Labor and Delivery Skills Checklist
  Labor and Delivery Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to FILL IN THE BLANK 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.  
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

 
       
Rating Stars (Click) WORK SETTINGS 1 2 3 4  
L and D  
LDRP  
Antepartum  
Mother Baby  
Rating Stars (Click) ANTEPARTUM 1 2 3 4  
Diabetes  
Fetal Demise  
HELLP Syndrome  
Hyperemesis  
Immunologic Disorder  
Infectious Disease  
Multiple Gestation  
Placenta Previa/Abruptio  
Pre-Term Labor  
Premature Rupture of Membranes  
Rating Stars (Click) SPECIAL PROCEDURES 1 2 3 4  
Conduct Stress Test  
Conduct Non-Stress Test  
Assist with External Version  
Assist with Umbilical Blood Sampling  
Use of Nitrazine/Fern Test  
Rating Stars (Click) PAIN MANAGEMENT 1 2 3 4  
Epidural Anesthesia  
General Anesthesia  
Spinal Anesthesia  
Response to Pain Management  
Rating Stars (Click) FETAL MONITORING 1 2 3 4  
External  
IUPC Placement/Monitoring  
Spiral Electrode Placement  
Identify, Document & Treat Abnormal FHR Patterns  
Rating Stars (Click) LABOR MANAGEMENT 1 2 3 4  
Auscultate Fetal Heart Tones  
Determine Fetal Position  
Assess Contraction Characteristics  
Assess Status of Membranes  
Assess Station/Dilation/Effacement  
Positioning  
Leopold's Maneuver  
Assess for Reflexes/Clonus  
Bladder Catheterization  
Amnioinfusion (Assist or Perform)  
Recognize Complications of AROM  
Rating Stars (Click) DELIVERY MANAGEMENT 1 2 3 4  
Delivery Table Set Up  
Circulate Vaginal Delivery  
Circulate C - Section  
Scrub C - Section  
Rating Stars (Click) NEONATAL MANAGEMENT 1 2 3 4  
Radiant Warmer  
APGAR Scores  
Neonatal Vital Signs  
Neonatal Resuscitation  
Naso/Oropharyngeal Suctioning  
Bulb Syringe Suction  
Rating Stars (Click) COMPLICATIONS 1 2 3 4  
Placenta Previa/Abruptio  
Asthma  
Cardiac Disease  
Chorioamnionitis  
Diabetes  
Pregnancy Induced Hypertension  
HELLP  
Hemolytic Anemia  
Hemorrhage  
HIV Positive  
HBV Disease  
Malpresentations  
Multiple Gestation  
Pre-Term Labo  
Fetal Demise  
Rh Disease  
Rating Stars (Click) POST PARTUM CARE 1 2 3 4  
Vaginal Delivery  
Cesarean Section  
Anesthesia - General  
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  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Antibiotics/Antivirals  
Antihypertensives  
Antiseizure  
Betamethasone  
Insulin  
Magnesium Sulfate  
Methergine  
Opioids and Reversal Agents  
Pitocin  
Terbutaline  
Rating Stars (Click)  IV THERAPY 1 2 3 4  
Start Ivs  
IV Management  
Blood Product Administration  
Rating Stars (Click) NEWBORN CARE 1 2 3 4  
Newborn Assessment  
Infant Vital Signs  
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  
Jaundice/Bilirubin  
Phototherapy  
Thermoregulation  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals/Core Measures  
Experience in a "Baby Friendly" Facility  
Fall Risk Assessment/Prevention  
Restraints/Use of Least Restrictive Device  
Parent/Family Teaching  
Age Specific/Population-Based Care  
Isolation Precautions  
Infection Prevention  
Charge Experience  
Interpretation and Communication of Lab Values  
Rating Stars (Click) EMR 1 2 3 4  
Epic   
Cerner   
Eclipsys   
McKesson   
Meditech   
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
  EMR Conversion
   
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
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)  
CERTIFICATIONS   Expiry Date :   
BLS  
NRP  
S.T.A.B.L.E.  
ACLS  
AWHONN FHM Intermediate  
AWHONN FHM Advanced  
NCC - EFM  
Other: Specify