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Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently

General Skills Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Experience in level II nursing
Experience in level III nursing
Awareness of HCAHPS
Setting: Childrens hospital
Setting: University healthcare facility
Setting: High risk delivery center
Setting: Community hospital
Family teaching
Consents
Specialty beds: giraffe incubator
Specialty beds: radiant warmer bed
Restrictive devices (restraints)
Preparation for transport/transfer
Air transport (jet or helicopter)
Other transport experience: stable return transport
Other transport experience: procedural transport
End of life care/palliative care
Wound assessment & care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
Blood Glucose Monitoring (BGM)
Insulin/dextrose administration
National Patient Safety Goals
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Infant dosage calculations
Delivery methods: IM/IV/SQ
Medication reconciliation
Labeling (medications & specimens)
Anticoagulation therapy
Steroids (inhaled/IV/PO)
Monitoring conscious sedation
Pain assessment & management
Infection control
Universal precautions
Isolation
Minimize risk falls
Skin assessment
Prevention of pressure ulcers
IV Therapy Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Starting & maintaining IVs
Blood draw: heel stick/venous
Central venous insertion & management
Blood draw: central line
Maintain umbilical catheter (arterial/venous)
TPN administration
Administration of blood & blood products
Infusion pumps
Cardiovascular Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
CV assessment
Invasive hemodynamic monitoring
Cardiac Monitoring & Emergency Care
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
NRP protocols & medication
Use of S.T.A.B.L.E. program & protocols
Broslow system
EKG interpretation & treatment
Use of rapid response teams
Defibrillation/cardioversion
Care of Infant with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Congenital heart disease
CHF
Hemodynamic instability
Hypovolemic shock
Post cardiac surgery
Medication Administration
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Antidysrythmics
Antihypertensives
Cardiac glycoside (digoxin)
Platelet inhibitors (aggrastat/integrillin/reopro)
Vasoactive agents
Pulmonary Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Respiratory Assessment
Obtain & interpret blood gases
Airway management (nasal/oral/ET)
Tracheostomy care & management
Oxygen therapy (NC/oxyhood)
Pulse oximeter
Ventilation & management
High Frequency Jet Vent (HFJV)
Partial liquid ventilation
Nitric oxide therapy
Surfactant therapy
ECMO
Assist with & manage chest tube
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Apnea
Bronchopulmonary Dysplasia (BPD)
Diaphragmatic hernia
MAS (Meconium Aspiration Syndrome)
Pulmonary edema
Persistent Pulmonary Hypertension (PPHN)
Respiratory Distress Syndrome (RDS)
Pneumothorax
Medication Administration
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Bronchodilators
Neurological Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Neurological assessment
Drug withdrawal & abstinence scoring
Care of Infant with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Seizures
Meningitis
External VP shunt/reservoirs
ICP monitoring
Spinal disorders
Neurological development & positioning
Medications
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Anticonvulsants
Gastrointestinal Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
GI assessment (include palate & girth)
Nutritional assessment
Feedings
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assist with breast/bottle feeding
Breastmilk handling & storage
Gavage
Placement of OGT/NGT
Gastrostomy tubes
Colostomy/ileostomy care
Care of Infant with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Tracheoesophogeal fistula (TEF)
Cleft lip/palate
Necrotizing Entercolitios (NEC)
Gastroenteritis/omphaloocele
Inguinal hernia
Post abdominal surgery
Renal/GU Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Urinary catheter insertion & management
Peritoneal dialysis
Assist with circumcision
Post circumcision care
Care of Infant with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Acute renal failure
Malformations of GU tract
Hydronephrosis
Infectious Diseases Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assist with lumbar puncture
Care of Infant with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Neonatal sepsis
HIV positive mother
HBsAg positive mother
Medication
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Immunizations
Anti-infectives
Respigam/synergis prophylaxis
Admission/Assessment Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Attending high risk deliveries
APGAR scoring
Gestational age
Eye exam
Hearing screen
Thermoregulation
Care of infant under phototherapy
Experience in level II nursery
Experience in level III nursery
Age Specific Competencies Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Neonatal (< 23 weeks)
Neonatal (24-28 weeks)
Neonatal (29-32 weeks)
Neonatal (>33 weeks)
ATTESTATION *