Skills Assessment - Nursery Neonatal Intensive Care
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The following checklist will be used to match your skills and interests with available assignments.
Please enter your information, and we will store this information with your application/profile.
Please indicate your level of proficiency by marking the appropriate number.
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First Name:
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Middle Initial:
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Last Name:
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SSN:
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E-mail Address:
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Home Phone:
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Work Phone:
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Cell Phone:
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City:
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State:
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0. Theory, no practice 1. Limited 2. Confident 3. Very Confident
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Cardiovascular:
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Experience:
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Assess heart sounds and peripheral pulses
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0
1
2
3
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Interpret arrhythmia
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0
1
2
3
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Intervene appropriately for arrhythmia
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0
1
2
3
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Transducer set-up and maintenance UVC/UAC
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0
1
2
3
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Obtain specimens UVC/UAC
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0
1
2
3
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Hemodynamic monitoring
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0
1
2
3
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Assist with Central line insertion
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0
1
2
3
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Draw blood samples from central line
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0
1
2
3
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Care of patient with acute heart failure
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0
1
2
3
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Care of patient with post-op cardiac surgery
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0
1
2
3
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Care of patient in shock
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0
1
2
3
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Care for the pre- and post-cardiac cath patient
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0
1
2
3
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Care for the post-op thoracic surgery
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0
1
2
3
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Care of patient with PDA Ligation
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0
1
2
3
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Care of patient with Transposition of Great Vessels
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0
1
2
3
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Care of patient with tetralogy of Fallot
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0
1
2
3
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Participate in resuscitation by performing defibrillation
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0
1
2
3
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Participate in resuscitation by preparing emergency drugs
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0
1
2
3
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Participate in resuscitation by performing CPR
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0
1
2
3
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Participate in resuscitation as a team member
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0
1
2
3
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Pulmonary:
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Assess lung sounds
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0
1
2
3
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Set up O2 devices
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0
1
2
3
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Pulse oximetry monitoring
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0
1
2
3
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Open, establish airway
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0
1
2
3
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Interpret ABG
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0
1
2
3
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Assess ventilator settings
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0
1
2
3
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Suction and care of endotracheal tube
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0
1
2
3
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Use Ambu bag
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0
1
2
3
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Assist with intubation
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0
1
2
3
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Assist with chest tube insertion
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0
1
2
3
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Care for the patient with asthma
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0
1
2
3
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Care for the patient with mechanical ventilation
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0
1
2
3
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Care for the patient with RDS
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0
1
2
3
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Care for the patient with chest tubes
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0
1
2
3
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Care for the patient with a tracheostomy
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0
1
2
3
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Care for the patient with meconium aspiration
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0
1
2
3
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Care for the patient with cystic fibrosis
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0
1
2
3
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Care for the patient with pulmonary edema
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0
1
2
3
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Care for the patient with respiratory distress
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0
1
2
3
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Care for the patient with respiratory failure
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0
1
2
3
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Neurological:
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Assess Glasgow Coma Scale
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0
1
2
3
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Identify sudden change in LOC
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0
1
2
3
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Assess sensory, motor, cry
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0
1
2
3
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Assess pupils
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0
1
2
3
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Reflex assessment (Babinski, gag)
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0
1
2
3
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Identify, intervene for seizure
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0
1
2
3
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Care for the patient with ICP monitoring
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0
1
2
3
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Care for the patient who is post-op neurosurgical
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0
1
2
3
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Care for the patient in a comatose state
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0
1
2
3
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Care for the patient by assisting with lumbar puncture
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0
1
2
3
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Care for the patient with intracranial hemorrhage
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0
1
2
3
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Care for the patient with neuromuscular disease
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0
1
2
3
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Care for the patient with meningitis
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0
1
2
3
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GI/Renal/Endocrine/Nutrition:
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Insert N/G, orogastric tube
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0
1
2
3
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Care for the patient with gastroenteritis
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0
1
2
3
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Care for the patient with dehydration
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0
1
2
3
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Care for the patient with Diabetes mellitus
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0
1
2
3
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Care for the patient with a GI bleed
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0
1
2
3
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Care for the patient with hemodialysis
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0
1
2
3
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Care for the patient with DKA
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0
1
2
3
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Care for the patient with TPN
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0
1
2
3
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Care for the patient with enteral nutrition
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0
1
2
3
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Care for the patient with bowel obstruction
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0
1
2
3
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Care for the patient with appendicitis
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0
1
2
3
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Care for the patient with pH probe
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0
1
2
3
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Care for the patient with gastroesophageal reflux
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0
1
2
3
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Care for the patient with necrotizing enterocolitis
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0
1
2
3
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Hematology/Oncology:
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Administer blood and blood products
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0
1
2
3
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Administer chemotherapeutic agents
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0
1
2
3
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Care for the patient with neutropenia
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0
1
2
3
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Care for the patient with Sickle Cell Anemia
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0
1
2
3
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Care for the patient with HIV
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0
1
2
3
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Care for the patient with Leukemia
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0
1
2
3
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Medications:
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Calculate neonate/newborn dosing
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0
1
2
3
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Use of Infusion pump
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0
1
2
3
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Use of Syringe pump
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0
1
2
3
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Use PCA pumps
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0
1
2
3
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Use epidural pumps
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0
1
2
3
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Administer IV Epinephrine
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0
1
2
3
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Administer IV Dopamine
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0
1
2
3
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Administer IV Lidocaine
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0
1
2
3
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Administer IV Amiodarone (Cordarone)
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0
1
2
3
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Administer IV Adenosine
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0
1
2
3
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Administer IV Atropine
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0
1
2
3
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Administer IV Thrombolytics (i.e., TPA, Streptokinase)
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0
1
2
3
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Administer IV Heparin
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0
1
2
3
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Administer IV Benzodiazepines (i.e., Valium, Versed, Ativan)
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0
1
2
3
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Administer IV Propofol (Diprivan)
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0
1
2
3
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Administer IV Neuromuscular blocking agents (i.e., Pavulon,Norcuron)
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0
1
2
3
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Administer IV Morphine
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0
1
2
3
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General:
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Assess and care of the newborn
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0
1
2
3
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Assess and care of the critically ill newborn
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0
1
2
3
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Assess and care of the low birth weight infant
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0
1
2
3
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Provide cord care
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0
1
2
3
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Knowledge of age-appropriate vital signs
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0
1
2
3
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Knowledge of normal serum values
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0
1
2
3
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Use of radiant warmers
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0
1
2
3
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Use of phototherapy
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0
1
2
3
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Care of the patient with sepsis
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0
1
2
3
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Care of the patient with hyperbilirubinemia
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0
1
2
3
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Assess and manage pain
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0
1
2
3
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Admit unstable patient
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0
1
2
3
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Transport patient within hospital for testing
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0
1
2
3
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Start peripheral IV/scalp vein
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0
1
2
3
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Maintain a heparin/saline lock
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0
1
2
3
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Age-Specific Practice Criteria:
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Please check the box corresponding to each
age group for which you have expertise in
providing age-appropriate nursing care.
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Newborn/Neonate (birth - 30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School age children (5 - 12 years)
Adolescents (12 - 18 years)
Young adults (18-39 years)
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Experience With Age Groups:
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Able to adapt care to incorporate normal growth and development
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0
1
2
3
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Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level
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0
1
2
3
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Can ensure a safe environment reflecting specific needs of various age groups
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0
1
2
3
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