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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 |
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| Rating Stars (Click) | WORK SETTINGS | 1 | 2 | 3 | 4 | ||
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L and D | ||||||
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LDRP | ||||||
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Antepartum | ||||||
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Mother Baby | ||||||
| Rating Stars (Click) | ANTEPARTUM | 1 | 2 | 3 | 4 | ||
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Diabetes | ||||||
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Fetal Demise | ||||||
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HELLP Syndrome | ||||||
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Hyperemesis | ||||||
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Immunologic Disorder | ||||||
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Infectious Disease | ||||||
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Multiple Gestation | ||||||
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Placenta Previa/Abruptio | ||||||
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Pre-Term Labor | ||||||
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Premature Rupture of Membranes | ||||||
| Rating Stars (Click) | SPECIAL PROCEDURES | 1 | 2 | 3 | 4 | ||
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Conduct Stress Test | ||||||
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Conduct Non-Stress Test | ||||||
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Assist with External Version | ||||||
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Assist with Umbilical Blood Sampling | ||||||
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Use of Nitrazine/Fern Test | ||||||
| Rating Stars (Click) | PAIN MANAGEMENT | 1 | 2 | 3 | 4 | ||
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Epidural Anesthesia | ||||||
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General Anesthesia | ||||||
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Spinal Anesthesia | ||||||
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Response to Pain Management | ||||||
| Rating Stars (Click) | FETAL MONITORING | 1 | 2 | 3 | 4 | ||
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External | ||||||
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IUPC Placement/Monitoring | ||||||
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Spiral Electrode Placement | ||||||
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Identify, Document & Treat Abnormal FHR Patterns | ||||||
| Rating Stars (Click) | LABOR MANAGEMENT | 1 | 2 | 3 | 4 | ||
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Auscultate Fetal Heart Tones | ||||||
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Determine Fetal Position | ||||||
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Assess Contraction Characteristics | ||||||
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Assess Status of Membranes | ||||||
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Assess Station/Dilation/Effacement | ||||||
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Positioning | ||||||
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Leopold's Maneuver | ||||||
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Assess for Reflexes/Clonus | ||||||
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Bladder Catheterization | ||||||
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Amnioinfusion (Assist or Perform) | ||||||
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Recognize Complications of AROM | ||||||
| Rating Stars (Click) | DELIVERY MANAGEMENT | 1 | 2 | 3 | 4 | ||
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Delivery Table Set Up | ||||||
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Circulate Vaginal Delivery | ||||||
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Circulate C - Section | ||||||
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Scrub C - Section | ||||||
| Rating Stars (Click) | NEONATAL MANAGEMENT | 1 | 2 | 3 | 4 | ||
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Radiant Warmer | ||||||
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APGAR Scores | ||||||
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Neonatal Vital Signs | ||||||
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Neonatal Resuscitation | ||||||
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Naso/Oropharyngeal Suctioning | ||||||
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Bulb Syringe Suction | ||||||
| Rating Stars (Click) | COMPLICATIONS | 1 | 2 | 3 | 4 | ||
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Placenta Previa/Abruptio | ||||||
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Asthma | ||||||
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Cardiac Disease | ||||||
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Chorioamnionitis | ||||||
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Diabetes | ||||||
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Pregnancy Induced Hypertension | ||||||
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HELLP | ||||||
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Hemolytic Anemia | ||||||
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Hemorrhage | ||||||
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HIV Positive | ||||||
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HBV Disease | ||||||
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Malpresentations | ||||||
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Multiple Gestation | ||||||
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Pre-Term Labo | ||||||
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Fetal Demise | ||||||
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Rh Disease | ||||||
| Rating Stars (Click) | POST PARTUM CARE | 1 | 2 | 3 | 4 | ||
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Vaginal Delivery | ||||||
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Cesarean Section | ||||||
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Anesthesia - General | ||||||
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Anesthesia - Spinal | ||||||
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Bladder Distention | ||||||
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Breast Milk Collection and Storage | ||||||
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Breast Pump | ||||||
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Breastfeeding - Latch Score | ||||||
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Breastfeeding - Supplemental Feeding | ||||||
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Breastfeeding Support | ||||||
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Contraceptive Education | ||||||
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Epidural/PCA | ||||||
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Homan's Sign | ||||||
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Multiple Births | ||||||
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Parent/Infant Interaction/Attachment | ||||||
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Post Partum Hemorrhage | ||||||
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Pregnancy Induced Hypertension | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
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Antibiotics/Antivirals | ||||||
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Antihypertensives | ||||||
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Antiseizure | ||||||
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Betamethasone | ||||||
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Insulin | ||||||
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Magnesium Sulfate | ||||||
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Methergine | ||||||
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Opioids and Reversal Agents | ||||||
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Pitocin | ||||||
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Terbutaline | ||||||
| Rating Stars (Click) | IV THERAPY | 1 | 2 | 3 | 4 | ||
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Start Ivs | ||||||
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IV Management | ||||||
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Blood Product Administration | ||||||
| Rating Stars (Click) | NEWBORN CARE | 1 | 2 | 3 | 4 | ||
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Newborn Assessment | ||||||
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Infant Vital Signs | ||||||
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Ballard Scale/Dubowitz | ||||||
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Car Seat Education | ||||||
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Circumcision Care/Teach to Parents | ||||||
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Cord Care/Teach to Parents | ||||||
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Immunizations - Infant | ||||||
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Infant Caretaking Skills | ||||||
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Infant Identification and Security | ||||||
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Metabolic Screen | ||||||
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Jaundice/Bilirubin | ||||||
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Phototherapy | ||||||
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Thermoregulation | ||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||
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National Patient Safety Goals/Core Measures | ||||||
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Experience in a "Baby Friendly" Facility | ||||||
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Fall Risk Assessment/Prevention | ||||||
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Restraints/Use of Least Restrictive Device | ||||||
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Parent/Family Teaching | ||||||
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Age Specific/Population-Based Care | ||||||
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Isolation Precautions | ||||||
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Infection Prevention | ||||||
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Charge Experience | ||||||
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Interpretation and Communication of Lab Values | ||||||
| Rating Stars (Click) | EMR | 1 | 2 | 3 | 4 | ||
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Epic | ||||||
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Cerner | ||||||
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Eclipsys | ||||||
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McKesson | ||||||
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Meditech | ||||||
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Other Computerized System | ||||||
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Computerized Physician Order Entry | ||||||
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Bar Coding for Medication Administration | ||||||
| EMR Conversion | |||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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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 | |||||||