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NICU 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: 

 

 

 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

CARDIOVASCULAR

 

 

 

 

 

Auscultation (rate, rhythm, volume)

N/A  

1

2

3

4

Blood pressure/invasive (arterial-line)

N/A  

1

2

3

4

Blood pressure/non-invasive

N/A  

1

2

3

4

Heart sounds/murmurs

N/A  

1

2

3

4

Perfusion

N/A  

1

2

3

4

Pulses

N/A  

1

2

3

4

EKG interpretation

N/A  

1

2

3

4

Cardioversion/Defibrillation

N/A  

1

2

3

4

Invasive hemodynamic monitoring

N/A  

1

2

3

4

Central venous pressure

N/A  

1

2

3

4

Cardiac arrest

N/A  

1

2

3

4

Congenital heart disease/defects

N/A  

1

2

3

4

Hemodynamic instability

N/A  

1

2

3

4

Hypovolemic shock

N/A  

1

2

3

4

Post cardiac surgery

N/A  

1

2

3

4

Dobutamine

N/A  

1

2

3

4

Dopamine

N/A  

1

2

3

4

Epinephrine

N/A  

1

2

3

4

Nipride

N/A  

1

2

3

4

Sodium bicarbonate

N/A  

1

2

3

4

 

PULMONARY

 

 

 

 

 

Breath sounds

N/A  

1

2

3

4

Rate and work of breathing

N/A  

1

2

3

4

Apnea monitor use

N/A  

1

2

3

4

Assist with intubation

N/A  

1

2

3

4

Bulb syringe

N/A  

1

2

3

4

CPAP (nasal cannula)

N/A  

1

2

3

4

Endotracheal tube stabilation

N/A  

1

2

3

4

Endotracheal tube suctioning

N/A  

1

2

3

4

Extubation

N/A  

1

2

3

4

Nasal airway/ suctioning

N/A  

1

2

3

4

Oral airway/suctioning

N/A  

1

2

3

4

Tracheostomy care and suctioning

N/A  

1

2

3

4

Assist with chest tube insertion/removal/set-up

N/A  

1

2

3

4

Oxygen therapy delivery systems:

N/A  

1

2

3

4

Anesthesia bag and mask

N/A  

1

2

3

4

Self-inflating bag and mask

N/A  

1

2

3

4

Nasal cannula

N/A  

1

2

3

4

Nebulizer

N/A  

1

2