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Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently

Settings Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Inpatient oncology unit
Outpatient oncology unit
Hospice / palliative care
Participation in support groups
Death & dying counseling
General Skills Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Awareness of HCAHPS
Advanced directives
Patient / family teaching
Restrictive devices (restraints)
Lift / transfer devices
Specialty beds
End of life care / palliative care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
National Patient Safety Goals
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Labeling
Anticoagulation therapy
Reconciliation
Monitoring conscious sedation
Pain assessment & management
Use of PCA (IV, intrathecal, epidural)
Infection control
Universal precautions
Isolation
Minimize risk for falls
Prevention of pressure ulcers
Wound care
Cardiac Monitoring & Emergency Care
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Obtains 12 lead EKG
Interpretation of rhythm strips
Treatment of dysrythmias
Use of rapid response teams
Cardiac arrest/CPR
O2 therapy & delivery
Pulse oximetry
Use of doppler
IV Therapy
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Starting & maintaining peripheral IVs
Blood draw: venous
Central line care
Blood draw: central line
Care & management of ports
Care & management of PICC / Groshong / Hickman
TPN & lipids
Administration of blood / blood products
Administration of chemotherapy
Continuous infusion
IV push
Oral
Monitoring chemotherapy (does not initiate)
Other
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Diabetes mellitus
Blood Glucose Monitoring (BGM)
Insulin administration
Cardiovascular Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Cardiac assessment
Care of Patient with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
CHF
Cardiac disease (CAD / MI / post CABG)
Hypertension
Pacemakers
Respiratory Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Ascultation of breath sounds
Chest PT
Tracheostomy care
Oral or nasotracheal suctioning
Assist with chest tube insertion & management
Assist with thoracentesis
Care of Patient with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Asthma
COPD
Pneumonia
Tuberculosis
GI/GU Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
NG tube insertion
Long term feeding tube insertion (Dobhoff / Keofeed)
Care of the patient with enteral feedings
Gastrostomy tube
Jejunostomy tube
Colostomy & enterostomal care
Ileostomy
Peritoneal dialysis
Hemodialysis
Care of shunts & fistulas
Nephrostomy tube
Suprapubic catheter
Foley catheter insertion & management
Neuro Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Comprehensive neuro assessment
Seizure precautions
Care of Patient with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Post neuro surgery
TIA/CVA
Degenerative neurological disorders
Oncology Specific Care Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assist with bone marrow biopsy
Immuno- suppression / laminar airflow
Administration of chemotherapy
Use & Administration of the Following:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Fluorouracil (5-FU)
Doxorubicin (Adriamycin)
Methotrexate (amethopterin)
Mitomycin (Mutamycin)
Bleomycin (blenoxane)
Hydroxyurea (Hydrea)
Melphalan (Alkeran)
Usulfan (Myleran)
Etoposide (VP- 16- 213)
Cistplatin
Vinblastine (Velban)
Vincristine (Oncovin)
Cyclo- phosphamide (Cytoxan)
Avastin
Taxol
Herceptin
Carboplatin
Taxotere
Oxaliplatin
Dilantin
Corticosteroids
Decadron
IVIG
Epogen / neupogen
Biotheraputic agents (Rituxan)
Care of the Patient Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Pre & post Bone Marrow Transplant (BMT)
BMT patient care
Patient & donor education
Peripheral blood stem cells
Solid tumors
Hematologic disorders
Autologous BMT
Allogeneic BMT
BMT complications
Infection
Graft rejection
GVHD Graft- Versus- Host Disease
Care of Oncology Adverse Effects Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Nausea / vomiting / diarrhea
Stomatitis
Neuropathy
Neutropenia
Thrombo- cytopenia
Nutritional needs
Fever
Infection
Septic shock
Cardiovascular Compromise
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Cardiac dysrhythmias
Superior vena cava syndrome
Cardiac tamponade
Carotid rupture
Lymphedema
Respiratory Compromise
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Pneumonia
Atelectasis
Pneumothorax
Pleural effusion
Pulmonary embolism
Respiratory distress
GI/GU Compromise
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Bowel obstruction
Renal failure
Pancreatitis
GI bleed
Hematologic Compromise
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
DIC (Disseminated Intravascular Coagulopathy)
Hemorrhage
Fluid & Electrolytes Compromise
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Electrolyte imbalances
Hypercalcemia
Hypovolemia
Skin & Muscle
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Stress fractures
Spinal Cord Compression (SCC)
Care of Patients Receiving Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Radiation therapy
External radiotherapy
Total body irradiation
Intraoperative Radiation Therapy (IORT) & implants
Brachytherapy
Radiation safety procedures
Age Specific Competencies Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Newborn / neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (ages 2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)
ATTESTATION *