Labor & Delivery Skills Checklist

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.

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Abruptio Placenta
Asthma

Beta Strep

Breech

Cardiac Disease

Cesarean Section

Chorioamnionitis

Chronic Hypertension

Collagen Vascular Disease

Diabetes

Eclampsia

Episiotomy

Fetal Demise

Forceps Delivery

HELLP Syndrome

Hemolytic Anemia

Hemorrhage

Hepatitis B

HIV Positive

Hypertension

Infants

a. IDM Protocol

b. AGA Protocol

c. LGA Protocol

d. SGA Protocol

Malpresentations

NSVD

Placentia Previa

Rh Disease/Incompatibilities

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Seizure
Sickle Cell Disease

Stillborn

Substance Abuse

Trauma

Uterine Rupture

Vacuum Extraction Delivery

Vasa Previa

VBAC

Version

ANTEPARTUM CARE / PROCEDURES


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Triage of Obstetrical Patients
Non Stress Tests (NST)

Oxytocin Challenge Tests (OCT)

Assist with Ultrasound

Assist with Amniocentesis

Assist with Sterile Speculum Exam

Reflex Checks/Edema Assessment

Pelvimetry

L&D CARE/PROCEDURES


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Vaginal Delivery Set Up
Emergency Vaginal Delivery

Sterile Vaginal Exams

a. Effacement

b. Dilatation

c. Station

d. Presentation

Leopold's Maneuvers

Breathing/Relaxation Techniques

AROM - assist

Premature Membrane Rupturing

Ruptured Membrane Testing

a. Fern test

b. Nitrazine test

Foley/Straight Catheter Insertion

Assess/Document Labor Progression

Assess/Document Maternal Status

Bladder Assessment

IUPC Placement/Calibration - assist

Assess/Document Fetal Status

Fetal Scalp Electrode Placement

a. Assist with FSE

b. Perform FSE

FHR Pattern Recognition/Interventions

Fetal Scalp Blood Sampling - assist

Fetoscope/Doptone

Forceps/Vacuum Extraction

Shoulder Dystocia

Amnioinfusion

L&D CARE/PROCEDURES


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Oxygen Therapy
a. Bag & Mask

b. Face Mask

c. Nasal Cannula

Intravenous Therapy

a. Blood/Blood Products Transfusion

b. Central Line Maintenance

c. Peripheral insertion/maintenance

d. Saline/Heparin Lock

Specimen Collection

a. Vaginal Fluid

b. Vaginal Swab

c. Urine

d. Venous Blood Draw

Cesarean Section Set Up

Emergency C-Section

Scrub C-Section

Circulate C-Section

Recovery Room Care after C-Section

Assist/Monitor Anesthesia Surveillance

General Anesthesia

Regional Anesthesia/Epidural/Spinal

Postpartum Tubal Ligations

Adult Resuscitation

POSTPARTUM CARE/PROCEDURES


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Couplet Care
Fundus Assessment

Fundal Massage

Lochia Assessment

Perineum Care

Foley Cath/Straight Cath

Incisional Care

Parent/Infant Bonding/Teaching

Breast Feeding Education/Support

Bereavement Support

Post Anesthesia Recovery Care

Emergency Interventions

Hemorrhage

Sterile Dressing Changes

Surgical Wound Care

Pain Management

a. Patient controlled analgesia (PCA)

b. Narcotic Agents

c. Non-narcotic agents

d. Non-pharmacological measures

CARE OF NEWBORN


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Newborn Assessment/APGAR
Gestational Age Assessment

Suctioning

Meconium

ID/Security Banding

Cord Care

Circumcision

a. Set-up

b. Assist

Infant Feedings

a. Breastfeeding - assist

i. latch-on

ii. Positioning

iii. pumping and storage

b. Bottle

Phototherapy Treatment

Specimen Collection

a. Heel Stick

b. Percutaneous umbilical sampling

c. Umbilical blood sampling

Temperature

a. Axillary

b. Oral

c. Tympanic

d. Rectal

Infant/Neonate Resuscitation

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Antibiotics
Antihypertensives

Cervical Ripening Agents

Epidural Anesthesia

Heparin

Indomethacin

Incisional Care

Infant Meds

a. Aquamephyton

b. Erythromycin ointment

Insulin

Magnesium Sulfate

Narcotics

Oxytocin

Procardia

Prostin Gel

Prostin Suppositories

Ritrodrine

Terbutaline

Continuous IV Administration

Eye Instillations

IM Injections

IV Push

SQ Injections

Z-Tract Injections

EQUIPMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Breast Pump
a. Electric

b. Manual

Cardiac Monitor

Glucometer

Oxygen Flow Meter

Pulse Oximeter

Defibrillator

Radiant Warmer

PCA Pump

Phototherapy Equipment

a. Bili Lights

b. Bili Meter

Transport Incubator

Computer Charting Systems

Infusion Pumps (specific brands)

ASSESSMENT/OTHER


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Admission of patients to unit
Assess Breath Sounds

Assess Heart Sounds

Cardiac Monitor

Care Planning

Charge Nurse responsibilities

Circulation Checks

Computerized Charting

Fontanel Assessment

Head circumference measurement

Neurological Assessments

Pain assessment using pain scales

Patient Teaching

Thermal Environment Maintenance

Use of Restraints

Vital Signs

Do you speak any languages other than English?

Yes

No

If yes, which language(s)?

Age Specific Skills

Check the box under EACH age group that you have experience with and are comfortable with for each skill below.

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different communication needs for the age group & changes communication methods and terminology accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different safety risks for the age group and alters the environment accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the normal growth and development for the age group and adapts care accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

*

I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.