Skill Checklists

NICU

This checklist was electronically signed on (Today’s date)

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.

Proficiency Scale:

  • 1 = No Experience

  • 2 = Need Training

  • 3 = Able to perform with supervision

  • 4 = Able to perform independently

Patient Types

Neonates < 28 Weeks

Neonates 29 - 34 Weeks

Neonates > 34 Weeks

Work Settings

Level II NICU

Level III NICU

Level IV NICU

Cardiovascular

Cardiac Surgery - Pre-op

Cardiac Surgery - Immediate Post-op

Congenital Heart Disease/Defects

CHF/Pulmonary Edema

Hemodynamic Instability

Pulmonary

Bronchopulmonary Dysplasia

Diaphragmatic Hernia

Fresh Tracheostomy

Meconium Aspiration

Persistent Pulmonary Hypertension

Pneumonia

Respiratory Distress Syndrome/Failure

Interpretation of ABGs

Assist with Intubation/Extubation

Endotracheal Suctioning

Chest Tube Placement and Management

Modes of Ventilation (AC/PC/SIMV/CPAP/BiPAP)

High Frequency Ventilation

Inhaled NO

ECMO

Neurological

Ballard/Dubowitz

Reflexes Based on Gestational Age

Hydrocephalus

Intraventricular Hemorrhage

Meningocele/Myelomeningocele

Neonatal Abstinence Score/Syndrome

Seizures

Gastrointestinal

Colostomy/Ileostomy

Gastroschisis/Omphalocele

GI Bleeding

Necrotizing Enterocolitis

Post Abdominal Procedure

FEEDINGS

Breast Milk Handling/Storage

Breast Pump

Gavage Feedings

NG/OG/NJ Tube Placement and Management

Renal / Endocrine / Genetic

Circumcision Care

Genetic Disorders

Hypo/Hyperglycemia

Infant of Diabetic Mother

Malformations of the GU Tract/Kidney

Phototherapy

Renal Failure

Infectious Diseases

Neonatal Sepsis

Septic Work Up

Assist with lumbar puncture

Medications

Calculation of Neonatal Dosages

Antibiotics/Antivirals

Anticonvulsants

Immunizations

Digoxin

IV Vasopressors

Prostaglandin

Bronchodilators

Steroids

Caffeine

Surfactant

Automated Medication Dispensing (i.e. Pyxis, Omnicell)

IV Therapy

Administration of Blood/Blood Products

Central Line Catheter/Dressings

Management of UAC/UVC Lines

Radial Arterial Lines

Cardiac Monitoring & Emerg. Response

Attend High Risk Deliveries

Preparation for Transport

Transport Neonate

Rhythm Interpretation

Dysrhythmia Management

Professional Knowledge and Skills

National Patient Safety Goals/Core Measures

Bereavement/Postmortem Care

Neonatal Skin Care

Pressure Ulcer Risk Assessment/Prevention

Patient/Family Teaching

Age Specific/Population-Based Care

Isolation Precautions

Infection Prevention

Pain Assessment & Management

Charge Experience

Interpretation and Communication of Lab Values

EMR

Epic

Cerner

Eclipsys

McKesson

Meditech

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication Administration

EMR Conversion - yes

Certifications

BLS

NRP

PALS

S.T.A.B.L.E

NCC Certification - RNC-NIC

Other: Specify

I hereby certify that ALL information I have provided 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.