Pediatric Skills Checklist
  Pediatric Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
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.  
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  
Pediatric MedSurg  
Pediatric Step Down/Telemetry  
Pediatric Oncology  
Pediatric Ortho  
Pediatric Neuro  
Rating Stars (Click) CARDIOVASCULAR 1 2 3 4  
Congenital Heart Disease/Repair  
Pre Cardiac Surgery  
Post Cardiac Surgery  
Heart Sounds  
Rating Stars (Click) PULMONARY 1 2 3 4  
Reactive Airway Disease  
RSV  
Tuberculosis  
Esophageal Atresia  
Epiglottitis  
Tonsillitis  
Laryngotracheobronchitis (Croup)  
ENT Surgery  
Oxygen Delivery Systems  
Tracheostomy Management  
Oral Suctioning  
Deep Suctioning  
Management of Chest Tubes  
Apnea Monitor  
Home Ventilator Therapy  
Rating Stars (Click) NEUROLOGIC/ORTHOPEDIC 1 2 3 4  
Brain Injury  
Spinal Cord Injury  
Seizure Disorders  
Meningitis  
Neuromuscular Disease  
Extremity Fracture/Cast  
Post Vertebral Surgery  
Traction - General  
Traction - Halo  
Pin Care  
VP Shunts/Internal/External  
Rating Stars (Click) GASTROINTESTINAL 1 2 3 4  
Cleft Lip/Palate  
Inflammatory Bowel Disease  
Colostomy/Ileostomy  
Surgical Drains  
Failure to Thrive  
Feeding Intolerance  
Gastroenteritis/Dehydration  
Bowel Obstruction  
Short Gut Syndrome  
Breastfeeding Support/Handling of Breast Milk  
Rating Stars (Click) RENAL/GENITOURINARY 1 2 3 4  
Circumcision  
Testicular Torsion  
Glomerulonephritis  
Renal Failure  
Renal Transplant  
Urinary Retention  
Bladder Scan  
Insertion/Management of Bladder Catheters  
Management of Suprapubic Catheters  
Rating Stars (Click) ENDOCRINE/METABOLIC 1 2 3 4  
Diabetes - Hypo/Hyperglycemia  
Diabetic Ketoacidosis  
IV Insulin Pumps  
Indwelling Insulin Pumps  
Hyperbilirubinemia  
Bili Bed  
Rating Stars (Click) ONCOLOGY 1 2 3 4  
Chemotherapy Administration  
Hodgkin's Disease  
Hemophilia  
Sickle Cell Anemia  
Leukemia  
Solid Tumors  
Bone Marrow Transplant  
Rating Stars (Click) INFECTIOUS DISEASE 1 2 3 4  
Childhood Communicable Diseases  
Hepatitis  
HIV  
Kawasaki Disease  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Pediatric Dosage Calculations  
Anti-Hypertensives  
Anticoagulants  
Anti-Seizure Medications  
Benzodiazepines  
Digoxin  
Diurectics  
Emergency Medications  
Inhaled Medications  
Insulin  
Narcotics/Opioid Analgesics (IV/Oral/Injection)  
Non-Opioid Analgesics (IV/Oral/Injection)  
Procedural Sedation - Recovery  
Reversal Agents  
Steroids (IV/Oral/Inhaled)  
Automated Medication Dispensing (i.e. Pyxis, Omnicell)  
Rating Stars (Click) IV THERAPY 1 2 3 4  
Starting Ivs  
Central Line Blood Draw  
Central Line/Implanted Line Care  
TPN/Lipids  
Blood Product Administration  
Administration of Chemotherapy  
Rating Stars (Click) CARDIAC MONITORING & EMERG. RESPONSE 1 2 3 4  
Pediatric Early Warning Score (PEWS)/Rapid Response Team  
Dysrhythmia Interpretation  
Dysrhythmia Management  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals/Core Measures  
Recognize/Report Signs of Abuse  
Fall Risk Assessment/Prevention  
Pressure Ulcer Risk Assessment/Prevention  
Restraints/Use of Least Restrictive Device  
Normal Growth and Development  
Age Specific/Population Based Care  
Patient Family Teaching  
Isolation Precautions  
Infection Prevention  
Reporting Communicable Diseases  
Pain Assessment & Management  
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  
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 PROFESSIONAL KNOWLEDGE AND SKILLS Expiry Date :  
BLS  
PALS  
CPHON  
  Chemo Certification: Specify  
  PICC Certification: Specify  
  Other: Specify  
  Other: Specify