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 |
![]() |
||||||
Neonates 29 - 34 Weeks |
![]() |
||||||
Neonates > 34 Weeks |
![]() |
||||||
WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Level II NICU |
![]() |
||||||
Level III NICU |
![]() |
||||||
Level IV NICU |
![]() |
||||||
CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cardiac Surgery - Pre-op |
![]() |
||||||
Cardiac Surgery - Immediate Post-op |
![]() |
||||||
Congenital Heart Disease/Defects |
![]() |
||||||
CHF/Pulmonary Edema |
![]() |
||||||
Hemodynamic Instability |
![]() |
||||||
PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Bronchopulmonary Dysplasia |
![]() |
||||||
Diaphragmatic Hernia |
![]() |
||||||
Fresh Tracheostomy |
![]() |
||||||
Meconium Aspiration |
![]() |
||||||
Persistent Pulmonary Hypertension |
![]() |
||||||
Pneumonia |
![]() |
||||||
Respiratory Distress Syndrome/Failure |
![]() |
||||||
Interpretation of ABGs |
![]() |
||||||
Assist with Intubation/Extubation |
![]() |
||||||
Endotracheal Suctioning |
![]() |
||||||
Chest Tube Placement and Management |
![]() |
||||||
Modes of Ventilation (AC/PC/SIMV/CPAP/BiPAP) |
![]() |
||||||
High Frequency Ventilation |
![]() |
||||||
Inhaled NO |
![]() |
||||||
ECMO |
![]() |
||||||
NEUROLOGIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Ballard/Dubowitz |
![]() |
||||||
Reflexes Based on Gestational Age |
![]() |
||||||
Hydrocephalus |
![]() |
||||||
Intraventricular Hemorrhage |
![]() |
||||||
Meningocele/Myelomeningocele |
![]() |
||||||
Neonatal Abstinence Score/Syndrome |
![]() |
||||||
Seizures |
![]() |
||||||
GASTROINTESTINAL | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Colostomy/Ileostomy |
![]() |
||||||
Gastroschisis/Omphalocele |
![]() |
||||||
GI Bleeding |
![]() |
||||||
Necrotizing Enterocolitis |
![]() |
||||||
Post Abdominal Procedure |
![]() |
||||||
FEEDINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Breast Milk Handling/Storage |
![]() |
||||||
Breast Pump |
![]() |
||||||
Gavage Feedings |
![]() |
||||||
NG/OG/NJ Tube Placement and Management |
![]() |
||||||
RENAL/ENDOCRINE/GENETIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Circumcision Care |
![]() |
||||||
Genetic Disorders |
![]() |
||||||
Hypo/Hyperglycemia |
![]() |
||||||
Infant of Diabetic Mother |
![]() |
||||||
Malformations of the GU Tract/Kidney |
![]() |
||||||
Phototherapy |
![]() |
||||||
Renal Failure |
![]() |
||||||
INFECTIOUS DISEASES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Neonatal Sepsis |
![]() |
||||||
Septic Work Up |
![]() |
||||||
Assist with Lumbar Puncture |
![]() |
||||||
MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Calculation of Neonatal Dosages |
![]() |
||||||
Antibiotics/Antivirals |
![]() |
||||||
Anticonvulsants |
![]() |
||||||
Immunizations |
![]() |
||||||
Digoxin |
![]() |
||||||
IV Vasopressors |
![]() |
||||||
Prostaglandin |
![]() |
||||||
Bronchodilators |
![]() |
||||||
Steroids |
![]() |
||||||
Caffeine |
![]() |
||||||
Surfactant |
![]() |
||||||
Automated Medication Dispensing (i.e. Pyxis, Omnicell) |
![]() |
||||||
IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Administration of Blood/Blood Products |
![]() |
||||||
Central Line Catheter/Dressings |
![]() |
||||||
Management of UAC/UVC Lines |
![]() |
||||||
Radial Arterial Lines |
![]() |
||||||
Start IVs |
![]() |
||||||
CARDIAC MONITORING & EMERG. RESPONSE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Attend High Risk Deliveries |
![]() |
||||||
Preparation for Transport |
![]() |
||||||
Transport Neonate |
![]() |
||||||
Rhythm Interpretation |
![]() |
||||||
Dysrhythmia Management |
![]() |
||||||
PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
National Patient Safety Goals/Core Measures |
![]() |
||||||
Bereavement/Postmortem Care |
![]() |
||||||
Neonatal Skin Care |
![]() |
||||||
Pressure Ulcer Risk Assessment/Prevention |
![]() |
||||||
Restraints/Use of Least Restrictive Device |
![]() |
||||||
Patient/Family Teaching |
![]() |
||||||
Age Specific/Population-Based Care |
![]() |
||||||
Isolation Precautions |
![]() |
||||||
Infection Prevention |
![]() |
||||||
Pain Assessment & Management |
![]() |
||||||
Charge Experience |
![]() |
||||||
Interpretation and Communication of Lab Values |
![]() |
||||||
EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Epic |
![]() |
||||||
Cerner |
![]() |
||||||
Eclipsys |
![]() |
||||||
McKesson |
![]() |
||||||
Meditech |
![]() |
||||||
Other Computerized System |
![]() |
||||||
Computerized Physician Order Entry |
![]() |
||||||
Bar Coding for Medication Administration |
![]() |