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This checklist was electronically signed on (Today’s date)
This checklist is designed to guide our client facilities in assessing your proficiency in your nursing specialty. Please use the scale provided to indicate your level of experience and expertise in each of the areas listed below.
Skill Level Indicator:
★ = No Experience
★★ = Requires Training
★★★ = Capable with Supervision
★★★★ = Capable Independently
L and D
LDRP
Antepartum
Mother Baby
Diabetes
Fetal Demise
HELLP Syndrome
Perform Pulses/Circulation Checks
Hyperemesis
Immunologic Disorder
Infectious Disease
Multiple Gestation
Placenta Previa/Abruptio
Pre-Term Labor
Premature Rupture of Membranes
Conduct Stress Test
Conduct Non-Stress Test
Assist with External Version
Assist with Umbilical Blood Sampling
Use of Nitrazine/Fern Test
Epidural Anesthesia
General Anesthesia
Spinal Anesthesia
Response to Pain Management
External
IUPC Placement/Monitoring
Spiral Electrode Placement
Identify, Document & Treat Abnormal FHR Patterns
Auscultate Fetal Heart Tones
Determine Fetal Position
Assess Contraction Characteristics
Assess Status of Membranes
Assess Station/Dilation/Effacement
Positioning
Leopold's Maneuver
Assess for Reflexes/Clonus Tones
Bladder Catheterization
Amnioinfusion (Assist or Perform)
Recognize Complications of AROM
Delivery Table Set Up
Circulate Vaginal Delivery
Circulate C - Section
Scrub C - Section
Radiant Warmer
APGAR Scores
Neonatal Vital Signs
Neonatal Resuscitation
Naso/Oropharyngeal Suctioning
Bulb Syringe Suction
Asthma
Cardiac Disease
Chorioamnionitis
Pregnancy Induced Hypertension
HELLP
Hemolytic Anemia
Hemorrhage
HIV Positive
HBV Disease
Malpresentations
Pre-Term Labo
Rh Disease
Vaginal Delivery
Cesarean Section
Anesthesia - Spinal)
Bladder Distention
Breast Milk Collection and Storage
Breast Pump
Breastfeeding - Latch Score
Breastfeeding - Supplemental Feeding
Breastfeeding Support
Contraceptive Education
Epidural/PCA
Homan's Sign
Multiple Births
Parent/Infant Interaction/Attachment
Post Partum Hemorrhage
Antibiotics/Antivirals
Antihypertensives
Antiseizure
Betamethasone
Insulin
Methergine
Opioids and Reversal Agents
Pitocin
Terbutaline
Start Ivs
IV Management
Blood Product Administration
Newborn Assessment
Infant Vital Signs
Ballard Scale/Dubowitz
Car Seat Education
Circumcision Care/Teach to Parents
Cord Care/Teach to Parents
Immunizations - Infant
Infant Caretaking Skills
Infant Identification and Security
Metabolic Screen
Jaundice/Bilirubin
Phototherapy
Thermoregulation
National Patient Safety Goals/Core Measures
Experience in a "Baby Friendly" Facility
Fall Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Parent/Family Teaching
Age Specific/Population-Based Care
Isolation Precautions
Infection Prevention
Charge Experience
Interpretation and Communication of Lab Values
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Bar Coding for Medication Administration
EMR Conversion
BLS
5
CNRN
ACLS
CCRN
Other:
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
