Pediatric 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
Newborn/Neonate (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
General Skills
Standard Precautions*
- 0
- 1
- 2
- 3
- 4
- 5
Isolation Precautions*
- 0
- 1
- 2
- 3
- 4
- 5
Pediatric Respiratory/Cardiac Arrest*
- 0
- 1
- 2
- 3
- 4
- 5
Adult Respiratory/Cardiac Arrest*
- 0
- 1
- 2
- 3
- 4
- 5
Crash Carts*
- 0
- 1
- 2
- 3
- 4
- 5
Defibrillators*
- 0
- 1
- 2
- 3
- 4
- 5
Care of Patient in Restraints*
- 0
- 1
- 2
- 3
- 4
- 5
Automated Med Dispensing Systems*
- 0
- 1
- 2
- 3
- 4
- 5
Care Planning & Discharge Planning*
- 0
- 1
- 2
- 3
- 4
- 5
Patient/Family Education*
- 0
- 1
- 2
- 3
- 4
- 5
Electronic Documentation*
- 0
- 1
- 2
- 3
- 4
- 5
Patient Head to Toe Assessment*
- 0
- 1
- 2
- 3
- 4
- 5
Cardiovascular General Skills
Auscultation (rate, rhythm, volume)*
- 0
- 1
- 2
- 3
- 4
- 5
Blood Pressure/Invasive (arterial line)*
- 0
- 1
- 2
- 3
- 4
- 5
Heart Sounds/Murmurs*
- 0
- 1
- 2
- 3
- 4
- 5
Perfusion*
- 0
- 1
- 2
- 3
- 4
- 5
Central Venous Pressure*
- 0
- 1
- 2
- 3
- 4
- 5
Invasive Hemodynamic Monitoring
Interpretation of Lab Results - CBC/Electrolytes*
- 0
- 1
- 2
- 3
- 4
- 5
Defibrillation/Cardioversion*
- 0
- 1
- 2
- 3
- 4
- 5
EKG Interpretation (Basic & Advanced)*
- 0
- 1
- 2
- 3
- 4
- 5
Cardiovascular - Care of the Child With
Bacterial Endocarditis*
- 0
- 1
- 2
- 3
- 4
- 5
Congenital heart Disease/Defects Cardiac Arrest*
- 0
- 1
- 2
- 3
- 4
- 5
Cardiac Transplant*
- 0
- 1
- 2
- 3
- 4
- 5
Cardiogenic Shock*
- 0
- 1
- 2
- 3
- 4
- 5
Cardiomyopathy*
- 0
- 1
- 2
- 3
- 4
- 5
Hypovolemic Shock*
- 0
- 1
- 2
- 3
- 4
- 5
Myocarditis*
- 0
- 1
- 2
- 3
- 4
- 5
Post Cardiac Surgery*
- 0
- 1
- 2
- 3
- 4
- 5
Post Interventional Cardiac Cath*
- 0
- 1
- 2
- 3
- 4
- 5
Medications Knowledge and Use Of
Dobutamine (Dobutrex)*
- 0
- 1
- 2
- 3
- 4
- 5
Dopamine (Intropin)*
- 0
- 1
- 2
- 3
- 4
- 5
Epinephrine (Adrenalin)*
- 0
- 1
- 2
- 3
- 4
- 5
Nipride (Nitroprusside)*
- 0
- 1
- 2
- 3
- 4
- 5
Nitroglycerine (Tridil)*
- 0
- 1
- 2
- 3
- 4
- 5
Sodium Bicarbonate*
- 0
- 1
- 2
- 3
- 4
- 5
Antiarrhythmics*
- 0
- 1
- 2
- 3
- 4
- 5
Respiratory General Skills
Breath Sounds/Work of Breathing*
- 0
- 1
- 2
- 3
- 4
- 5
Obtaining Blood Gases
Arterial*
- 0
- 1
- 2
- 3
- 4
- 5
Heelstick*
- 0
- 1
- 2
- 3
- 4
- 5
Peripheral*
- 0
- 1
- 2
- 3
- 4
- 5
Interpretation of ABG’s*
- 0
- 1
- 2
- 3
- 4
- 5
Oximeter*
- 0
- 1
- 2
- 3
- 4
- 5
Airway Management
Assist with Intubation*
- 0
- 1
- 2
- 3
- 4
- 5
Assist with Extubation*
- 0
- 1
- 2
- 3
- 4
- 5
Suctioning
Bulb Syringe*
- 0
- 1
- 2
- 3
- 4
- 5
