Non-Licensed Nursing Competency Document
Unit Specific – 7N Cardiac Step Down
2010
Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self,
peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.
Name : _______________________________________
Group B
Unit Specific Competencies
Competency: Phlebotomy
Key topics:
 Patient identification
 Patient safety
 Technique
Required:
Completion of Phlebotomy Learning module in Mosby’s Nursing
Skills with test score of 100%. Include Test in your packet.
Click here to access Mosby’s Skills: Mosby's Nursing Skills
1. Search Venipuncture: VACUTAINER Method. DO
NOT SELECT PEDIATRICS.
2. Click on Venipuncture: VACUTAINER Method and
select the Extended Text Version. This is your reading
assignment.
3. You also need to view Illustrations and view the
Demonstration.
4. After you have done steps 3 & 4 you are ready for your
test.
5. Click on the Test icon.
6. Complete the test, print, and turn in with a grade of 100%.
Read and verify understanding of the following policies. Click
here for Signature Sheet – Phlebotomy and include in your
packet.
SA 30-0.05 Patient Identification
CL 30-8.10 Collection of Blood for Laboratory Testing
CL 30-8.22 Labeling of Laboratory Specimens
Phlebotomy Skills Verification: Click here for checklist and have
an RN observe and verify your skills on the provided checklist on
3 successful venipunctures. Include checklist in your packet.
Successful completion of 4 hour Phlebotomy Lab Rotation.
Contact Nurse Educator to set up rotation. Click here for
evaluation sheet to take with you. Instruct Lab personnel to
return form to their Asst Manager.
Competency: Telemetry
Key topics:
 Purpose
 Lead placement
Date Completed
Evaluator
Non-Licensed Nursing Competency Document
Unit Specific – 7N Cardiac Step Down
2010
Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self,
peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.
 Patient education
Required:
Completion of Telemetry Learning module in Mosby’s Nursing
Skills. Click here to access Mosby’s Skills: Mosby's Nursing
Date Completed
Evaluator
Date Completed
Evaluator
Skills
1. Search Electrophysiologic Monitoring Hardwire and
Telemetry
2. Click on Electrophysiologic Monitoring Hardwire and
Telemetry and select the Extended Text Version. This is
your reading assignment.
3. You also need to view Illustrations and view slides 12-17
in Demonstrations.
Your signature verifies
completion:_____________________________
Competency: Cardiac Surgery
Key topics:
 Sternal Precautions
 Chest Tubes
Required:
Completion of module: Sternal Precautions
Click here to access: The Learning Exchange
 Click on My Current Course Schedule to complete or
 Click on Completed Courses and Events to retrieve the
date you completed it.
View chapters 3 & 4 of the Oasis Setup and Operation Video.
Click here to view video:
Setup and Operation Video
Your signature verifies
completion:____________________________
Skills Demonstration – use provided checklist and have
RN/Nurse Educator verify your skills related to chest tubes.
Include checklist in your packet. Click here for checklist: Chest
Tubes
Competency: ACS & PM/ICD Insertion; Pre and Post Procedure Care
Key topics:
 Patient Monitoring
 Patient Safety
Complete ONE of the following:
Skills Demonstration – use provided checklist and have
peer/nurse educator verify your skills related to Groin Prep.
Include checklist in your packet. Click here for checklist: Groin
Prep
Date Completed
Evaluator
Non-Licensed Nursing Competency Document
Unit Specific – 7N Cardiac Step Down
2010
Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self,
peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.
Complete Exemplar Statement regarding the care of a patient post
procedure (i.e. post pacemaker/ICD insertion or post cath). Click
here for form: Exemplar. Include Exemplar in your packet.
Competency: Heart Failure
Key topics:
 Daily Weight Monitoring
 Strict I/O Measurement
Complete ONE of the following:
Skills Demonstration – use provided checklist and have
peer/nurse educator verify your skills related to Daily Weight
Monitoring. Include checklist in your packet. Click here for
checklist: Daily Weights
Complete exemplar statement regarding the care of a heart failure
patient you cared for and specifically describe your interventions
related to intake and output measurements for this patient. Click
here for exemplar statement: Heart Failure
Date Completed
Evaluator
Date Completed
Evaluator
Competency: Technical Skills
Key topics:
 VS
 Clean Catch
 Surgical Scrub
 Assisting RN with Trach Care
Complete ONE of the following:
Skills Demonstration – use provided checklist and have
peer/nurse educator verify your skills related to Obtaining VS.
Include checklist in your packet. Click here for checklist: VS
Skills Demonstration – use provided checklist and have
peer/nurse educator verify your skills related to Obtaining a Clean
Catch Urine Specimen. Include checklist in your packet. Click
here for checklist: Clean Catch
Skills Demonstration – use provided checklist and have
peer/nurse educator verify your skills related to Performing a
Surgical Scrub. Include checklist in your packet. Click here for
checklist: Surgical Scrub
Skills Demonstration – use provided checklist and have
peer/nurse educator verify your skills related to Assisting RN
with Trach Care. Include checklist in your packet. Click here for
checklist: Trach Care
Hospital Wide Competencies
Competency: Safety: Demonstrates ability to respond to emergency situations
Key topics:
 Emergency response (NPSG 15)
Required:
Current BLS (Healthcare provider) or Heartsaver/AED completed
Date Completed
Evaluator
Non-Licensed Nursing Competency Document
Unit Specific – 7N Cardiac Step Down
2010
Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self,
peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.
(Current certification expires _____________)
Completion of Learning Module: Acute Coronary Syndrome in the
Learning Exchange
Click here to access: The Learning Exchange


Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
Competency: Prevention of Harm to Staff: Takes measures to prevent injury to
self and co-workers
Required:
Date Completed
Evaluator
Completion of module: Safety 2010 in the Learning Exchange.
Click here to access: The Learning Exchange


Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
Completes annual safety modules in Vandysafe prior to annual
evaluation; provide date of completion.
 Universal Safety Training
 Patient or Blood and Body Fluid Contact Training
Click here to access: VandySafe
TB Mask Fitting (Date completed) _____________
Click Here for Fit Testing Schedule
Competency: Prevention of Harm to Patients: Takes measures to prevent injury
to patients and families
Key prevention topics:
 Restraint use (NPSG 2, 8, 9, 15)
 Foley cath- related UTI’s (NPSG 7)
 Blood Stream infections (NPSG,7)
 Falls (NPSG 2, 9)
 VAP (NPSG 7)
 Pressure Ulcers (NPSG 7, 14)
Required:
Date Completed
Evaluator
initials*
Date Completed
Evaluator
initials*
Review of Restraint Policy (CL 30-04.18). Click here to access policy
and provide date of review: Restraints
Demonstration of Restraint Application/Discontinuation Competency
at:
 Safety Fair OR
 Unit Based Competency Demonstration
Provide date and include checklist in your packet. Click here for
checklist: Restraints
Compliance Tracking: Provide Date of Completion
Required:
Non-Licensed Nursing Competency Document
Unit Specific – 7N Cardiac Step Down
2010
Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self,
peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.
Standards of Conduct in the Learning Exchange.
Click here to access: The Learning Exchange


Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
HIPAA in the Learning Exchange.
Click here to access: The Learning Exchange


Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
Conflict of Interest: click here to create
conflict of interest disclosure
 Log into the system using your vunetid and password
 Under My Disclosures click on Create Disclosure to the right
of the box
Signed Job Description: click here to access, print, and sign:
CP Job Description
Hemoccult Testing Certification
(Expires annually; list date completed)
VUMC Policy Review in the Learning Exchange:
Click here to access: The Learning Exchange


Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
Equal Employment Opportunity & Affirmative Action (HR – 001)
Anti-Harrassment (HR – 002)
Hours of Work (HR – 003)
Attendance & Punctuality (HR – 026)
Smoking & Tobacco (HR – 031)
Substance Abuse (HR – 035)
Solicitation (HR – 039)
False Claims/Whistleblower (HR – 040)
Dress Code (OP 10-10.16)
I certify that the information and competency data I submitted are true and accurately reflects my
work and abilities to function as a nurse on my unit or area. I understand that my ongoing
professional growth is my responsibility and that I will notify my educator or assistant manager
if I have further training needs. I agree to submit additional competency assessment data if
requested by the Management Team.
Employee: _______________________ _________________________
(print last name, first)
Date: ____________
(signature)
By signing and dating below, I acknowledge that I have read and understand the policies listed
above and that I agree to comply with them as I manage patient care.
Non-Licensed Nursing Competency Document
Unit Specific – 7N Cardiac Step Down
2010
Instructions: Evaluator sign and date each column when it is complete. Evaluator may be self,
peer, or leadership. Provide dates and attach tests, checklists, etc. if applicable.
Employee: _______________________ _________________________
(print last name, first)
Date: ____________
(signature)
Verified by: ________________________________________________
Date: ___________
Please complete this form as documentation of annual competency completion and place in
unit-designated area.