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1.877.891.4286
1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
LDRP RN – Skills Checklist
This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Age of Patients Cared For
Newborn (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (64 - 79 years)
*
0
1
2
3
4
5
Elderly Adults (over 79+ years)
*
0
1
2
3
4
5
General Skills
Patient and Family Teaching
*
0
1
2
3
4
5
Coaching Needs
*
0
1
2
3
4
5
Universal Precautions
*
0
1
2
3
4
5
Isolation Precautions
*
0
1
2
3
4
5
Care of the Patient in restraints
*
0
1
2
3
4
5
Cardiac Monitoring
*
0
1
2
3
4
5
Pulse Oximetry
*
0
1
2
3
4
5
Ventilator Management (Adult)
*
0
1
2
3
4
5
Ventilator Management (Newborn)
*
0
1
2
3
4
5
Prep and Administration of Emergency Meds
*
0
1
2
3
4
5
Infant/Neonatal Cardiac/Respiratory Arrest
*
0
1
2
3
4
5
Adult Cardiac/Respiratory Arrest
*
0
1
2
3
4
5
End of Life Care
*
0
1
2
3
4
5
Fetal Monitoring - Basic
*
0
1
2
3
4
5
Fetal Monitoring - Advanced
*
0
1
2
3
4
5
IV Therapy
*
0
1
2
3
4
5
Administration of Blood/Blood Products
*
0
1
2
3
4
5
Knowledge of Normal Lab Values
*
0
1
2
3
4
5
Newborn
*
0
1
2
3
4
5
Labor Patient
*
0
1
2
3
4
5
Pain Management
*
0
1
2
3
4
5
Automated Med Dispensing System
*
0
1
2
3
4
5
Automated Med Dispensing System - List Types
*
Electronic Documentation
*
0
1
2
3
4
5
Electronic Documentation - List Types
*
Care of Patients with Pre-Existing Conditions/High Risk OB
Cardiac Disease
*
0
1
2
3
4
5
Neurological Disease
*
0
1
2
3
4
5
Seizure Disorder
*
0
1
2
3
4
5
Chronic Diabetes Mellitus
*
0
1
2
3
4
5
Pregnancy Induced Diabetes Mellitus
*
0
1
2
3
4
5
Asthma
*
0
1
2
3
4
5
Chronic Hypertension
*
0
1
2
3
4
5
Pregnancy-Induced Hypertension
*
0
1
2
3
4
5
Infectious Disease
*
0
1
2
3
4
5
HBV
*
0
1
2
3
4
5
HIV
*
0
1
2
3
4
5
Sickle Cell Disease
*
0
1
2
3
4
5
RH Incompatibilities
*
0
1
2
3
4
5
Hemolytic Anemia
*
0
1
2
3
4
5
Collagen Vascular Disease
*
0
1
2
3
4
5
Hemorrhage
*
0
1
2
3
4
5
Drug Addiction/Withdrawal
*
0
1
2
3
4
5
Pyelonephritis
*
0
1
2
3
4
5
Abruptio Placenta
*
0
1
2
3
4
5
Placenta Previa
*
0
1
2
3
4
5
Placenta Acreta
*
0
1
2
3
4
5
Preeclampsia
*
0
1
2
3
4
5
Eclampsia
*
0
1
2
3
4
5
Premature Labor
*
0
1
2
3
4
5
Malpresentations
*
0
1
2
3
4
5
Breech
*
0
1
2
3
4
5
Transverse Lie/Shoulder
*
0
1
2
3
4
5
Face Presentation
*
0
1
2
3
4
5
Brow Presentation
*
0
1
2
3
4
5
Multiple Gestation
*
0
1
2
3
4
5
PROM
*
0
1
2
3
4
5
Chorioamnionitis
*
0
1
2
3
4
5
Poly/Oligohydramnios
*
0
1
2
3
4
5
Prior Tubal Ligation
*
0
1
2
3
4
5
VBAC Management/Trial of Labor
*
0
1
2
3
4
5
Uterine Rupture
*
0
1
2
3
4
5
Incompetent Cervex (Shirodkar Suture/Cerclage)
*
0
1
2
3
4
5
Spontaneous Abortions- Complete/Incomplete
*
0
1
2
3
4
5
Intrauterine Growth Retardation (IUGR)
*
0
1
2
3
4
5
Postdate Pregnancy
*
0
1
2
3
4
5
HELLP Syndrome
*
0
1
2
3
4
5
DIC
*
