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 RIGHTS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Communicates and obtains information while respecting the rights and privacy and confidentiality of information |
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| Involves the patient and family and respects their role in determining the nature of care to be provided, including Advanced Directives |
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| Complies with nursing staff responsibility include in the hospital policy related to Organ Donation |
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| Meets patient and families needs regarding communication, including interpreter services |
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| Provides accurate information to patient and families in a timely manner |
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| LABOR AND DELIVERY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess cervical dilation |
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| Assess labor status |
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| Speculum examination |
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| Obtaining vaginal/cervical cultures |
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| Application of external ECG/TOCO EFM |
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| Application of internal ECG |
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| Interpretation of external/internal ECG |
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| Assisting with insertion of IUPC |
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| Conducting NST/BSST |
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| IV insertion |
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| Pitocin Titration for induction/augmentation |
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| Assist with epidural |
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| Assist/monitor amnioinfusion |
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| Assist with scalp pH test |
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| Assist with vacuum delivery |
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| Assist with forceps delivery |
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| Assist with vaginal delivery |
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| Circulate for cesarean section delivery |
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| Emergency cesarean section set up |
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| Assist with twin deliveries |
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| Assist with breech |
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| Management of D&C |
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| Management of fetal demise/stillborn |
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| Adoption procedures |
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| Management of diabetic mother |
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| Diabetic mother |
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| PIH |
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| Pre-eclamptic |
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| Preterm labor |
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| Prolapsed cord |
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| Abruption |
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| Placenta previa |
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| Retained placenta |
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| Herpes |
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| Uterine prolapse |
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| Hemorrhage |
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| Shoulder dystocia |
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| DIC |
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| Accretia |
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| Episiotomy |
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| Delivery table set-up |
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| MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Magnesium |
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| Pitocin |
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| Terbutaline |
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| Antibiotics |
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| Narcotics |
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| Hemabate |
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| Methergine |
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| Narcan |
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| Insulin |
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| Heparin |
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| MATERNITY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Oobtain cord blood gas |
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| Postpartum care |
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| Nipple care |
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| Episiotomy care |
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| PIH |
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| Pre-eclamptic |
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| Postpartum hemorrhage |
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| Care of newborn |
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| Breastfeeding |
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| Bottle feeding |
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| Infant formulas |
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| D10W |
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| PKU Testing |
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| Stabilize/admit to nursery |
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| Care of newborn with anomaly |
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| Heel sticks/dorsal sticks |
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| Blood glucose monitoring |
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| Phototherapy |
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| Set up/care of newborn receiving phototherapy |
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| Set up/assist with circumcision |
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| Discharge of mother/baby |
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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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