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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
Setting - Children’s hospital
Setting - University healthcare facility
Setting - Community hospital
Family teaching
Assessment of normal growth & development
Recognize/report signs of child abuse/neglect
Consents
Specialty beds
Restrictive devices (restraints)
End of life care/pallative care
Wound assessment & care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
Diabetic care & education
Blood Glucose Monitoring (BGM)
Insulin administration
National Patient Safety Goals
Accurate patient identification
Awareness of HCAHPS
Effective communication
Interpretation & communication of lab values
Medication administration
Pediatric dosage calculations
Delivery methods: eye/ear/IM/IV/SQ
Medication reconciliation
Labeling (medications & specimens)
Anticoagulation therapy
Pain assessment & management
Steroids (inhaled/IV/PO)
Monitoring conscious sedation
Infection control
Universal precautions
Isolation
Minimize risk falls
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 peripheral IVs
Blood draw: venous
Central line care (includes PICC/Broviac/Groshong/Hickman)
Blood draw: central line
Care & management of ports
Care & management of nonvascular devices (epidural, intrathecal)
TPN & lipids
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
Pediatric CV assessment
Assist with Insertion & Management of:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Arterial line
CVC (central venous catheter)
Swanz-Ganz
Hemodynamic monitoring
Extra Corporeal Membrane Oxygenation (ECMO)
Use of doppler
Cardiac Monitoring & Emergency Care
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Administration of PALS protocols & medications
Broslow system
Interpretation & treatment of dysrythmias
Rapid response team member
Use of rapid response teams
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Bacterial endocarditis
DIC
Post cardiac cath
Cardiac transplant
Cardiogenic shock
Cardiomyopathy
Congenital heart disease/defects
Hypovolemic shock
Myocarditis/pericarditis
Permanent pacemaker
Temporary pacemaker
Medications
(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/Integrilin/ReoPro)
Anti-rejection immunosuppressants
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 (rate & work of breathing)
Equipment/Procedures
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Metered dose inhaler
Nebulized medications
Assist with & manage intubation
Tracheostomy care
Assist with & maintain chest tube
Obtain & interpret Arterial blood gas
O2 therapy (NC/oxyhood/tent)
Thoracentisis
Ventilator management
Use of paralytics
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Acute Respiratory Distress Syndrome (ARDS)
Respiratory Syncytial Virus (RSV)
Chronic respiratory disease
Croup
Epiglottits
Reactive Airway Disease (RAD)
Status asthmaticus
Pulmonary hypertension
Pneumonia
Near drowning
Medications
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Bronchodilators
Racemic epinephrine
Neurological Experience
Neuro assessment
Glascow coma scale
Procedures
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assisting with LP
Intracranial pressure (ICP) insertion & monitoring
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Muscular degenerative diseases
Meningitis
Coma
Brain death/organ procurement
Encephalitis/encephalopathy
External ventricular drains
VP shunts/reservoirs
TBI (Traumatic Brain Injury)
Status epilepticus
Spinal cord injury
Post nuero surgery
Medications
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Anticonvulsants
Mannitol
Psychostimulants (Ritalin/Adderall)
Orthopedics Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Orthopedic assessment
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Traction
Cervical traction
Pinned fractures
Post vertebral surgery
Gastrointestinal Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
GI assessment
Nutritional assessment
Equipment/Procedures
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Abdominal decompression (NG, sump tubes, intermittent & continuous suction)
Colostomy/ileostomy
Placement of feeding tubes (NG)
G-tube/J-tube
Gastrointestinal - cont. Experience
Feedings
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assist with breastfeeding
Breastmilk handling & storage
Bottle
Gavage
Use of feeding pumps
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Abdominal trauma; bleeding
Ascites
Surgical abdomen
Severe dehydration/gastroenteritis
Hepatic failure
Hepatitis
Hyperbilirubinemia
Necrotizing Entercolitios (NEC)
Ruptured spleen
GI bleeding
GI organ transplants
Renal/Genitourinary Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assessment of fluid balance
Equipment/Procedures
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Assist with suprapubic taps
Insertion & care of foley catheter
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Acute renal failure
Hemodialysis
Peritoneal dialysis
Hemolytic Uremic Syndrome (HUS)
Post renal transplant
Nephritis
Ileal conduit
Skin Care Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Skin assessment
Surgical wound healing
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Burns
Traumatic wounds
Vacuum Assisted Device (VAC)
Oncology Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Administration of chemotherapy
Monitoring of chemotherapy (does not initiate)
Assist with bone marrow aspiration
Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Acute anemia
Acute tumor lysis syndrome
Bone marrow transplant
Leukemia
Malignant tumors
Neutropenia
Radiation implant
Sickle cell anemia
Hemophilia
Graft verses host disease
Inpatient hospice
Autoimmune Diseases Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Addison’s disease
Cushing’s disease
Celiac disease/gluten intolerance
Grave’s disease
Hypothyroidism
Lupus
Infectious Diseases Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Usual child diseases (mumps/measles/chicken pox)
CMV/HIV/AIDS
Tuberculosis
Septic shock
Fever management
Medication/Administration
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Antiinfectives
Miscellaneous Experience - Care of Child with:
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Trauma
Craniofacial reconstruction
ENT surgery
Ingestions/overdose
Suicidal ideation/attempts
Age Specific Competencies Experience
(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Newborn/neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescents (ages 13-21 years)
Young adult (ages 22-39 years)
Adults (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)
ATTESTATION *