The following has all of the text for you to create your own survey using whatever survey tool you like.
Note that, if you create your own, you may have to modify the output to use the other modules we are deploying in the coming days–to avoid that, use our Google Forms templates.
Template text below:
[Insert Your Institution Name] Nursing Skills Survey
Last Name
__________________________________________
First Name
__________________________________________
Your Primary Clinical Specialty
- Ambulatory
- Cardiac Floor
- Emergency Room
- General Medicine Floor
- ICU
- Labor & Delivery
- Neuro
- Oncology
- Pediatric Floor
- Perioperative Services
- Surgical Floor
- Telemetry
- Other… Please Specify ________________________________
For the following skill sets or work examples, please indicate your skill level for each domain:
SKILLED: This is a part of your current job, and you are very comfortable performing these actions. (e.g. ICU nurse = titrating vasoactive drips, L+D nurse = Care Peri/Postpartum Patient).
NEED TRAINING: You have done this type of work before, but you would need some training or supervision to feel comfortable; or, this is not something you do every day but that you are willing to perform if necessary.
NOT COMFORTABLE: These are skills or tasks that you are either entirely unfamiliar with (and do not think you could learn in a safe way within 1-2 weeks), or that you would NOT be willing to do for any reason.
| SKILL/WORK | SKILLED | NEED TRAINING | NOT COMFORTABLE |
| Bedside Adult Medicine | ◯ | ◯ | ◯ |
| General Inpatient Pediatrics | ◯ | ◯ | ◯ |
| Peri/Postpartum Patients | ◯ | ◯ | ◯ |
| Ventilated Patients | ◯ | ◯ | ◯ |
| Management of CRRT | ◯ | ◯ | ◯ |
| Non-Critical Emergency Dept Patients | ◯ | ◯ | ◯ |
| Management of IV Infusions | ◯ | ◯ | ◯ |
| Titrating Vasoactive Drips | ◯ | ◯ | ◯ |
| Monitoring for Basic Arrhythmias | ◯ | ◯ | ◯ |
| Participating in Code | ◯ | ◯ | ◯ |
| ED Triage | ◯ | ◯ | ◯ |
| Performing ECG | ◯ | ◯ | ◯ |
| Medication Admnistration | ◯ | ◯ | ◯ |
| IV Insertion | ◯ | ◯ | ◯ |
| Foley Insertion | ◯ | ◯ | ◯ |
| NG/OG placement | ◯ | ◯ | ◯ |
| ACLS Certification | ◯ | ◯ | ◯ |
| PALS Certification | ◯ | ◯ | ◯ |