Licensed Nursing Competency Document
7N Cardiac Step Down - 2012
DUE: 12/31/2012
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 : _______________________________________
Unit Specific Competencies
Competency: Cardiac Surgery
Key prevention topics:
 Chest Tubes
 External Pacemakers
Required:
Date Completed
Evaluator
Date Completed
Evaluator
Demonstrate proficiency in set up and management of Chest Tubes
at one of the following:


Chest Tube Inservice with skills check off
At the bedside; have peer/nurse educator check you off
while caring for a patient with a chest tube.
Include checklist in your packet. Click here for checklist:
CT Checklist
Be prepared to demonstrate your skills. Resources in preparation:
Mosby's Nursing Skills and Atriummed
Demonstrates proficiency in management of External Pacemakers
at one of the following:


External Pacemaker Inservice with skills check off
At the bedside; have peer/nurse educator check you off
while caring for a patient with an external pacemaker.
Include checklist in your packet. Click here for checklist:
PM checklist
Resources: Medtronic External Pacemaker User Manual
Competency: VAD
Key prevention topics:
 Knowledge Assessment
 Skill Demonstration
Required:
Demonstrate proficiency in management of a VAD patient at one of
the following – Must be checked off by VAD Super user or Nurse
Educator:


VAD Inservice with skills checkoff
At the bedside; have superuser/nurse educator check you
off while caring for a patient with a VAD.
Include checklist in your packet. Click here for checklist:
VAD checklist
AND
Successfully completes Heartmate II Competency Assessment Test.
Click here for test: VAD Test
Include test in your packet.
Please complete this form as documentation of annual competency completion and place in
unit-designated area.
Licensed Nursing Competency Document
7N Cardiac Step Down - 2012
DUE: 12/31/2012
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.
Be prepared to demonstrate your skills. Resources in preparation:
Healthcare Provider Training Video
Heartmate II Manual
OR
Date Completed
Evaluator
Date Completed
Evaluator
Date Completed
Evaluator
Date Completed
Evaluator
Attend a Superuser Training Session during current year.
Sign up for class with Nurse Educator. Next class scheduled
for August 27th.
List date of training session: _________________________
Competency: Telemetry
Key prevention topics
 Lead Placement
 Rhythm Identification
Required:
Complete competency exemplar on Telemetry. Include exemplar in
your packet. Click here for worksheet: Telemetry
Competency: Patient Education
Key prevention topics:
 Health Literacy
 Educational Resources
 Patient Education
Required:
View video on Health Literacy and successfully complete quiz.
 Click here for video: Health Literacy Video
 Click here for quiz: Health Literacy Quiz
OR
Complete competency exemplar on Patient Education. Include
exemplar in your packet.
 Click here for worksheet: Patient Education Exemplar
Resources in Preparation:
 Health Literacy – Statistics at a Glance
 Words to Watch Facts Sheet
 Manual: “Health Literacy and Patient Safety: Help
Patients Understand” by the American Medical
Association
Competency: Quality Improvement Initiatives
Key prevention topics:
 Pressure Ulcers
 Falls
 Hand Hygiene
 Pain
Required - Complete 1 of the following:
Pressure Ulcer Prevention: Complete a Pressure Ulcer Prevention
Review on a patient you are assigned to using the tool provided.
Include tool in packet. Click here for tool: Pressure Ulcers
Please complete this form as documentation of annual competency completion and place in
unit-designated area.
Licensed Nursing Competency Document
7N Cardiac Step Down - 2012
DUE: 12/31/2012
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.
Prevention Review
OR
Falls Prevention: Complete a Falls Prevention Review on a patient
you are assigned to. Include tool in packet. Click here for tool:
Falls Prevention Review
OR
Hand Hygiene: Complete 10 hand hygiene observations AND
Infection Prevention Tracer Survey. Record on tools provided.
Include tools in packet. Click here for tools:
 Hand Hygiene Audit Tool
 Infection Prevention Tracer Survey
OR
Pain Assessment Review: Complete a Pain Assessment Review on
a patient you are assigned to using the tool provided. Include tool
in packet. Click here for tool: Pain Assessment Review
Resources in Preparation: Vanderbilt Policies




