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 | ||
Couplet Care |
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Antepartum |
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Postpartum |
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Newborn Nursery |
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LDRP |
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POST PARTUM | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Vaginal Deliver |
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Cesarian Section |
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Anesthesia - General |
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Anesthesia - Local |
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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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Tubal Ligation |
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ANTEPARTUM | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Amniocentesis |
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Cardiac Disorders |
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Diabetes |
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Hyperemesis |
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Multiple Gestation |
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Non-Stress Test |
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PIH/HELLP |
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Placenta Previa/Abruptio |
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Post- Trauma |
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Pre-Term Labor/Premature Rupture of Membranes |
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Substance Abuse |
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FHM Interpretaton and Management |
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Fetal Assessment |
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Labor Assessment |
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Assist with Ultrasound |
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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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Cervical Ripening Agents |
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Immunizations - Mother |
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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 | ||
Starting 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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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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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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Pressure Ulcer 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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Pain Assessment & Management - Adult |
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Pain Assessment & Management - Neonate |
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Charge Experience |
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Interpretation and Communication of Lab Values |
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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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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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Other: Specify |
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Other: Specify |
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FHM - Other Specify |
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