Neonatal ICU Skills Checklist

Neonatal Intensive Care

Name*

Telephone*

Who is your recruiter?*

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
Aortic/Pulmonary Valve Stenosis
Atrial/Ventricular Septal Defects

Bradycardia

Coarctation of the Aorta

Congenitial Heart Disease

DIC

Hemodynamic Instability

Hypoplastic Left Heart System

Hypovolemic Shock

Patent Ductus Arteriosus

Post Cardiac Surgery

Tetralogy of Fallot

Transient Tachypnea

Transposition of the Great Arteries

Apnea

Bronchopulmonary Dysplasia (BPD)

Diaphragmatic Hernia

Meconium Aspiration Syndrome (MAS)

Pneumothorax

PPHN/PFC

Respiratory Distress Syndrome (RDS)

Respiratory Syncytial Virus (RSV)

Tracheostomy - fresh

Anencephaly

Cerebral Palsy

Hydrocephalus

Intraventricular Hemorrhage (IVH)

Meningitis

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Periventricular Leukomalacia (PVL)
Seizures

Spina Bifida

Anal Atresia

Cleft Lip/Palate

Cystic Kidney Disease

Esophageal Atresia

Fetal Hydronephrosis

Gastroschisis/Omphalocele

IDM Hyperglycemia

IDM Hypoglycemia

Inguinal Hernia

Intestinal Obstruction

Jaundice/Hyperbilirubinemia

Necrotizing Enterocolitis (NEC)

Post Abdominal Surgery

Pyloric Stenosis

Tracheoesphogeal Fistula (TEF)

Birth Injuries

Congenital Hip Dislocation

Drug Addiction/Exposure

Fetal Alcohol Syndrome

HIV Positive Mother

HBsAg Positive Mother

Retinopathy of Prematurity (ROP)

Sepsis

Brain Death/Organ Procurement

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Aminophylline/Caffeine
Anticoagulants

Anticonvulsant Medications

Dobutamine (Dobutrex)

Dopamine (Intropin)

Epinephrine

Eye Prophylaxis

Immunizations

Insulin Drip

NaHCO3

Prostaglandin

Respigam/Synergis Prophylaxis

Steroids

Vitamin K

Pain Medications

IM Meds

IV drips

IV push

Eye Instillations

Dosage calculations for neonates

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Airway Management
a. Bulb Syringe

b. CPAP (nasal prongs)

c. Endotracheal Tube

i. Assist with insertion

ii. Stabilization of ETT

iii. Extubation

d. Suctioning

i. ETT

ii. Nasal

iii. Oral

iv. Tracheostomy

Cardiac Resuscitation

Chest Physiotherapy

Chest tube & drainage system

a. Set up

b. Assist with insertion

c. Care & maintenance

d. Troubleshooting

e. Removal

Continuous Bladder Irrigation

EKG Intrepretation

Exchange Transfusion

Extracorporeal Membrane Oxygenation

Hemodynamic Monitoring, non-invasive

a. Auscultation

b. Doppler

c. Automatic BP cuff

d. Palpation

Hemodynamic Monitoring - Invasive

Feedings

a. Breastfeeding - assist

b. Breastmilk handling/storage

c. Bottle

d. Continuous tube feeding

e. Gavage

f. Reflux precautions

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
g. Placement of Tubes
i. Orogastric tube

il. Nasogastric tube

iii. Nasojejunal tube

h. Assessing Feeding Tolerance

Gastric Suctioning - Intermittent

Gastric Suctioning - Continuous

Interpretation of Lab Results

a. Blood gases

b. Bilirubin

c. CBC/Diff

d. Cultures

e. Maternal lab results

f. Urine (test & interpret)

i. Glucose

il. Labstix

iii. pH

iv. Specific Gravity

v. Occult Blood

Intracranial Pressure Monitoring

IV's

a. Starting IV

b. Site & Patency Assessment

c. Administration Blood/Blood Products

d. Maintenance/Discontinuation of:

i. Broviac

il. Hickman

iii. Heparin/Saline Lock

iv. Percutaneous Arterial Line

v. Peripheral IV

vi. PICC

vii. Umbilical Arterial Catheter

viii. Umbilical Venous Catheter

e. Hyperalimenation

Lumbar Puncture (assist with)

Nitric Oxide Therapy

Orthopedic Devices - casts, splints, etc

Oxygen Therapy Administration

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
a. Bag & mask
b. ET tube

c. Oxyhood

d. Nasal CPAP

e. Nebulizer

f. Trach Collar

Skin

a. Skin breakdown prevention

b. Wound healing

c. Color change

i. Mottling

il. Petechiae

iii. Cyanosis

iv. jaundice

Specimen Collection

a. Blood

i. Arterial stick

ii. Heel stick

iii. Peripheral

iv. Umbilical

b. Cultures

i. Blood

ii. Wound

iii. Sputum

Stool Testing

Temperature

a. Rectal

b. Skin

c. Axillary

Transillumination

Wound/Ostomy Care

a. Colostomy care/bag change

b. Ileostomy care/bag change

c. Irrigations

d. Sterile Dressing changes

e. Surgical wounds with drains

EQUIPMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Cardiac Monitor
Centrifuge

Defibrillator

Glucometer

O2 Analyzer

Oxygen Flow Meter

Oxyhood

Phototherapy Equipment

a. Bili blanket

b. Bili lights

c. Bili meter

Computer Charting Systems

Positioning Devices

Pulse Oximeter

Thermoregulation

a. Isolette with Humidity

b. Radiant Warmer

c. Warming Lights

Transport Incubator

Ventilator

a. CPAP/PEEP

b. High frequency jet

c. IMV

d. Transport

e. Oscillating

f. Home Ventilator

ASSESSMENT/OTHER


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Experience in:
a. Level II Nursery

b. Level III Nursery

Abdominal Girth Measurement

Admission of patients to unit

APGAR Scoring

Assess Breath Sounds

Assess Heart Sounds

Ballard Score

Bereavement support

Breastfeeding Teaching

Care Planning

Charge Nurse responsibilities

Circulation Checks

Computerized Charting

Developmental Intervention/Assessment

Dubowitz Score

Fontanel Assessment

Head circumference measurement

Isolation Procedures

Neurological Assessments

Pain Assessment

Pain Management

Parent Teaching of Normal Infant

Patient Teaching

ROM exercises

Sedation

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.