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NICU SKILLS CHECKLIST | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| 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. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | PATIENT TYPES | 1 | 2 | 3 | 4 | ||
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Neonates < 28 Weeks | ||||||
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Neonates 29 - 34 Weeks | ||||||
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Neonates > 34 Weeks | ||||||
| Rating Stars (Click) | WORK SETTINGS | 1 | 2 | 3 | 4 | ||
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Level II NICU | ||||||
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Level III NICU | ||||||
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Level IV NICU | ||||||
| Rating Stars (Click) | CARDIOVASCULAR | 1 | 2 | 3 | 4 | ||
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Cardiac Surgery - Pre-op | ||||||
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Cardiac Surgery - Immediate Post-op | ||||||
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Congenital Heart Disease/Defects | ||||||
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CHF/Pulmonary Edema | ||||||
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Hemodynamic Instability | ||||||
| Rating Stars (Click) | PULMONARY | 1 | 2 | 3 | 4 | ||
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Bronchopulmonary Dysplasia | ||||||
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Diaphragmatic Hernia | ||||||
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Fresh Tracheostomy | ||||||
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Meconium Aspiration | ||||||
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Persistent Pulmonary Hypertension | ||||||
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Pneumonia | ||||||
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Respiratory Distress Syndrome/Failure | ||||||
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Interpretation of ABGs | ||||||
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Assist with Intubation/Extubation | ||||||
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Endotracheal Suctioning | ||||||
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Chest Tube Placement and Management | ||||||
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Modes of Ventilation (AC/PC/SIMV/CPAP/BiPAP) | ||||||
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High Frequency Ventilation | ||||||
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Inhaled NO | ||||||
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ECMO | ||||||
| Rating Stars (Click) | NEUROLOGIC | 1 | 2 | 3 | 4 | ||
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Ballard/Dubowitz | ||||||
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Reflexes Based on Gestational Age | ||||||
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Hydrocephalus | ||||||
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Intraventricular Hemorrhage | ||||||
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Meningocele/Myelomeningocele | ||||||
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Neonatal Abstinence Score/Syndrome | ||||||
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Seizures | ||||||
| Rating Stars (Click) | GASTROINTESTINAL | 1 | 2 | 3 | 4 | ||
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Colostomy/Ileostomy | ||||||
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Gastroschisis/Omphalocele | ||||||
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GI Bleeding | ||||||
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Necrotizing Enterocolitis | ||||||
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Post Abdominal Procedure | ||||||
| Rating Stars (Click) | FEEDINGS | 1 | 2 | 3 | 4 | ||
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Breast Milk Handling/Storage | ||||||
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Breast Pump | ||||||
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Gavage Feedings | ||||||
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NG/OG/NJ Tube Placement and Management | ||||||
| Rating Stars (Click) | RENAL/ENDOCRINE/GENETIC | 1 | 2 | 3 | 4 | ||
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Circumcision Care | ||||||
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Genetic Disorders | ||||||
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Hypo/Hyperglycemia | ||||||
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Infant of Diabetic Mother | ||||||
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Malformations of the GU Tract/Kidney | ||||||
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Phototherapy | ||||||
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Renal Failure | ||||||
| Rating Stars (Click) | INFECTIOUS DISEASES | 1 | 2 | 3 | 4 | ||
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Neonatal Sepsis | ||||||
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Septic Work Up | ||||||
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Assist with Lumbar Puncture | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
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Calculation of Neonatal Dosages | ||||||
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Antibiotics/Antivirals | ||||||
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Anticonvulsants | ||||||
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Immunizations | ||||||
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Digoxin | ||||||
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IV Vasopressors | ||||||
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Prostaglandin | ||||||
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Bronchodilators | ||||||
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Steroids | ||||||
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Caffeine | ||||||
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Surfactant | ||||||
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Automated Medication Dispensing (i.e. Pyxis, Omnicell) | ||||||
| Rating Stars (Click) | IV THERAPY | 1 | 2 | 3 | 4 | ||
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Administration of Blood/Blood Products | ||||||
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Central Line Catheter/Dressings | ||||||
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Management of UAC/UVC Lines | ||||||
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Radial Arterial Lines | ||||||
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Start IVs | ||||||
| Rating Stars (Click) | CARDIAC MONITORING & EMERG. RESPONSE | 1 | 2 | 3 | 4 | ||
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Attend High Risk Deliveries | ||||||
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Preparation for Transport | ||||||
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Transport Neonate | ||||||
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Rhythm Interpretation | ||||||
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Dysrhythmia Management | ||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||
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National Patient Safety Goals/Core Measures | ||||||
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Bereavement/Postmortem Care | ||||||
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Neonatal Skin Care | ||||||
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Pressure Ulcer Risk Assessment/Prevention | ||||||
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Restraints/Use of Least Restrictive Device | ||||||
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Patient/Family Teaching | ||||||
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Age Specific/Population-Based Care | ||||||
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Isolation Precautions | ||||||
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Infection Prevention | ||||||
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Pain Assessment & Management | ||||||
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Charge Experience | ||||||
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Interpretation and Communication of Lab Values | ||||||
| Rating Stars (Click) | EMR | 1 | 2 | 3 | 4 | ||
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Epic | ||||||
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Cerner | ||||||
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Eclipsys | ||||||
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McKesson | ||||||
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Meditech | ||||||
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Other Computerized System | ||||||
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Computerized Physician Order Entry | ||||||
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Bar Coding for Medication Administration | ||||||
| EMR Conversion | |||||||
| CERTIFICATIONS | Expiry Date : | ||||||
| BLS | |||||||
| NRP | |||||||
| PALS | |||||||
| S.T.A.B.L.E | |||||||
| NCC Certification - RNC-NIC | |||||||
| Other: Specify | |||||||
| Other: Specify | |||||||