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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
Neonatal Intensive Care 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
Neonate (birth - 23 weeks)
*
0
1
2
3
4
5
Neonate (23 - 28 weeks)
*
0
1
2
3
4
5
Neonate (29 - 32 weeks)
*
0
1
2
3
4
5
Neonate (over 32+ weeks)
*
0
1
2
3
4
5
Full Term Newborn
*
0
1
2
3
4
5
Neurological
Assessment Of Neurological Status
*
0
1
2
3
4
5
Intracranial Pressure Monitoring
*
0
1
2
3
4
5
Neurological - Care of Neonate With
Spina Bifida
*
0
1
2
3
4
5
Myelomeningocele
*
0
1
2
3
4
5
Brain Death/Organ Procurement
*
0
1
2
3
4
5
Externalized VP Shunt/Reservoirs
*
0
1
2
3
4
5
Intraventricular Hemorrhage
*
0
1
2
3
4
5
Increased Intracranial Pressure
*
0
1
2
3
4
5
Meningitis
*
0
1
2
3
4
5
Seizures
*
0
1
2
3
4
5
Anticonvulsant Medications
*
0
1
2
3
4
5
Cardiovascular
Assessment/Auscultation (rate, rhythm, volume)
*
0
1
2
3
4
5
Blood Pressure/Invasive (arterial line)
*
0
1
2
3
4
5
Blood Pressure/Non-invasive
*
0
1
2
3
4
5
Heart Sounds/Murmurs
*
0
1
2
3
4
5
Perfusion
*
0
1
2
3
4
5
Pulses
*
0
1
2
3
4
5
EKG Interpretation/Rhythm Recognition
*
0
1
2
3
4
5
Defibrillation/Cardioversion
*
0
1
2
3
4
5
Invasion Hemodynamic Monitoring
*
0
1
2
3
4
5
Central Venous Pressure
*
0
1
2
3
4
5
Cardiovascular - Care of Neonate With
Cardiac Arrest
*
0
1
2
3
4
5
Cardiac Transplant
*
0
1
2
3
4
5
Cardiomyopathy
*
0
1
2
3
4
5
Congenital Heart Disease/Defects
*
0
1
2
3
4
5
Hemodynamic Instability
*
0
1
2
3
4
5
Cardiogenic/Hypovolemic Shock
*
0
1
2
3
4
5
Post Cardiac Surgery
*
0
1
2
3
4
5
Post Cardiac Cath
*
0
1
2
3
4
5
Hyper/Hypotension
*
0
1
2
3
4
5
Knowledge and Use Of
Vasopressin
*
0
1
2
3
4
5
Digoxin
*
0
1
2
3
4
5
Dobutamine
*
0
1
2
3
4
5
Dopamine
*
0
1
2
3
4
5
Epinephrine
*
0
1
2
3
4
5
Nipride
*
0
1
2
3
4
5
Sodium Bicarbonate
*
0
1
2
3
4
5
Respiratory
Assessment of Breath Sounds
*
0
1
2
3
4
5
Rate and Work of Breathing
*
0
1
2
3
4
5
Interpretation of ABGs
*
0
1
2
3
4
5
Assist with Chest Tube Insertion
*
0
1
2
3
4
5
Assist With Chest Tube Removal
*
0
1
2
3
4
5
ECMO (Extracorporeal Membrane Oxygenation)
*
0
1
2
3
4
5
Thoracentesis
*
0
1
2
3
4
5
Use of Artificial Surfactant
*
0
1
2
3
4
5
Respiratory - Airway Management
Assist with Intubation
*
0
1
2
3
4
5
Bulb Syringe
*
0
1
2
3
4
5
Endotracheal Tube Suctioning
*
0
1
2
3
4
5
In-Line Suction
*
0
1
2
3
4
5
Open ET Catheter Suction
*
0
1
2
3
4
5
Extubation
*
0
1
2
3
4
5
Nasal/Oral Airway/Suctioning
*
0
1
2
3
4
5
Tracheostomy/Suctioning
*
0
1
2
3
4
5
Apnea Monitor
*
0
1
2
3
4
5
Respiratory Insufficiency
*
0
1
2
3
4
5
Respiratory Arrest
*
0
1
2
3
4
5
Respiratory - O2 Therapy Delivery Systems
Bag and Mask
*
0
1
2
3
4
5
Nasal Cannula
*
0
1
2
3
4
5
Nebulizer
*
0
1
2
3
4
5
Oxyhood/Tent
*
0
1
2
3
4
5
Trach Collar
*
0
1
2
3
4
5
Respiratory - Obtaining Labs
Arterial
*
0
1
2
3
4
5
Heelstick
*
0
1
2
3
4
5
Peripheral
*
0
1
2
3
4
5
Umbilical Line
*
0
1
2
3
4
5
Respiratory - Use of Ventilators
CPAP/PEEP
*
0
1
2
3
4
5
High Frequency Jet Ventilator
*
0
1
2
3
4
5
Home Ventilator
