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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