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
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Cardiac Surgery - Immediate Post-op
Congenital Heart Disease/Defects
Bronchopulmonary Dysplasia
Persistent Pulmonary Hypertension
Respiratory Distress Syndrome/Failure
Assist with Intubation/Extubation
Chest Tube Placement and Management
Modes of Ventilation (AC/PC/SIMV/CPAP/BiPAP)
High Frequency Ventilation
Reflexes Based on Gestational Age
Intraventricular Hemorrhage
Meningocele/Myelomeningocele
Neonatal Abstinence Score/Syndrome
Gastroschisis/Omphalocele
Necrotizing Enterocolitis
Breast Milk Handling/Storage
NG/OG/NJ Tube Placement and Management
Infant of Diabetic Mother
Malformations of the GU Tract/Kidney
Assist with Lumbar Puncture
Calculation of Neonatal Dosages
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Administration of Blood/Blood Products
Central Line Catheter/Dressings
Management of UAC/UVC Lines
CARDIAC MONITORING & EMERG. RESPONSE
Attend High Risk Deliveries
Preparation for Transport
PROFESSIONAL KNOWLEDGE AND SKILLS
National Patient Safety Goals/Core Measures
Bereavement/Postmortem Care
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Age Specific/Population-Based Care
Pain Assessment & Management
Interpretation and Communication of Lab Values
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration