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.
| WORK SETTINGS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Couplet Care |
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| Antepartum |
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| Postpartum |
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| Newborn Nursery |
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| LDRP |
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| POST PARTUM | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| ANTEPARTUM | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| IV THERAPY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Starting Ivs |
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| IV Management |
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| Blood Product Administration |
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| NEWBORN CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| PROFESSIONAL KNOWLEDGE AND SKILLS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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) |
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| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| 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 |
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| EMR Conversion |
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| Other: Specify |
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| Other: Specify |
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| FHM - Other Specify |
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