Nasal Airway/Suctioning*
- 0
- 1
- 2
- 3
- 4
- 5
Oral Airway/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
Tracheostomy/Suctioning*
- 0
- 1
- 2
- 3
- 4
- 5
Apnea Monitor*
- 0
- 1
- 2
- 3
- 4
- 5
Chest Physiotherapy*
- 0
- 1
- 2
- 3
- 4
- 5
Chest Tube (Assist With)
Insertion*
- 0
- 1
- 2
- 3
- 4
- 5
Removal*
- 0
- 1
- 2
- 3
- 4
- 5
ECMO (Extracorporeal Membrane Oxygenation)*
- 0
- 1
- 2
- 3
- 4
- 5
End Tidal CO2*
- 0
- 1
- 2
- 3
- 4
- 5
O2 Therapy
Nasal Cannula*
- 0
- 1
- 2
- 3
- 4
- 5
Bag & Mask*
- 0
- 1
- 2
- 3
- 4
- 5
Isolette*
- 0
- 1
- 2
- 3
- 4
- 5
Oxyhood*
- 0
- 1
- 2
- 3
- 4
- 5
Tent*
- 0
- 1
- 2
- 3
- 4
- 5
Trach Collar*
- 0
- 1
- 2
- 3
- 4
- 5
Thoracentesis*
- 0
- 1
- 2
- 3
- 4
- 5
Ventilators
CPAP/PEEP/BIPAP*
- 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
Pressure Ventilator*
- 0
- 1
- 2
- 3
- 4
- 5
Volume Ventilator*
- 0
- 1
- 2
- 3
- 4
- 5
Weaning*
- 0
- 1
- 2
- 3
- 4
- 5
Respiratory - Care of Child With
Bronchiolitis (RSV)*
- 0
- 1
- 2
- 3
- 4
- 5
Pneumonia*
- 0
- 1
- 2
- 3
- 4
- 5
Croup*
- 0
- 1
- 2
- 3
- 4
- 5
Chronic Respiratory Disease*
- 0
- 1
- 2
- 3
- 4
- 5
Status Asthmaticus*
- 0
- 1
- 2
- 3
- 4
- 5
Lung Transplant*
- 0
- 1
- 2
- 3
- 4
- 5
Epiglottitis*
- 0
- 1
- 2
- 3
- 4
- 5
Fresh Tracheostomy*
- 0
- 1
- 2
- 3
- 4
- 5
Foreign Body Aspiration*
- 0
- 1
- 2
- 3
- 4
- 5
Flail Chest*
- 0
- 1
- 2
- 3
- 4
- 5
Hemothorax*
- 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
Medications Knowledge and Use Of
Steroids*
- 0
- 1
- 2
- 3
- 4
- 5
Bronchodilators*
- 0
- 1
- 2
- 3
- 4
- 5
Racemic Epinephrine*
- 0
- 1
- 2
- 3
- 4
- 5
Neuro General Skills
Glasgow Coma Scale*
- 0
- 1
- 2
- 3
- 4
- 5
Neurological Status*
- 0
- 1
- 2
- 3
- 4
- 5
Assist with Lumbar Puncture*
- 0
- 1
- 2
- 3
- 4
- 5
Seizure Precautions*
- 0
- 1
- 2
- 3
- 4
- 5
Intracranial Pressure Monitoring*
- 0
- 1
- 2
- 3
- 4
- 5
Neuro - Care of Child With
Head Trauma*
- 0
- 1
- 2
- 3
- 4
- 5
Post Neurosurgery*
- 0
- 1
- 2
- 3
- 4
- 5
Spinal Cord Injury*
- 0
- 1
- 2
- 3
- 4
- 5
Status Epilepticus*
- 0
- 1
- 2
- 3
- 4
- 5
Coma*
- 0
- 1
- 2
- 3
- 4
- 5
Brain Death/Organ Procurement*
- 0
- 1
- 2
- 3
- 4
- 5
Encephalitis*
- 0
- 1
- 2
- 3
- 4
- 5
Meningitis*
- 0
- 1
- 2
- 3
- 4
- 5
Externalized VP Shunt/Reservoirs*
- 0
- 1
- 2
- 3
- 4
- 5
Neuromuscular Disease*
- 0
- 1
- 2
- 3
- 4
- 5
Medications Knowledge and Use Of
Mannitol*
- 0
- 1
- 2
- 3
- 4
- 5
Sedatives*
- 0
- 1
- 2
- 3
- 4
- 5
Anticonvulsants*
- 0
- 1
- 2
- 3
- 4
- 5
Gastrointestinal General Skills
Abdominal Assessment*
- 0
- 1
- 2
- 3
- 4
- 5
Interpretation of Lab Results - Serum Electrolytes*