0
1
2
3
4
5
Fetal Demise
*
0
1
2
3
4
5
Antepartum
Triage of Obstetrical Patients
*
0
1
2
3
4
5
Assessment of Birth Plan
*
0
1
2
3
4
5
Perform Admission Risk Assessment
*
0
1
2
3
4
5
Non-Stress Test (NST)
*
0
1
2
3
4
5
Induction of Labor
*
0
1
2
3
4
5
Oxytocin Challenge Tests (OCT)
*
0
1
2
3
4
5
Biophysical Profile
*
0
1
2
3
4
5
Assist with Sonogram
*
0
1
2
3
4
5
Perform Sonogram
*
0
1
2
3
4
5
Assist with Amniocentesis
*
0
1
2
3
4
5
Normal Perinatal Vital Signs
*
0
1
2
3
4
5
Deep Tendon Reflex Checks (DTR’s)
*
0
1
2
3
4
5
Edema Assessment
*
0
1
2
3
4
5
Clonus
*
0
1
2
3
4
5
Assess for Comfort
*
0
1
2
3
4
5
Breathing/Relaxation Techniques
*
0
1
2
3
4
5
Coaching
*
0
1
2
3
4
5
Positioning
*
0
1
2
3
4
5
Medications
Ritodrine
*
0
1
2
3
4
5
Magnesium Sulfate
*
0
1
2
3
4
5
Terbutaline
*
0
1
2
3
4
5
Indomethacin
*
0
1
2
3
4
5
Procardia
*
0
1
2
3
4
5
Pitocin
*
0
1
2
3
4
5
Oxytocin
*
0
1
2
3
4
5
Cervidil
*
0
1
2
3
4
5
Cytotec
*
0
1
2
3
4
5
Prostin Suppositories
*
0
1
2
3
4
5
Assist with Prostin Gel
*
0
1
2
3
4
5
Antibiotics
*
0
1
2
3
4
5
Antihypertensives
*
0
1
2
3
4
5
Heparin
*
0
1
2
3
4
5
Stadol
*
0
1
2
3
4
5
Nubain
*
0
1
2
3
4
5
Morphine
*
0
1
2
3
4
5
Demerol
*
0
1
2
3
4
5
Fentanyl
*
0
1
2
3
4
5
Insulin Drips
*
0
1
2
3
4
5
Insulin Pumps
*
0
1
2
3
4
5
Insulin SC
*
0
1
2
3
4
5
AZT/Other Antiviral Medications
*
0
1
2
3
4
5
Rhogam
*
0
1
2
3
4
5
IV Therapy/Procedures
Starting PIV’s
*
0
1
2
3
4
5
PICC Lines-Care and Maintenance
*
0
1
2
3
4
5
Central Venous Lines-Care and Maintenance
*
0
1
2
3
4
5
Invasive Hemodynamic Monitoring
*
0
1
2
3
4
5
Blood Draw from PICC/CVL
*
0
1
2
3
4
5
Administration of Blood/Blood Products
*
0
1
2
3
4
5
IV Infusion Pumps
*
0
1
2
3
4
5
Blood/Fluid Warmers
*
0
1
2
3
4
5
Labor Assessment/Procedures Maternal
Normal Vital Signs - Baseline
*
0
1
2
3
4
5
Identify Common Cardiac Arrhythmias
*
0
1
2
3
4
5
Assist with Sterile Speculum Exam
*
0
1
2
3
4
5
Perform Sterile Speculum Exam
*
0
1
2
3
4
5
Vaginal Exam - Manual
*
0
1
2
3
4
5
Status of Membranes
*
0
1
2
3
4
5
Assist with Rupture of Membranes
*
0
1
2
3
4
5
Fern Test
*
0
1
2
3
4
5
Nitrazine
*
0
1
2
3
4
5
Presence of Clonus
*
0
1
2
3
4
5
DTR’s
*
0
1
2
3
4
5
Edema
*
0
1
2
3
4
5
Progression Of Labor
*
0
1
2
3
4
5
Dilation
*
0
1
2
3
4
5
Effacement
*
0
1
2
3
4
5
Fetal Position
*
0
1
2
3
4
5
Fetal Presentation
*
0
1
2
3
4
5
Station
*
0
1
2
3
4
5
Contraction Characteristics
*
0
1
2
3
4
5
Determination of Fetal Head Position
*
0
1
2
3
4
5
Documentation of Labor Status and Interventions
*
0
1
2
3
4
5
Labor Suppressants
*
0
1
2
3
4
5
Collection of Blood Specimens
*
0
1
2
3
4
5
Collect Urine Specimens
*
0
1
2
3
4
5
Toxicology Studies
*
0
1
2
3
4
5
Collect Vaginal Cultures
*
0
1
2
3
4
5
Fluid
*
0
1
2
3
4
5
Herpes
*
0
1
2
3
4
5
Chlamydia
*
0
1
2
3
4
5
Group B Strep
*
0
1
2
3
4
5
Perform Leopold’s Maneuvers
*
0
1
2
3
4
5
