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
Couplet Care
Antepartum
Postpartum
Newborn Nursery
LDRP
Vaginal Deliver
Cesarian Section
Anesthesia - General
Anesthesia - Local
Anesthesia - Spinal
Bladder Distention
Breast Milk Collection and Storage
Breast Pump
Breastfeeding - Latch Score
Breastfeeding - Supplemental Feeding
Breastfeeding Support
Contraceptive Education
Epidural/PCA
Homan's Sign
Multiple Births
Parent/Infant Interaction/Attachment
Post Partum Hemorrhage
Pregnancy Induced Hypertension
Tubal Ligation
Amniocentesis
Cardiac Disorders
Diabetes
Hyperemesis
Multiple Gestation
Non-Stress Test
PIH/HELLP
Placenta Previa/Abruptio
Post- Trauma
Pre-Term Labor/Premature Rupture of Membranes
Substance Abuse
FHM Interpretaton and Management
Fetal Assessment
Labor Assessment
Assist with Ultrasound
Antibiotics/Antivirals
Antihypertensives
Antiseizure
Cervical Ripening Agents
Immunizations - Mother
Insulin
Magnesium Sulfate
Methergine
Opioids and Reversal Agents
Pitocin
Terbutaline
Starting Ivs
IV Management
Blood Product Administration
Newborn Assessment
Ballard Scale/Dubowitz
Car Seat Education
Circumcision Care/Teach to Parents
Cord Care/Teach to Parents
Immunizations - Infant
Infant Caretaking Skills
Infant Identification and Security
Metabolic Screen
Phototherapy
Thermoregulation
National Patient Safety Goals/Core Measures
Experience in a "Baby Friendly" Facility
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Parent/Family Teaching
Age Specific/Population-Based Care
Isolation Precautions
Infection Prevention
Pain Assessment & Management - Adult
Pain Assessment & Management - Neonate
Charge Experience
Interpretation and Communication of Lab Values
Infant (Birth - 1 year)
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)
Elderly (ages 80+ years)
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
EMR Conversion - yes
BLS
NRP
AWHONN FHM - Intermediate
AWHONN FHM - Advanced
Lactation Consultant - IBCLC
S.T.A.B.L.E
Other: Specify
FHM - Other Specify
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