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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