- 0
- 1
- 2
- 3
- 4
- 5
Feedings (Storage and Prep of)*
- 0
- 1
- 2
- 3
- 4
- 5
Bottle*
- 0
- 1
- 2
- 3
- 4
- 5
Breast*
- 0
- 1
- 2
- 3
- 4
- 5
Gavage*
- 0
- 1
- 2
- 3
- 4
- 5
TPN*
- 0
- 1
- 2
- 3
- 4
- 5
PPN*
- 0
- 1
- 2
- 3
- 4
- 5
Gastrostomy/Button
J-Tubes*
- 0
- 1
- 2
- 3
- 4
- 5
NG to Suction*
- 0
- 1
- 2
- 3
- 4
- 5
Placement of Naso/Orogastric Tube*
- 0
- 1
- 2
- 3
- 4
- 5
Test for Occult Blood*
- 0
- 1
- 2
- 3
- 4
- 5
Gastrointestinal - Care of Child With
Anal Fissure*
- 0
- 1
- 2
- 3
- 4
- 5
Cleft Lip/Palate*
- 0
- 1
- 2
- 3
- 4
- 5
New Colostomy*
- 0
- 1
- 2
- 3
- 4
- 5
New Ileostomy*
- 0
- 1
- 2
- 3
- 4
- 5
Diaphragmatic Hernia*
- 0
- 1
- 2
- 3
- 4
- 5
Severe Failure to Thrive (FTT)*
- 0
- 1
- 2
- 3
- 4
- 5
Pyloric Stenosis Repair*
- 0
- 1
- 2
- 3
- 4
- 5
GE Reflux*
- 0
- 1
- 2
- 3
- 4
- 5
Crohn’s Disease*
- 0
- 1
- 2
- 3
- 4
- 5
Ulcerative Colitis*
- 0
- 1
- 2
- 3
- 4
- 5
Severe Gastroenteritis/Dehydration*
- 0
- 1
- 2
- 3
- 4
- 5
Intestinal Parasites*
- 0
- 1
- 2
- 3
- 4
- 5
Necrotizing Enterocolitis (NEC)*
- 0
- 1
- 2
- 3
- 4
- 5
Surgical Abdomen*
- 0
- 1
- 2
- 3
- 4
- 5
Liver Transplant*
- 0
- 1
- 2
- 3
- 4
- 5
Small Bowel Transplant*
- 0
- 1
- 2
- 3
- 4
- 5
Medications Knowlede and Use Of
Antiemetics*
- 0
- 1
- 2
- 3
- 4
- 5
Renal/Genitourinary General Skills
Interpretation Of Lab Results (UA/BUN/Creatinine)*
- 0
- 1
- 2
- 3
- 4
- 5
Test Urine and Interpret*
- 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 Tap*
- 0
- 1
- 2
- 3
- 4
- 5
Catheter*
- 0
- 1
- 2
- 3
- 4
- 5
Diaper/Bag*
- 0
- 1
- 2
- 3
- 4
- 5
Insertion & Care Of Straight And Foley Catheter*
- 0
- 1
- 2
- 3
- 4
- 5
Suprapubic*
- 0
- 1
- 2
- 3
- 4
- 5
Renal/Genitourinary - Care of Child With
Acute Renal Failure*
- 0
- 1
- 2
- 3
- 4
- 5
CAVH*
- 0
- 1
- 2
- 3
- 4
- 5
Peritoneal Dialysis*
- 0
- 1
- 2
- 3
- 4
- 5
Hemodialysis*
- 0
- 1
- 2
- 3
- 4
- 5
Hemolytic Uremic Syndrome (HUS)*
- 0
- 1
- 2
- 3
- 4
- 5
Nephritis*
- 0
- 1
- 2
- 3
- 4
- 5
Nephrotic Syndrome*
- 0
- 1
- 2
- 3
- 4
- 5
Renal Tansplant*
- 0
- 1
- 2
- 3
- 4
- 5
Syndrome Inappropriate ADH (SIADH)*
- 0
- 1
- 2
- 3
- 4
- 5
Endocrine/Metabolic General Skills
Electrolyte Balance*
- 0
- 1
- 2
- 3
- 4
- 5
Blood Glucose Testing*
- 0
- 1
- 2
- 3
- 4
- 5
Knowledge of Lab Work - Thyroid Studies*
- 0
- 1
- 2
- 3
- 4
- 5
Endocrine/Metabolic - Care of Child With
Diabetes Mellitus*
- 0
- 1
- 2
- 3
- 4
- 5
Diabetic Ketoacidosis*
- 0
- 1
- 2
- 3
- 4
- 5
Diabetic Coma*
- 0
- 1
- 2
- 3
- 4
- 5
Hyper/Hypocalcemia*
- 0
- 1
- 2
- 3
- 4
- 5
Hyperbilirubinemia*
- 0
- 1
- 2
- 3
- 4
- 5
