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Post Partum Nursery 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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Couplet Care | ||||||
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Antepartum | ||||||
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Postpartum | ||||||
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Newborn Nursery | ||||||
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LDRP | ||||||
| Rating Stars (Click) | POST PARTUM | 1 | 2 | 3 | 4 | ||
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Vaginal Deliver | ||||||
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Cesarian Section | ||||||
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Anesthesia - General | ||||||
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Anesthesia - Local | ||||||
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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 | ||||||
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Tubal Ligation | ||||||
| Rating Stars (Click) | ANTEPARTUM | 1 | 2 | 3 | 4 | ||
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Amniocentesis | ||||||
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Cardiac Disorders | ||||||
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Diabetes | ||||||
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Hyperemesis | ||||||
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Multiple Gestation | ||||||
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Non-Stress Test | ||||||
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PIH/HELLP | ||||||
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Placenta Previa/Abruptio | ||||||
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Post- Trauma | ||||||
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Pre-Term Labor/Premature Rupture of Membranes | ||||||
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Substance Abuse | ||||||
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FHM Interpretaton and Management | ||||||
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Fetal Assessment | ||||||
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Labor Assessment | ||||||
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Assist with Ultrasound | ||||||
| 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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Cervical Ripening Agents | ||||||
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Immunizations - Mother | ||||||
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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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Starting 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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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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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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Pressure Ulcer 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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Pain Assessment & Management - Adult | ||||||
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Pain Assessment & Management - Neonate | ||||||
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Charge Experience | ||||||
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Interpretation and Communication of Lab Values | ||||||
| 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) | ||||||
| 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 | |||||||
| CERTIFICATIONS | Expiry Date : | ||||||
| BLS | |||||||
| NRP | |||||||
| AWHONN FHM - Intermediate | |||||||
| AWHONN FHM - Advanced | |||||||
| Lactation Consultant - IBCLC | |||||||
| S.T.A.B.L.E | |||||||
| Other: Specify | |||||||
| Other: Specify | |||||||
| FHM - Other Specify | |||||||