Pressure Ulcer Prevention and Treatment
Falls Prevention - Adult
Hand Hygiene
Pain Management Guidelines
Hospital Wide Competencies
Competency: Safety:
Safely responds to emergency situations
Key topics:
 Emergency response (NPSG 15)
 Safe Blood administration (NPSG 1,3)
Required:
Date Completed
Current BLS (Healthcare provider) status
(Current certification expires _____________)
Completion of Learning Module: Acute Coronary Syndrome in the
Learning Exchange
Click here to access: The Learning Exchange



Evaluator
Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
This course is part of the VUH 2012 Licensed Nursing
Competency Program in The Learning Exchange.
AND one of the following:
 Current EOR or ACLS
(My current certification expires ________________)
 New requirement for 7N RNs: all RNs are expected to be
ACLS certified by 12/31/2012 or within 1year of hire if
new employee.
OR
 Mock Code experience in new employee orientation, Safety Fair
Date Completed
Evaluator
Please complete this form as documentation of annual competency completion and place in
unit-designated area.
Licensed Nursing Competency Document
7N Cardiac Step Down - 2012
DUE: 12/31/2012
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.
or Department Based activity (Done every 2 years)
Last Date Completed _________________)
AND one of the following:
Date Completed Evaluator
Blood Administration
 Mock transfusion practice/return demonstration in a real or
simulated setting using this checklist: Blood Administration
OR
 Peer observation of blood transfusion process using this
checklist: Blood Audit Tool
Competency: Prevention of Harm to Staff: Takes measures to prevent injury to self and
co-workers
Required:
Date Completed Evaluator
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
Annual TB Mask Fitting. Provide Completion Date:___________
Click Here for Fit Testing Schedule
Competency: Prevention of Harm to Patients:
Takes measures to prevent injury to
patients and families
Key prevention topics:
1. Restraints
2. National Patient Safety Goals
Required:
Completion of module: Patient Restraint Review – Current
Employees in the Learning Exchange.
Click here to access: The Learning Exchange



Date Completed
Evaluator
Click on My Current Course Schedule to complete or
Click on Completed Courses and Events to retrieve the
date you completed it.
This course is part of the VUH 2012 Licensed Nursing
Competency Program in The Learning Exchange.
Demonstration of Restraint Application/Discontinuation –
required every other year.
List date of completion: __________________
Demonstrate Competency at:
 Hands on Clinical Safety OR
 Unit Based Competency Demonstration
Provide date and include checklist in your packet. Click here for
checklist: Restraints
Completion of module: VUH - National Patient Safety Goals
Review 2012 in the Learning Exchange.
Click here to access: The Learning Exchange

Click on My Current Course Schedule to complete or
Please complete this form as documentation of annual competency completion and place in
unit-designated area.
Licensed Nursing Competency Document
7N Cardiac Step Down - 2012
DUE: 12/31/2012
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.
 Click on Completed Courses and Events to retrieve the
date you completed it.
 This course is part of the VUH 2012 Licensed Nursing
Competency Program in The Learning Exchange
Compliance Tracking: Provide Date of Completion
Required:
Standards of Conduct in the Learning Exchange.
Click here to access: The Learning Exchange


Date Completed
Evaluator
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:
RN II Job Description
RN III Job Description
Sure Stepp Flexx Certification
(Expires annually; list date completed)
 Proficiency Testing for recertification is offered on the 1st
Tuesday of every month in TVC Room 4801 from
7:30 AM – 2:00 PM.
 The written tests can be taken prior to arrival for the
proficiency testing. Tests can be found in The Learning
Exchange Search the title above and assign yourself
the module.
Hemoccult Testing Certification
(Expires annually; list date completed)
 Proficiency Testing for recertification is offered on the 1st
Tuesday of every month in TVC Room 4801 from
7:30 AM – 2:00 PM.
 The written tests can be taken prior to arrival for the
proficiency testing. Tests can be found in The Learning
Exchange Search the title above and assign yourself
the module.
VUMC Policy Review in the Learning Exchange:
Click here to access: The Learning Exchange
 Click on My Current Course Schedule to complete or
Please complete this form as documentation of annual competency completion and place in
unit-designated area.
Licensed Nursing Competency Document
7N Cardiac Step Down - 2012
DUE: 12/31/2012
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.
 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)
CNE Requirement: attach copies of certificates
RNII requirement: 10 hours
RNIII requirement: 15 hours
List Professional Certifications:
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.
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.
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.