Thyroid Dysfunction*
- 0
- 1
- 2
- 3
- 4
- 5
Medications Knowledge and Use Of
Growth Hormone*
- 0
- 1
- 2
- 3
- 4
- 5
Insulin*
- 0
- 1
- 2
- 3
- 4
- 5
Thyroid Medications*
- 0
- 1
- 2
- 3
- 4
- 5
Orthopedics General Skills
Specialized Orthopedic Bed*
- 0
- 1
- 2
- 3
- 4
- 5
Orthopedics - Care of Child With
Cervical Traction*
- 0
- 1
- 2
- 3
- 4
- 5
Pinned Fractures*
- 0
- 1
- 2
- 3
- 4
- 5
Post Vertebral Surgery*
- 0
- 1
- 2
- 3
- 4
- 5
Wound Management
Assessment Of Skin Status*
- 0
- 1
- 2
- 3
- 4
- 5
Stasis Ulcers*
- 0
- 1
- 2
- 3
- 4
- 5
Surgical Wound Healing*
- 0
- 1
- 2
- 3
- 4
- 5
Air Fluidized, Low Airloss Beds*
- 0
- 1
- 2
- 3
- 4
- 5
Sterile Dressing Changes*
- 0
- 1
- 2
- 3
- 4
- 5
Wound Care/Irrigations*
- 0
- 1
- 2
- 3
- 4
- 5
JP*
- 0
- 1
- 2
- 3
- 4
- 5
Penrose*
- 0
- 1
- 2
- 3
- 4
- 5
Hemovac*
- 0
- 1
- 2
- 3
- 4
- 5
Burns
First Degree*
- 0
- 1
- 2
- 3
- 4
- 5
Second Degree*
- 0
- 1
- 2
- 3
- 4
- 5
Third Degree*
- 0
- 1
- 2
- 3
- 4
- 5
Pressure sores*
- 0
- 1
- 2
- 3
- 4
- 5
Staged Decubitus Ulcers*
- 0
- 1
- 2
- 3
- 4
- 5
Surgical Wounds with Drain(s)*
- 0
- 1
- 2
- 3
- 4
- 5
Traumatic Wounds*
- 0
- 1
- 2
- 3
- 4
- 5
Oncology General Skills
Reverse Isolation*
- 0
- 1
- 2
- 3
- 4
- 5
Nutritional Status*
- 0
- 1
- 2
- 3
- 4
- 5
Interpretation of Lab Result
Blood Chemistry*
- 0
- 1
- 2
- 3
- 4
- 5
Blood Counts*
- 0
- 1
- 2
- 3
- 4
- 5
Oncology - Care of Child With
Malignant Tumors*
- 0
- 1
- 2
- 3
- 4
- 5
Fresh Oncologic Surgery*
- 0
- 1
- 2
- 3
- 4
- 5
Acute Tumor Lysis Syndrome*
- 0
- 1
- 2
- 3
- 4
- 5
Leukemia*
- 0
- 1
- 2
- 3
- 4
- 5
Bone Marrow Transplant*
- 0
- 1
- 2
- 3
- 4
- 5
Disseminated Intravascular Coagulation*
- 0
- 1
- 2
- 3
- 4
- 5
Inpatient Chemotherapy*
- 0
- 1
- 2
- 3
- 4
- 5
Radiation Implant*
- 0
- 1
- 2
- 3
- 4
- 5
Medications Knowledge and Use Of
Chemotherapeutic Agents*
- 0
- 1
- 2
- 3
- 4
- 5
Infectious Diseases General Skills
Interpretation Of Lab Results*
- 0
- 1
- 2
- 3
- 4
- 5
Cultures (Including Sensitivities)*
- 0
- 1
- 2
- 3
- 4
- 5
CBC/differential (shift)*
- 0
- 1
- 2
- 3
- 4
- 5
Obtain Culture Specimens
Blood*
- 0
- 1
- 2
- 3
- 4
- 5
Swab*
- 0
- 1
- 2
- 3
- 4
- 5
Urine*
- 0
- 1
- 2
- 3
- 4
- 5
Sputum*
- 0
- 1
- 2
- 3
- 4
- 5
Infectious Diseases - Care of Child With
Cytomegalovirus (CMV)*
- 0
- 1
- 2
- 3
- 4
- 5
HIV/AIDS*
- 0
- 1
- 2
- 3
- 4
- 5
Septic Shock*
- 0
- 1
- 2
- 3
- 4
- 5
Tuberculosis*
- 0
- 1
- 2
- 3
- 4
- 5
Hepatitis*
- 0
- 1
- 2
- 3
- 4
- 5
Common Childhood Communicable Diseases*
- 0
- 1
- 2
- 3
- 4
- 5
Phlebotomy/IV Therapy
Peripheral IV Insertion, Care and Maintenance*
