Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Ambulatory Orientation,Checklists - Core and Department Specific,Resources


Urology - Departments & Programs, UW Health, Ambulatory Education, Ambulatory Orientation, Checklists - Core and Department Specific, Resources


UROLOGY - CLINICAL TRAINING CHECKLIST ----- This is due three months from hire date------

Employee Name: __________________________________ Employee Credentials:________ Hire Date: ____________

Clinic Location/ number: _______________________ Employee Number ________________________

*Refer to appropriate UWMF policy *** N/A on checklist indicates that it is not indicated for the employee***
***Each area should either be discussed or observed by preceptor***

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Employee is able to gather data relevant to the following:
Benign Prostatic Hyperplasia (BPH) – see signs and symptoms
Erectile dysfunction
Prostate or testicular cancer
Last testicular exam or practice of self exams
Signs and symptoms Benign Prostatic Hyperplasia (BPH):
weak stream, straining, nocturia, double voiding, dribbling

Evaluation of incontinence
Signs and symptoms urinary frequency or urgency
Signs and symptoms hematuria or retention
Signs and symptoms of kidney stones and history of kidney stones
Signs and symptoms of interstitial cystitis
Patient's bed wetting history
Patient's history of Kegel exercises
Patient's history of prostatitis or other prostate problems
Patient's history of prior collagen implants

Signs and symptoms urinary infections

Able to determine patient’s knowledge level/deficit and ability to understand
Able to identify cultural practices related to care
Able to elicits info regarding relationships with significant others

Patient Education- Employee participates in patient/family teaching

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Health Education - Employee demonstrates knowledge & can discuss with

Interstitial Cystitis
Urinary Tract Infections
Kegal Exercises
Urinary Incontinence Male and Female / Surgery for Stress Urinary Incontinence
Bladder Cancer
CT Urogram
Ureteral Stents
Kidney Stones
Nutrition-Lower Sodium, Acidify Urine, Prevention and Treatment Calcium Stone
Prostate Cancer
PSA Test
Testicular Self Examination
Prostate Ultrasound and Biopsy
Erectile Dysfunction
Vacuum Erection Therapy
Add catheter care, PTNS, AUS, and penile prosthesis
Circumcision Care
Bedwetting-Medication vs Wetting Alarm
Undescended Testicles

Employee is able to appropriately care for a patient with the following:
SP Catheter
Foley Catheter*
Teach Self Catheterization
Bladder Training
Kegal Exercises

Demonstrate competence in making consults/referrals to other departments
Clinics diabetics, nutrition specialists, Physical Therapy-incontinence specialists
Oncology and Radiotherapy

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Counseling- demonstrate competence and provide appropriate resources
Gilda’s Club
Women's Health Center
Erectile Dysfunction

Demonstrate competence with the following Equipment/ Supplies
Assure all equipment/supplies are available based on patient needs
Assure all equipment functions before use
Assure all emergency equipment/supplies are current and available at all times
Demonstrate competence in the care of all urology equipment
Demonstrate competence in the TV set up for cystoscopy
Demonstrate competence in set up of prostate US and biopsy equipment
Procedures- Demonstrate competence to assist/set-up/patient care/follow-up
Cystoscopy (rigid, flexible, biopsies, cautery) *
Retrogrades *
Veruca freeze for condyloma
Small surgery set-up (excision of condyloma)
Stent removal with tethers and without
Prostate ultrasound and biopsy
Add Verapamil injections, xiaflex injections, Prostate US and bx in MSC
Proper and complete labeling of specimens and paperwork (as needed)

Diagnostic/therapeutic tests- Demonstrate competence to assist/set-
up/patient care/follow-up

Prostate Ultrasound Machine, Bladder Scanner –should be on own line
Cystometrogram and Stress Test- Dr. Wegenke only
M4 culture
Cytology and Cultures
Guidelines for Expedited Partner Therapy
Urine Dip

Proper and complete labeling of specimens and paperwork (as needed)

Demonstrate competence with Sterilization of Instruments/Autoclaving
Assures instrument cleaning and autoclaving is properly completed
Assures proper wrapping and marking of packs
Assures proper cleaning of autoclave

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Demonstrate competence with the following items related to surgery
Scheduling and Prior authorizations
Different Surgery Packets
Information required for the Surgery Packets

Administration of Medications
Verbalize appropriate dose, mechanism, side effects of the following

Bladder Cancer: Thiotepa, BCG, add mitomycin, interferon
Prostate Cancer: Lupron Depot 1,3,4, 6 month, Zoladex 1 & 3 month-remove
Nilandrone, Casodex, Eulixin.
Erectile Dysfunction: Viagra, Papaverine, Muse, Caverject, Cialis, Levitra,
verapamil and xiaflex

BPH: Cardura, Proscar, Flomax and Hytrin, uroxatrol, avidart, rapiflow, jaclyn
Anticholinergics: Levsin, Levbid-remove both, Detrol, and Detrol LA,
Vesicare, Sanctura, add Myrbetriq and Tovias Enaslex

Antispasmodics/Analgesics: Urispas, Ditropan, Ditropan XL and Pyridium
Anti-calculi: Lithostat and Urex
Antibiotics: Amoxicillian, Ampicillin, Cefazolin, Cephalexin, Ciprofloxacin,
Doxycycline, cephadoxine, levoquin, phosphomycin

Levofloxacin, Nitrofurantoin, TMP/SMX.
Interstitial Cystitis: RIMSO, Elmiron, Heparin, Solucortef

Patient education on vacuum therapy and administration of papaverine.
Administers IM adult, SQ adult *

Demonstrates knowledge of medication refills

Urology Policies (See Urology Policy Book)
Department policy on people with UTI's
Triage and time frame for returning phone calls



I, _________________________________________ (employee name) have completed the Urology Clinical Training Checklist and attest the
information is true and valid. I have demonstrated or discussed these skills and I am responsible for performing patient care as a Certified Medical
Assistant / Licensed Practical Nurse / Registered Nurse (circle one).

__________________________________________________ ___________________
Preceptor Date

____________________________________________________ ___________________
Supervisor Date

__________________________________________________ ___________________
Provider Date

Additional Preceptor Signatures/initials:
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________

Initially Completely 6-13-02, Updated 05-20-03, 08-26-04, 12-15-04, 08-04-05, 8/07, 9/11, 3/2012, 6/2014, 3/2017

 Send the original signed Clinical Training Checklist to Clinical Staff Education – 1035.
 One copy of the signed Clinical Training Checklist should be placed in the clinic’s staff employee’s file, and a copy given to the employee.

Brener, T., Doyle, R.M. (Ed.). (2008). Nursing 2008 drug handbook. Philadelphia, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby Elsevier.
Saunders. (2009). Campbell’s urology. (8th ed.). Philadelphia, PA: Saunders