Amnioinfusion (assist or perform) for
Variable Decelerations
*
0
1
2
3
4
5
Meconium
*
0
1
2
3
4
5
Prolapsed Cord
*
0
1
2
3
4
5
Vasa Previa
*
0
1
2
3
4
5
Catheter Insertion
Straight Cath
*
0
1
2
3
4
5
Foley
*
0
1
2
3
4
5
Labor Assessment/Procedures Fetal
Fetal Heart Rate - Doppler
*
0
1
2
3
4
5
Fetal Heart Rate - Auscultate
*
0
1
2
3
4
5
Document Fetal Position
*
0
1
2
3
4
5
Fetal Heart Rate Patterns: Identify and Treat Baseline
Variability
*
0
1
2
3
4
5
Variable Decelerations
*
0
1
2
3
4
5
Early Decelerations
*
0
1
2
3
4
5
Late Decelerations
*
0
1
2
3
4
5
Prolonged Decelerations
*
0
1
2
3
4
5
External Fetal Monitor Application
*
0
1
2
3
4
5
Internal Fetal Monitor Application (Assist)
*
0
1
2
3
4
5
Internal Fetal Monitor Application (Perform)
*
0
1
2
3
4
5
Spiral Electrode
*
0
1
2
3
4
5
Intrauterine Pressure Catheter (IUPC)
Placement
*
0
1
2
3
4
5
Calibration
*
0
1
2
3
4
5
Fluid Filled
*
0
1
2
3
4
5
Transducer Tipped
*
0
1
2
3
4
5
Delivery/C-Section
Assist with Vaginal Delivery
*
0
1
2
3
4
5
Forceps Extraction
*
0
1
2
3
4
5
Vacuum Extraction
*
0
1
2
3
4
5
Assist with High Risk Delivery
*
0
1
2
3
4
5
Shoulder Dystocia
*
0
1
2
3
4
5
Hemorrhage/Shock
*
0
1
2
3
4
5
Emergency Delivery
*
0
1
2
3
4
5
Abdominal Shave/Scrub Prep
*
0
1
2
3
4
5
Perineal Prep
*
0
1
2
3
4
5
Circulate for C-Section
*
0
1
2
3
4
5
Scrub for C-Section
*
0
1
2
3
4
5
Patient with General Anesthesia
*
0
1
2
3
4
5
Patient with Epidural Anesthesia
*
0
1
2
3
4
5
Circulate with Tubal Ligation
*
0
1
2
3
4
5
Scrub for Tubal Ligation
*
0
1
2
3
4
5
Assist with Placenta Delivery
*
0
1
2
3
4
5
Fundus Massage
*
0
1
2
3
4
5
Assist with Cervical Laceration Repair
*
0
1
2
3
4
5
Assist with Uterine Laceration Repair
*
0
1
2
3
4
5
Assist with Episiotomy Repair
*
0
1
2
3
4
5
Immediate Care of Newborn in Delivery Room - Newborn Assessment
Ballard
*
0
1
2
3
4
5
Dubowitz
*
0
1
2
3
4
5
Finnegan/Abstinence Scoring
*
0
1
2
3
4
5
Apgar Scores
*
0
1
2
3
4
5
Initial Vital Signs
*
0
1
2
3
4
5
Bulb Suctioning
*
0
1
2
3
4
5
Delee Suctioning
*
0
1
2
3
4
5
Wall Suctioning
*
0
1
2
3
4
5
Meconium Aspiration
*
0
1
2
3
4
5
Collect Cord Samples
*
0
1
2
3
4
5
Assist with UAC/UVC Insertion
*
0
1
2
3
4
5
Insertion of IV, Including Scalp IV
*
0
1
2
3
4
5
Radiant Warmer/Thermoregulation
*
0
1
2
3
4
5
Interventions for LGA, SGA, IUGR
*
0
1
2
3
4
5
Interventions for Infant of Diabetic Mother
*
0
1
2
3
4
5
Oxygen Administration
*
0
1
2
3
4
5
Bag/Mask Ventilation of the Newborn
*
0
1
2
3
4
5
Assist with Intubation
*
0
1
2
3
4
5
Transport Isolette
*
0
1
2
3
4
5
Heelstick Glucose
*
0
1
2
3
4
5
Eye Prophylaxis
*
0
1
2
3
4
5
Vitamin K
*
0
1
2
3
4
5
ID/Security Banding
*
0
1
2
3
4
5
Promote Bonding Behaviors
*
0
1
2
3
4
5
Lead Placement for Cardiac Monitor
*
0
1
2
3
4
5
Apnea Monitoring
*
0
1
2
3
4
5
Oxyhood
*
0
1
2
3
4
5
Immediate Care of Newborn in Delivery Room - Postpartum Care