- 0
- 1
- 2
- 3
- 4
- 5
Central Line Care and Maintenance*
- 0
- 1
- 2
- 3
- 4
- 5
PICC Line Care and Maintenance*
- 0
- 1
- 2
- 3
- 4
- 5
Drawing Blood from Central Line/PICC Line*
- 0
- 1
- 2
- 3
- 4
- 5
Drawing Venous Blood*
- 0
- 1
- 2
- 3
- 4
- 5
Administration Of Blood/Blood Products*
- 0
- 1
- 2
- 3
- 4
- 5
Cryoprecipitate*
- 0
- 1
- 2
- 3
- 4
- 5
Packed Red Blood Cells*
- 0
- 1
- 2
- 3
- 4
- 5
Whole Blood*
- 0
- 1
- 2
- 3
- 4
- 5
Phlebotomy/IV - Care of Child With
Central Line*
- 0
- 1
- 2
- 3
- 4
- 5
Port-A-Cath*
- 0
- 1
- 2
- 3
- 4
- 5
PICC*
- 0
- 1
- 2
- 3
- 4
- 5
Cutdown Line*
- 0
- 1
- 2
- 3
- 4
- 5
Peripheral Line*
- 0
- 1
- 2
- 3
- 4
- 5
Arterial Line*
- 0
- 1
- 2
- 3
- 4
- 5
Pain Management General Skills
Assessment - Pain Level Using Age Appropriate Scales*
- 0
- 1
- 2
- 3
- 4
- 5
Pain Management - Care of Child With
Epidural Analgesia*
- 0
- 1
- 2
- 3
- 4
- 5
PCA*
- 0
- 1
- 2
- 3
- 4
- 5
IV Conscious Sedation*
- 0
- 1
- 2
- 3
- 4
- 5
Medication Knowledge and Use Of
Analgesics*
- 0
- 1
- 2
- 3
- 4
- 5
Sedatives*
- 0
- 1
- 2
- 3
- 4
- 5
Reversal Agents*
- 0
- 1
- 2
- 3
- 4
- 5
Miscellaneous
Normal Growth And Development*
- 0
- 1
- 2
- 3
- 4
- 5
Normal Laboratory Values*
- 0
- 1
- 2
- 3
- 4
- 5
Recognize Signs of Abuse or Neglect*
- 0
- 1
- 2
- 3
- 4
- 5
Miscellaneous - Care of Child With
Anorexia/Bulimia*
- 0
- 1
- 2
- 3
- 4
- 5
Craniofacial Reconstruction*
- 0
- 1
- 2
- 3
- 4
- 5
Depression*
- 0
- 1
- 2
- 3
- 4
- 5
HEENT Surgery*
- 0
- 1
- 2
- 3
- 4
- 5
Ingestion of Foreign Body*
- 0
- 1
- 2
- 3
- 4
- 5
Ingestion of Poison or Toxins*
- 0
- 1
- 2
- 3
- 4
- 5
Plastic Surgery*
- 0
- 1
- 2
- 3
- 4
- 5
Suicide Attempt*
- 0
- 1
- 2
- 3
- 4
- 5
Multiple Trauma*
- 0
- 1
- 2
- 3
- 4
- 5
Near Drowning*
- 0
- 1
- 2
- 3
- 4
- 5
Medication Administration for Children
Calculation of Pediatric Doses*
- 0
- 1
- 2
- 3
- 4
- 5
Titration of IV Drips*
- 0
- 1
- 2
- 3
- 4
- 5
Eye/Ear Installations*
- 0
- 1
- 2
- 3
- 4
- 5
Metered Dose Inhaler*
- 0
- 1
- 2
- 3
- 4
- 5
Intravenous Medications (IV)*
- 0
- 1
- 2
- 3
- 4
- 5
Subcutaneous (SQ) Injections*
- 0
- 1
- 2
- 3
- 4
- 5
Z Track Injections*
- 0
- 1
- 2
- 3
- 4
- 5
Knowledge of Emergency Drug Action and Reaction*
- 0
- 1
- 2
- 3
- 4
- 5
Pediatric Drug Actions and Reactions*
- 0
- 1
- 2
- 3
- 4
- 5
Years of Experience in Each of the Following Pediatric Areas
Medical/Surgical*
Telemetry*
Oncology*
Neurology*
Psychiatry*
Rehabilitation*
Other (Specify)*
Total Years in Pediatric Nursing*
Chemotherapy cert?*
- 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*

