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.
WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
L and D |
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LDRP |
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Antepartum |
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Mother Baby |
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ANTEPARTUM | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Diabetes |
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Fetal Demise |
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HELLP Syndrome |
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Hyperemesis |
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Immunologic Disorder |
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Infectious Disease |
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Multiple Gestation |
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Placenta Previa/Abruptio |
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Pre-Term Labor |
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Premature Rupture of Membranes |
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SPECIAL PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Conduct Stress Test |
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Conduct Non-Stress Test |
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Assist with External Version |
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Assist with Umbilical Blood Sampling |
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Use of Nitrazine/Fern Test |
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PAIN MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Epidural Anesthesia |
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General Anesthesia |
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Spinal Anesthesia |
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Response to Pain Management |
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FETAL MONITORING | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
External |
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IUPC Placement/Monitoring |
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Spiral Electrode Placement |
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Identify, Document & Treat Abnormal FHR Patterns |
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LABOR MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Auscultate Fetal Heart Tones |
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Determine Fetal Position |
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Assess Contraction Characteristics |
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Assess Status of Membranes |
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Assess Station/Dilation/Effacement |
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Positioning |
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Leopold's Maneuver |
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Assess for Reflexes/Clonus |
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Bladder Catheterization |
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Amnioinfusion (Assist or Perform) |
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Recognize Complications of AROM |
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DELIVERY MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Delivery Table Set Up |
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Circulate Vaginal Delivery |
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Circulate C - Section |
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Scrub C - Section |
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NEONATAL MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Radiant Warmer |
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APGAR Scores |
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Neonatal Vital Signs |
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Neonatal Resuscitation |
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Naso/Oropharyngeal Suctioning |
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Bulb Syringe Suction |
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COMPLICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Placenta Previa/Abruptio |
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Asthma |
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Cardiac Disease |
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Chorioamnionitis |
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Diabetes |
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Pregnancy Induced Hypertension |
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HELLP |
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Hemolytic Anemia |
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Hemorrhage |
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HIV Positive |
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HBV Disease |
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Malpresentations |
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Multiple Gestation |
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Pre-Term Labo |
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Fetal Demise |
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Rh Disease |
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POST PARTUM CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Vaginal Delivery |
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Cesarean Section |
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Anesthesia - General |
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Anesthesia - Spinal |
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Bladder Distention |
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Breast Milk Collection and Storage |
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Breast Pump |
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Breastfeeding - Latch Score |
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Breastfeeding - Supplemental Feeding |
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Breastfeeding Support |
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Contraceptive Education |
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Epidural/PCA |
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Homan's Sign |
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Multiple Births |
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Parent/Infant Interaction/Attachment |
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Post Partum Hemorrhage |
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Pregnancy Induced Hypertension |
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MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Antibiotics/Antivirals |
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Antihypertensives |
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Antiseizure |
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Betamethasone |
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Insulin |
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Magnesium Sulfate |
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Methergine |
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Opioids and Reversal Agents |
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Pitocin |
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Terbutaline |
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IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Start Ivs |
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IV Management |
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Blood Product Administration |
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NEWBORN CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Newborn Assessment |
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Infant Vital Signs |
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Ballard Scale/Dubowitz |
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Car Seat Education |
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Circumcision Care/Teach to Parents |
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Cord Care/Teach to Parents |
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Immunizations - Infant |
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Infant Caretaking Skills |
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Infant Identification and Security |
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Metabolic Screen |
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Jaundice/Bilirubin |
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Phototherapy |
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Thermoregulation |
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PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
National Patient Safety Goals/Core Measures |
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Experience in a Baby Friendly Facility |
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Fall Risk Assessment/Prevention |
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Restraints/Use of Least Restrictive Device |
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Parent/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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Charge Experience |
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Interpretation and Communication of Lab Values |
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EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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EMR Conversion |
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Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Infant (Birth - 1 year) |
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Preschooler (ages 2-5 years) |
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Childhood (ages 6-12 years) |
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Adolescents (ages 13-21 years) |
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Young Adults (ages 22-39 years) |
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Adults (ages 40-64 years) |
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Older Adults (ages 65-79 years) |
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Elderly (ages 80+ years) |
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