Fundal Height
*
0
1
2
3
4
5
Fundal Massage
*
0
1
2
3
4
5
Lochia
*
0
1
2
3
4
5
Episiotomy Care
*
0
1
2
3
4
5
Perineum Care
*
0
1
2
3
4
5
Maternal Vital Signs
*
0
1
2
3
4
5
Recovering Post-Op C-Section Patients
*
0
1
2
3
4
5
Recovering Post-Op Tubal Ligation Patient
*
0
1
2
3
4
5
Fluid Balance
*
0
1
2
3
4
5
Assessment for DVT
*
0
1
2
3
4
5
Couplet Care
*
0
1
2
3
4
5
Breast Care
*
0
1
2
3
4
5
Breastfeeding
*
0
1
2
3
4
5
Immediate Care of Newborn in Delivery Room - Newborn Care
Cord Care
*
0
1
2
3
4
5
Circumcision Care
*
0
1
2
3
4
5
Bath Demonstration
*
0
1
2
3
4
5
Assist with Lumbar Puncture
*
0
1
2
3
4
5
Newborn Vital Signs
*
0
1
2
3
4
5
Immediate Care of Newborn in Delivery Room - Assist with Breastfeeding
Latch On
*
0
1
2
3
4
5
Positioning
*
0
1
2
3
4
5
Immediate Care of Newborn in Delivery Room - Care of the Infant With
Cardiac Anomalies
*
0
1
2
3
4
5
Drug Addiction/Withdrawal
*
0
1
2
3
4
5
Cystic Fibrosis
*
0
1
2
3
4
5
Meconium Aspiration
*
0
1
2
3
4
5
Pneumonia
*
0
1
2
3
4
5
Pulmonary Edema
*
0
1
2
3
4
5
RDS
*
0
1
2
3
4
5
NEC
*
0
1
2
3
4
5
Neuromuscular Disease
*
0
1
2
3
4
5
Spina Bifida
*
0
1
2
3
4
5
Seizure Activity
*
0
1
2
3
4
5
Tracheoesophageal Fistula
*
0
1
2
3
4
5
Sepsis
*
0
1
2
3
4
5
Sickle Cell Disease
*
0
1
2
3
4
5
Low Birth Weight Infants
*
0
1
2
3
4
5
Pain Management/Anesthesia
Assess Pain Level
*
0
1
2
3
4
5
Assess Acceptable Level of Pain
*
0
1
2
3
4
5
Intranasal Pain Medications
*
0
1
2
3
4
5
Oral Pain Medications
*
0
1
2
3
4
5
IV Pain Medications
*
0
1
2
3
4
5
PCA
*
0
1
2
3
4
5
IV Conscious Sedation
*
0
1
2
3
4
5
Epidural Pain Management
*
0
1
2
3
4
5
Intervention for Anesthesia Toxicity
*
0
1
2
3
4
5
Assist with Epidural Insertion
Positioning of Patient
*
0
1
2
3
4
5
Signs of Dural Puncture
*
0
1
2
3
4
5
Fluid Challenge
*
0
1
2
3
4
5
Hypotension
*
0
1
2
3
4
5
Intrathecal Narcotics
*
0
1
2
3
4
5
Misc.
List Any Additional Training
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List Any Additional Skills
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List Any Additional Equipment
*
Experience with ventilators?
*
Yes
No
Experience with cardiac monitors?
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Yes
No
NRP current?
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Yes
No
STABLE current?
*
Yes
No
Fetal monitoring course - Basic?
*
Yes
No
Fetal monitoring course - Intermediate?
*
Yes
No
Fetal monitoring course - Advanced?
*
Yes
No
My experience is mostly in… (list number of years in each setting)
Labor and Delivery
*
LDR
*
LDRP
*
Rural Hospital (Also list number of births per month)
*
Community Hospital (Also list number of births per month)
*
Number of deliveries per month (average in last year)
*
Have you ever experienced an unattended delivery?
*
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*