Pediatric Intensive Care RN – Skills Checklist

Age of Patients Cared For

General Skills

Cardiovascular General Skills

Invasive Hemodynamic Monitoring

Cardiovascular - Care of the Child With

Medications Knowledge and Use Of

Respiratory General Skills

Obtaining Blood Gases

Airway Management

Suctioning

Chest Tube (Assist With)

O2 Therapy

Ventilators

Respiratory - Care of Child With

Medications Knowledge and Use Of

Neuro General Skills

Neuro - Care of Child With

Medications Knowledge and Use Of

Gastrointestinal General Skills

Gastrostomy/Button

Gastrointestinal - Care of Child With

Medications Knowlede and Use Of

Renal/Genitourinary General Skills

Collection of Urine Specimens

Renal/Genitourinary - Care of Child With

Endocrine/Metabolic General Skills

Endocrine/Metabolic - Care of Child With

Medications Knowledge and Use Of

Orthopedics General Skills

Orthopedics - Care of Child With

Wound Management

Burns

Oncology General Skills

Interpretation of Lab Result

Oncology - Care of Child With

Medications Knowledge and Use Of

Infectious Diseases General Skills

Obtain Culture Specimens

Infectious Diseases - Care of Child With

Phlebotomy/IV Therapy

Phlebotomy/IV - Care of Child With

Pain Management General Skills

Pain Management - Care of Child With

Medication Knowledge and Use Of

Miscellaneous

Miscellaneous - Care of Child With

Medication Administration for Children

Years of Experience in Each of the Following Pediatric Areas

Information & Agreement