Credential & Previlage Cathlab Nurse

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Clinical Privilege For Cathlab Nurse

Name: Date:

Applicant: In the first columns below, place a check in the appropriate box for each privilege
listed below.
A yes or no response must be entered for every item.
Chairperson: Place your initials in the appropriate column. An entry must be made for every item.

CLINICAL PRIVILEGES Granted with


Yes No Granted Supervision Denied

  The staff nurse assumes primary responsibility for the assessment,


planning, implementation, and evaluation of nursing care for assigned
patients
  Circulating and scrub techniques.

  Quality assurance data collection.

  Digital image processing.

  Intra-aortic balloon setup and maintenance.

  Ensuring the delivery of quality nursing care and lab management


around-the-clock.
  Fostering a dynamic work environment that promotes interdisciplinary
teamwork and provides quality care.
  Serving as a role model and clinical practice resource for the Cardiac
Lab nursing staff.
 
Administers medications and treatments as ordered by physicians and
in keeping with the current clinical nursing practice.

 
Directing, monitoring and evaluating the care delegated to non-
licensed personnel.

 
Performing assessments, developing a plan of care, implementing and
evaluating the care.
 
Responsible/accountable for management of the patient and provision
of care utilizing the nursing process, environment, instrumentation,
and other health care team members.

 
Under the direct supervision of the Director, Cardiac Cath Lab, the
Registered Nurse in the Cardiac Cath Lab is responsible for the
provision of safe and effective care of the patient having invasive or
non-invasive special procedures in the Cardiac Cath Lab to include the
immediate pre-procedure period, during the procedure, and
immediately following the procedure.

 
Must hold a current certificate in C.P.R and A.C.L.S

I hereby certify that I am sound by physical & mental health

__________________________________ ____________
_______________
Signature of Applicant Regn. Number Code Number Date

Do not write below this line

RECOMMENDED BY:

______________________________________
MEDICAL SUPERINTENDENT

DATE:______________________

APPROVED BY:

___________________________________________________
Chairman, Credentialing & Privileging Committee

DATE:______________________

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