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: Cardiac Surgery
Key prevention topics:
 Sternal Precautions
 Chest Tubes
 External Pacemakers
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.
Date Completed
Evaluator
Date Completed
Evaluator
Demonstrate proficiency in set up and management of Chest Tubes
at one of the following:
 Skills Day


Chest Tube Inservice with participation in group
discussion
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:
 Skills Day


External Pacemaker Inservice with participation in
group discussion
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: Heart Failure
Key prevention topics:
 Core Measures
 Medications
 Patient Education
Required:
Heart Failure Core Measures Exemplar. Complete and include in
packet. Click here for exemplar: Heart Failure Exemplar
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.
AND One of the following:
Complete Heart Failure Case Study. Include document in your
packet. Click here for case study: Heart Failure
Read Heart Failure article and complete post test with score of at
least 90%. Include test in your packet. Click here for article:
http://jama.ama-assn.org/cgi/reprint/287/5/628.pdf and here for test:
Article Test
Watch any two of the Heart Failure Skylight Videos and complete
post test. Include post test in your packet. Click here for test.
1. Heart Failure: Getting Started with Treatment
2. Heart Failure: Eating to Feel Better
3. Heart Failure: Staying Active
4. Heart Failure: Understanding Your Medications
Date Completed
Evaluator
Date Completed
Evaluator
Date Completed
Evaluator
Competency: Acute Coronary Syndrome
Key prevention topics:
 Core Measures
 Medications
 12 Lead ECG
Groin Management
Required:
Attend Radial Band inservice. Provide date of inservice.
Demonstrates proficiency in the set up and completion of 12 Lead
EKG at one of the following:
 Skills Day


12Lead EKG Inservice with participation in group
discussion
At the bedside; have peer/nurse educator check you off
while completing EKG
Include checklist in your packet. Click here for checklist: 12 Lead
Resources in preparation: Mosby's Nursing Skills
Search Electrocardiograms: 12 Lead
Demonstrates proficiency in the management of a patient with a
Femostop at one of the following:
 Skills Day


Femostop Inservice with participation in group
discussion
At the bedside; have peer/nurse educator check you off on
Femostop Management
Include checklist in your packet. Click here for checklist:
Femostop
Resources: Cath Lab Sheath Pull Protocol
AND One of the following:
ACS Exemplar: Identify one patient you cared for with the
diagnosis of Acute MI and tell whether or not your patient met each
core measure; if they did not meet them describe the measures you
took to ensure they did. Click here for Core Measures. Click here
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.
for Exemplar. Other Resources: ‘Specifications Manual for
National Hospital Quality Measures’, version 2.6b'
Include exemplar in your packet.
Complete ACS Case Study and include in your packet. Click here
for Case Study: ACS
Competency: Arrhythmia
Key prevention topics:
 Arrhythmia Identification
 Post Procedure Monitoring
 Equipment
Required:
Complete competency exemplar on Telemetry. Include exemplar in
your packet. Click here for worksheet: Telemetry
Complete competency exemplar on Pacemaker/ICD. Include
exemplar in your packet. Click here for worksheet: PM/ICD
Attend or view as a webcast one Advanced Arrhythmia
Interpretation Session and participate in Group Discussion.
 Live event occurs the 4th Wed. q month 7:30-8:30; RM
5053 MCE; list date attended:_____________
 To view as a webcast click here to begin: Vanderbilt
Date Completed
Evaluator
Date Completed
Evaluator
Heart Webcast Portal; you must register at this portal
then click on the 7N link to get to webcasts; include
certificate in packet
Competency: Peritoneal Dialysis
Key prevention topics:
 Technique
 Infection Prevention
Required:
View Peritoneal Dialysis video and complete post test. click here to
view video; click here for post test. Locate Peritoneal Dialysis
Guide (in the cabinet above the sink at the charge nurse desk) Other
Resources:
Peritoneal Dialysis (PD) Exchange
Peritoneal Dialysis: Postoperative Sterile Dressing Changes for
New PD Catheter Exit Site
Peritoneal Dialysis: Obtaining a Specimen of Effluent Peritoneal
Dialysate
Peritoneal Dialysis: Adding Medication to Peritoneal Dialysis Fluid
Peritoneal Dialysis (PD): Routine Exit Site Catheter Care
Hospital Wide Competencies
Competency: Safety:
Key topics:
Safely responds to emergency situations
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.
 Emergency response (NPSG 15)
 Safe Blood administration (NPSG 1,3)
Required:
Current BLS (Healthcare provider) status
(Current certification expires _____________)
Completion of learning module: Building Blocks of Safe Blood
Administration 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.
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.
AND one of the following:
Date Completed Evaluator
 Current EOR or ACLS
(My current certification expires ________________) OR
 Mock Code experience in new employee orientation, Safety Fair
or Department Based activity (Done every 2 years)
Last Date Completed _________________)
AND one of the following:
Date Completed Evaluator
Blood Administration
Click here for checklist: Blood Administration and complete one of
the following; Include checklist in packet.
 Peer observation of blood transfusion process OR
 Mock transfusion practice/return demonstration in a real or
simulated setting OR
 Peer Documentation Audit of a patient’s medical record that has
received a blood transfusion; click here for audit if you choose to do
audit: Blood Audit Tool
Competency: Communication: Communicates pertinent information to those who need to
know and responds accordingly
Key Topics: (NPSG 1,2,7, 8, 9,14,15)
 Nursing Model Tactics
 Documentation
 Hand-over communication
Required:
Date Completed Evaluator
Completion of module: Universal Protocol Training 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
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.
date you completed it.
Completion of module: Overview of Patient Care 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.
Completion of module: Handover Communication 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
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
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.
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. Restraint use (NPSG 2, 8, 9, 15)
2. Medication Errors (NPSG 3, 8}
3. Foley cath- related UTI’s (NPSG 7)
4. Blood Stream infections (NPSG 7)
5. Pain (NPSG 2, 3, 8)
6. Falls (NPSG 2, 9)
7. VAP (NPSG 7)
8. Pressure Ulcers (NPSG 7, 14)
Required:
Date Completed Evaluator
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
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.
 Unit Based Competency Demonstration
Provide date and include checklist in your packet. Click here for
checklist: Restraints
Completion of module: Moderate Sedation Training 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.
Compliance Tracking: Provide Date of Completion
Required:
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:
RN II Job Description
RN III Job Description
Sure Stepp Flexx Certification
(Expires annually; list date completed)
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)
Date Completed
Evaluator
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.
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.
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.
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.