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Labor & Delivery, Postpartum and Newborn Nursery Skills Checklist
*required fields

My responses in this checklist represent a true reflection of my experience and comfort level.

 

Please self-rate your comfort level in performing tasks in connection with the below checklist.  Rate your level of comfort for each line item by following the below ranking system.  Simply fill in the appropriate option immediately following the rating number.

 

Typed Name (typing your name below serves as an electronic signature) *      Date*

                                                         

 

Phone*

           

 

 My Recruiting Professional at Health Source Group is: 

 

Certifications: (Check all that apply)

     BLS/BCLS/CPR:
     NALS:
     NRP:
     RNC:
     NCC:

Level of Comfort/Experience

N/A=Non-applicable

1=Inexperienced in this area

2=Limited comfort/experience in this area

3=Comfortable/experienced in this area

4=Very comfortable/highly experienced in this area

 

Area

Not Applicable

Inexperienced

Limited

Experienced

Highly Experienced

ALabor and Delivery

Cervical dilation and changes

N/A  

1

2

3

4

Cervical effacement and changes

N/A  

1

2

3

4

Duration, frequency, and quality of contractions

N/A  

1

2

3

4

Vaginal delivery

N/A  

1

2

3

4

Forceps vaginal delivery/vacuum extraction delivery

N/A  

1

2

3

4

Emergency delivery

N/A  

1

2

3

4

High risk delivery

N/A  

1

2

3

4

Placement of intrauterine pressure catheter

N/A  

1

2

3

4

Fetal scalp blood sampling procedure

N/A  

1

2

3

4

Artificial rupture of membranes procedure

N/A  

1

2

3

4

Vaginal exam

N/A  

1

2

3

4

Fundal assessment/height

N/A  

1

2

3

4

Use of fetalscope/doppler

N/A  

1

2

3

4

Interpretation of fetal monitoring

N/A  

1

2

3

4

Internal monitor/lead connection and calibration

N/A  

1

2

3

4

Foley catheter insertion or straight catheterization (cath)

N/A  

1

2

3

4

Perineal prep

N/A  

1

2

3

4

Abdominal shave/scrub prep

N/A  

1

2

3

4

Circulate for C-section

N/A  

1

2

3

4

Scrub for C-section

N/A  

1

2

3

4

Abruptio placenta

N/A  

1

2

3

4

Diabetes mellitus

N/A  

1

2

3

4

Infectious disease

N/A  

1

2

3

4

Malpresentations

N/A  

1

2

3

4

Multiple gestation

N/A  

1

2

3

4

Pregnancy-induced hypertension

N/A  

1

2

3

4

Preeclampsia

N/A  

1

2

3

4

Placenta previa

N/A  

1

2

3

4

Premature labor

N/A  

1

2

3

4

Prolapsed cord

N/A  

1

2

3

4

RH incompatibilities

N/A  

1

2

3

4

Sickle cell crisis

N/A  

1

2

3

4

Cytotec

N/A  

1

2

3

4

Prostaglandin

N/A  

1

2

3

4

Insulin drips

N/A  

1

2

3

4

Magnesium Sulfate

N/A  

1

2

3

4

Ritodrine

N/A  

1

2

3

4

Pitocin

N/A  

1

2

3

4

 

IV Therapy

Start/maintenance of periph