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
Communicates and obtains information while respecting the rights and privacy and confidentiality of information
Involves the patient and family and respects their role in determining the nature of care to be provided, including Advanced Directives
Complies with nursing staff responsibility include in the hospital policy related to Organ Donation
Meets patient and families needs regarding communication, including interpreter services
Provides accurate information to patient and families in a timely manner
Obtaining vaginal/cervical cultures
Application of external ECG/TOCO EFM
Application of internal ECG
Interpretation of external/internal ECG
Assisting with insertion of IUPC
Pitocin Titration for induction/augmentation
Assist/monitor amnioinfusion
Assist with scalp pH test
Assist with vacuum delivery
Assist with forceps delivery
Assist with vaginal delivery
Circulate for cesarean section delivery
Emergency cesarean section set up
Assist with twin deliveries
Management of fetal demise/stillborn
Management of diabetic mother
Stabilize/admit to nursery
Care of newborn with anomaly
Heel sticks/dorsal sticks
Set up/care of newborn receiving phototherapy
Set up/assist with circumcision
Age Specific Competencies
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)