CARE

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Dressing Changes*
Air Fluidized, Low Airloss Beds*
Pressure Relief Mattress / Seat Cushion*
Pressure Sores*
Leg Ulcers*
Burns*

WOUND VACS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Hemovacs*
Jackson-Pratt Tubes*
Penrose Drains*
T-Tubes*
Surgical Wound Irrigations & Dressings*

VASCULAR

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Discontinue PICC*
Care of Patient with DVT*
Draw Blood from Arterial Line*
Draw Blood from Central Line*
Peripheral IV Insertion, Care & Maintenance*
Discontinue Peripheral IV*
IV Infusion Pumps*
CVP Lines – Measurement of CVP*
Central Line Care & Maintenance (including dressing changes)*
Blood / Blood Product Administration*
Multi-Lumen Central Catheters*
Port-A-Caths (Infusa-Ports)*
Continuous Subcutaneous Infusion Pumps*
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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