NICU Skills Checklist

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GENERAL SKILLS EXPERIENCE:

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 *
Experience in level II nursing123
Experience in level III nursing123
Awareness of HCAHPS123
Setting: Childrens hospital123
Setting: University healthcare facility123
Setting: High risk delivery center123
Setting: Community hospital123
Family teaching123
Consents123
Specialty beds: giraffe incubator123
Specialty beds: radiant warmer bed123
Restrictive devices (restraints)123
Preparation for transport/transfer123
Air transport (jet or helicopter)123
Other transport experience: stable return transport123
Other transport experience: procedural transport123
End of life care/palliative care123
Wound assessment & care123
Automated Medication Dispensing System, Pyxis, Omnicell, or other123
Bar coding for medication administration123
Blood Glucose Monitoring (BGM)123
Insulin/dextrose administration123
National Patient Safety Goals123
Accurate patient identification123
Effective communication123
Interpretation & communication of lab values123
Medication administration123
Infant dosage calculations123
Delivery methods: IM/IV/SQ123
Medication reconciliation123
Labeling (medications & specimens)123
Anticoagulation therapy123
Steroids (inhaled/IV/PO)123
Monitoring conscious sedation123
Pain assessment & management123
Infection control123
Universal precautions123
Isolation123
Minimize risk falls123
Skin assessment123
Prevention of pressure ulcers123
IV THERAPY EXPERIENCE:

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 *
Starting & maintaining IVs123
Blood draw: heel stick/venous123
Central venous insertion & management123
Blood draw: central line123
Maintain umbilical catheter (arterial/venous)123
TPN administration123
Administration of blood & blood products123
Infusion pumps123
CARDIOVASCULAR EXPERIENCE:

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 *
CV assessment123
Invasive hemodynamic monitoring123
CARDIAC MONITORING & EMERGENCY CARE:

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 *
NRP protocols & medication123
Use of S.T.A.B.L.E. program & protocols123
Broslow system123
EKG interpretation & treatment123
Use of rapid response teams123
Defibrillation/cardioversion123
CARE OF INFANT WITH:

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 *
Congenital heart disease123
CHF123
Hemodynamic instability123
Hypovolemic shock123
Post cardiac surgery123
MEDICATION ADMINISTRATION:

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 *
Antidysrythmics123
Antihypertensives123
Cardiac glycoside (digoxin)123
Platelet inhibitors (aggrastat/integrillin/reopro)123
Vasoactive agents123
PULMONARY EXPERIENCE:

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 *
Respiratory Assessment123
Obtain & interpret blood gases123
Airway management (nasal/oral/ET)123
Tracheostomy care & management123
Oxygen therapy (NC/oxyhood)123
Pulse oximeter123
Ventilation & management123
High Frequency Jet Vent (HFJV)123
Partial liquid ventilation123
Nitric oxide therapy123
Surfactant therapy123
ECMO123
Assist with & manage chest tube123
CARE OF CHILD WITH:

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 *
Apnea123
Bronchopulmonary Dysplasia (BPD)123
Diaphragmatic hernia123
MAS (Meconium Aspiration Syndrome)123
Pulmonary edema123
Persistent Pulmonary Hypertension (PPHN)123
Respiratory Distress Syndrome (RDS)123
Pneumothorax123
MEDICATION ADMINISTRATION:

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 *
Bronchodilators123
NEUROLOGICAL EXPERIENCE:

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 *
Neurological assessment123
Drug withdrawal & abstinence scoring123
CARE OF INFANT WITH:

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 *
Seizures123
Meningitis123
External VP shunt/reservoirs123
ICP monitoring123
Spinal disorders123
Neurological development & positioning123
MEDICATIONS:

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 *
Anticonvulsants123
GASTROINTESTINAL EXPERIENCE:

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 *
GI assessment (include palate & girth)123
Nutritional assessment123
FEEDINGS:

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 *
Assist with breast/bottle feeding123
Breastmilk handling & storage123
Gavage123
Placement of OGT/NGT123
Gastrostomy tubes123
Colostomy/ileostomy care123
CARE OF INFANT WITH:

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 *
Tracheoesophogeal fistula (TEF)123
Cleft lip/palate123
Necrotizing Entercolitios (NEC)123
Gastroenteritis/omphaloocele123
Inguinal hernia123
Post abdominal surgery123
RENAL/GU EXPERIENCE:

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 *
Urinary catheter insertion & management123
Peritoneal dialysis123
Assist with circumcision123
Post circumcision care123
CARE OF INFANT WITH:

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 *
Acute renal failure123
Malformations of GU tract123
Hydronephrosis123
INFECTIOUS DISEASES EXPERIENCE:

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 *
Assist with lumbar puncture123
CARE OF INFANT WITH:

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 *
Neonatal sepsis123
HIV positive mother123
HBsAg positive mother123
MEDICATION:

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 *
Immunizations123
Anti-infectives123
Respigam/synergis prophylaxis123
ADMISSION/ASSESSMENT EXPERIENCE:

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 *
Attending high risk deliveries123
APGAR scoring123
Gestational age123
Eye exam123
Hearing screen123
Thermoregulation123
Care of infant under phototherapy123
Experience in level II nursery123
Experience in level III nursery123
AGE-SPECIFIC COMPETENCIES EXPERIENCE:

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 *
Neonatal (< 23 weeks)123
Neonatal (24-28 weeks)123
Neonatal (29-32 weeks)123
Neonatal (>33 weeks)123

Attestation

ATTESTATION: *