*
0
1
2
3
4
5
IMV
*
0
1
2
3
4
5
Oscillating
*
0
1
2
3
4
5
Pressure Ventilator
*
0
1
2
3
4
5
Volume Ventilator
*
0
1
2
3
4
5
CO2 Monitoring
*
0
1
2
3
4
5
Weaning
*
0
1
2
3
4
5
Respiratory - Care of Neonate With
Apnea
*
0
1
2
3
4
5
Meconium Aspiration
*
0
1
2
3
4
5
Persistent Pulmonary Hypertension (PPHN)
*
0
1
2
3
4
5
Bronchopulmonary Dysplasia (BPD)
*
0
1
2
3
4
5
Diaphragmatic Hernia
*
0
1
2
3
4
5
Fresh Tracheostomy
*
0
1
2
3
4
5
Pneumothorax
*
0
1
2
3
4
5
Respiratory Distress Syndrome (RDS)
*
0
1
2
3
4
5
Respiratory Failure
*
0
1
2
3
4
5
Respiratory - Knowledge and Use Of
Aldactazide
*
0
1
2
3
4
5
Lasix
*
0
1
2
3
4
5
Caffeine
*
0
1
2
3
4
5
Prostaglandin
*
0
1
2
3
4
5
Bronchodilators
*
0
1
2
3
4
5
Steroids
*
0
1
2
3
4
5
Gastrointestinal
Abdominal Girth
*
0
1
2
3
4
5
Bowel Sounds
*
0
1
2
3
4
5
Palate
*
0
1
2
3
4
5
Suck/Swallow
*
0
1
2
3
4
5
Care of Gastrostomy Tube
*
0
1
2
3
4
5
Test for Occult Blood
*
0
1
2
3
4
5
Feedings
Assist with Breast Feeding
*
0
1
2
3
4
5
Bottle
*
0
1
2
3
4
5
Breast Milk Handling/Storage
*
0
1
2
3
4
5
Gavage
*
0
1
2
3
4
5
Hospital Grade Electronic Breast Pump
*
0
1
2
3
4
5
Placement of Intestinal Tubes
Jejunal/Gastro
*
0
1
2
3
4
5
Nasogastric/Orogastric
*
0
1
2
3
4
5
Gastrointestinal - Care of Neonate With
Cleft lip/Palate
*
0
1
2
3
4
5
GI Bleed
*
0
1
2
3
4
5
Ostomy
*
0
1
2
3
4
5
Post Abdominal Surgery
*
0
1
2
3
4
5
Inguinal hernia
*
0
1
2
3
4
5
Necrotizing Enterocolitis
*
0
1
2
3
4
5
Gastroschesis/Omphalocele
*
0
1
2
3
4
5
Reflux
*
0
1
2
3
4
5
Tracheoesophageal Fistula (TEF)
*
0
1
2
3
4
5
Renal/GU/Metabolic/Endocrine General Skills
Fluid & Electrolyte Balance
*
0
1
2
3
4
5
Calculating Output
*
0
1
2
3
4
5
Knowledge/Interpretation of Lab results/Chemistry
*
0
1
2
3
4
5
Bilirubin
*
0
1
2
3
4
5
Glucose
*
0
1
2
3
4
5
Labstix
*
0
1
2
3
4
5
Occult Blood
*
0
1
2
3
4
5
pH
*
0
1
2
3
4
5
Specific Gravity
*
0
1
2
3
4
5
Collection of Urine Specimens
Assist with Suprapubic Tab
*
0
1
2
3
4
5
Catheter
Diaper/Bag
*
0
1
2
3
4
5
Phototherapy for Jaundice
*
0
1
2
3
4
5
Post Circumcision Care
*
0
1
2
3
4
5
Renal/GU/Metabolic/Endocrine - Care of Neonate With
Acute Renal Failure
*
0
1
2
3
4
5
DIC (Disseminated Intravascular Coagulation)
*
0
1
2
3
4
5
Disorders of Internal/External Organs
*
0
1
2
3
4
5
Drug Addiction/Withdrawal
*
0
1
2
3
4
5
Hyper/Hypokalemia
*
0
1
2
3
4
5
Hyper/Hyponatremia
*
0
1
2
3
4
5
Infant of Diabetic Mother - Monitor for Hyper/Hypoglycemia
*
0
1
2
3
4
5
Malformations of the GU Tract, Kidney
*
0
1
2
3
4
5
Peritoneal Dialysis
*
0
1
2
3
4
5
Infectious Diseases
Assist with Lumbar Puncture
*
0
1
2
3
4
5
Collect Culture Specimens
*
0
1
2
3
4
5
Isolation Techniques
*
0
1
2
3
4
5
Standard Precautions
*
0
1
2
3
4
5
Knowledge of Lab Results
CBC/Differential
*
0
1
2
3
4
5
Culture Reports
*
0
1
2
3
4
5
Maternal Lab Results
*
0
1
2
3
4
5
Infectious Disease - Care of Neonate With
Hepatitis Surface Antigen + Mother
*
0
1
2
3
4
5
HIV Positive Mother
*
0
1
2
3
4
5
Neonatal Sepsis
*
0
1
2
3
4
5
Infectious Disease - Knowledge and Use Of
Antibiotics
*
0
1
2
