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