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.
PATIENT TYPES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Neonates < 28 Weeks |
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Neonates 29 - 34 Weeks |
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Neonates > 34 Weeks |
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WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Level II NICU |
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Level III NICU |
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Level IV NICU |
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CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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NEUROLOGIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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FEEDINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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RENAL/ENDOCRINE/GENETIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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INFECTIOUS DISEASES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Neonatal Sepsis |
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Septic Work Up |
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Assist with Lumbar Puncture |
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MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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) |
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IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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CARDIAC MONITORING & EMERG. RESPONSE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 |
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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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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 |
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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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