3
4
5
HBIG
*
0
1
2
3
4
5
HBV
*
0
1
2
3
4
5
HIB
*
0
1
2
3
4
5
RespiGam/Synagis Prophylaxis
*
0
1
2
3
4
5
Medication Skills/Knowledge and Use Of
Calculation of Dosage
*
0
1
2
3
4
5
Prep and Administration of Emergency Meds
*
0
1
2
3
4
5
Emergency Drug Action & Reaction
*
0
1
2
3
4
5
Eye Prophylaxis - Vitamin K
*
0
1
2
3
4
5
Neonatal Drug Action & Reactions
*
0
1
2
3
4
5
Computerized/Automated Medication Administration System
*
0
1
2
3
4
5
Computerized/Automated Medication Administration System - List Types
*
Pain Management
Assessment Of Pain Level Using Age Appropriate Scales
*
0
1
2
3
4
5
Care of Neonate with Sedation
*
0
1
2
3
4
5
Use of Sedation Reversal Agents
*
0
1
2
3
4
5
IV Therapy/Phlebotomy - Administration of Blood/Blood Products
Cryoprecipitate
*
0
1
2
3
4
5
Packed Red Blood Cells
*
0
1
2
3
4
5
Plasma/Albumin
*
0
1
2
3
4
5
Whole Blood
*
0
1
2
3
4
5
Drawing Blood from Central Line
*
0
1
2
3
4
5
Drawing Venous Blood
*
0
1
2
3
4
5
IV Therapy/Phlebotomy - Delivery Systems
IV Pump
*
0
1
2
3
4
5
Syringe Pump
*
0
1
2
3
4
5
Hyperalimentation/TPN/PPN
*
0
1
2
3
4
5
Intralipid
*
0
1
2
3
4
5
IV Therapy/Phlebotomy - Managing IV Therapy
Insertion
*
0
1
2
3
4
5
Discontinuation
*
0
1
2
3
4
5
Dressing & Tubing Change
*
0
1
2
3
4
5
Rate Calculation
*
0
1
2
3
4
5
Site & Patency Assessment
*
0
1
2
3
4
5
IV Therapy/Phlebotomy - Care of the Neonate With
Central Line/Catheter/Dressing
*
0
1
2
3
4
5
Broviac
*
0
1
2
3
4
5
Groshong
*
0
1
2
3
4
5
Hickman
*
0
1
2
3
4
5
Port-A-Cath
*
0
1
2
3
4
5
Quinton
*
0
1
2
3
4
5
Percutaneous Arterial Line
*
0
1
2
3
4
5
PICC (peripherally inserted central catheter)
*
0
1
2
3
4
5
Umbilical Artery Line
*
0
1
2
3
4
5
Umbilical Venous Line
*
0
1
2
3
4
5
Other/Misc
Crash Carts
*
0
1
2
3
4
5
Defibrillators
*
0
1
2
3
4
5
Computerized Charting System
*
0
1
2
3
4
5
Computerized Charting System - List Types
*
Apgar Scoring
*
0
1
2
3
4
5
Eye Exam (r/o retinopathy)
*
0
1
2
3
4
5
Cord Care
*
0
1
2
3
4
5
Neonatal Skin Care
*
0
1
2
3
4
5
Positioning Devices
*
0
1
2
3
4
5
Preparation for Transport/Transfer
*
0
1
2
3
4
5
Gestational Age
Car Seat Safety
*
0
1
2
3
4
5
Ballard
*
0
1
2
3
4
5
Dubowitz
*
0
1
2
3
4
5
Other (Specify)
Maternal History
*
0
1
2
3
4
5
Screen for Hearing Loss
*
0
1
2
3
4
5
Equipment & Procedures
*
0
1
2
3
4
5
Bereavement/Postmortem Care
*
0
1
2
3
4
5
Consents
*
0
1
2
3
4
5
Immunization
*
0
1
2
3
4
5
Procedural
*
0
1
2
3
4
5
Treatment
*
0
1
2
3
4
5
Family Teaching/Education
*
0
1
2
3
4
5
Care Planning
*
0
1
2
3
4
5
Thermoregulation
Isolette with Humidity
*
0
1
2
3
4
5
Radiant Warmer
*
0
1
2
3
4
5
Temperature (auxillary, rectal, skin)
*
0
1
2
3
4
5
Weaning To Open Crib/Bassinet
*
0
1
2
3
4
5
Weights
Bed Scale
*
0
1
2
3
4
5
Scale
*
0
1
2
3
4
5
Please List any Other Relevant Skills
List Any Additional Training
List Any Additional Skills
List Any Additional Equipment
Experience with ventilators?
*
Yes
No
Experience with cardiac monitors?
*
Yes
No
NRP current?
*
Yes
No
STABLE current?
*
Yes
No
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
*