NICU Skills Checklist Date:* Name: (First, MI, Last)* Email PATIENT TYPESNeonatal < 23 Weeks* N/A Inexperienced Limited Experience Experienced Highly Experienced Neonatal 23-28 Weeks* N/A Inexperienced Limited Experience Experienced Highly Experienced Neonatal 29-32 Weeks* N/A Inexperienced Limited Experience Experienced Highly Experienced Neonatal > 32 Weeks* N/A Inexperienced Limited Experience Experienced Highly Experienced CARDIOVASCULARAssessment* N/A Inexperienced Limited Experience Experienced Highly Experienced Auscultation (Rate, Rhythm, Volume)* N/A Inexperienced Limited Experience Experienced Highly Experienced Blood Pressure (Invasive)* N/A Inexperienced Limited Experience Experienced Highly Experienced Heart Sounds/Murmurs* N/A Inexperienced Limited Experience Experienced Highly Experienced Equipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced EKG Interpretation* N/A Inexperienced Limited Experience Experienced Highly Experienced Defibrillation/Cardioversion* N/A Inexperienced Limited Experience Experienced Highly Experienced Invasive Hemodynamic Monitoring* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Cardiac Arrest* N/A Inexperienced Limited Experience Experienced Highly Experienced Cardiac Surgery - Pre Op* N/A Inexperienced Limited Experience Experienced Highly Experienced Cardiac Surgery - Immediate Post Op* N/A Inexprienced Limited Experience Experienced Highly Experienced Cardiogenic/Hypovolemic Shock* N/A Inexperienced Limited Experience Experienced Highly Experienced CHF* N/A Inexperienced Limited Experience Experienced Highly Experienced Congenital Heart Disease/Defects* N/A Inexperienced Limited Experience Experienced Highly Experienced Hemodynamic Instability* N/A Inexperienced Limited Experience Experienced Highly Experienced Hypertension* N/A Inexperienced Limited Experience Experienced Highly Experienced Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Digoxin (Lanoxin)* N/A Inexperienced Limited Experience Experienced Highly Experienced Dobutamine (Dobutrex)* N/A Inexperienced Limited Experience Experienced Highly Experienced Dopamine (Intropin)* N/A Inexperienced Limited Experience Experienced Highly Experienced Epinephrine* N/A Inexperienced Limited Experience Experienced Highly Experienced Milrinone* N/A Inexperienced Limited Experience Experienced Highly Experienced Prostaglandin* N/A Inexperienced Limited Experience Experienced Highly Experienced Sodium Bicarbonate* N/A Inexperienced Limited Experience Experienced Highly Experienced PULMONARYAssessment* N/A Inexperienced Limited Experience Experienced Highly Experienced Lung Sounds* N/A Inexperienced Limited Experience Experienced Highly Experienced Respiratory Effort* N/A Inexperienced Limited Experience Experienced Highly Experienced Interpretation of Lab Results* N/A Inexperienced Limited Experience Experienced Highly Experienced ABGs* N/A Inexperienced Limited Experience Experienced Highly Experienced Equipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Assist with Intubation/Extubation* N/A Inexperienced Limited Experience Experienced Highly Experienced CPAP/Nasal CPAP* N/A Inexperienced Limited Experience Experienced Highly Experienced Endotracheal Tube Stabilization* N/A Inexperienced Limited Experience Experienced Highly Experienced Endotracheal Tube Suctioning - Inline* N/A Inexperienced Limited Experience Experienced Highly Experienced Endotracheal Tube Suctioning - Open* N/A Inexperienced Limited Experience Experienced Highly Experienced Tracheostomy Care/Suctioning* N/A Inexperienced Limited Experience Experienced Highly Experienced Apnea Monitoring* N/A Inexperienced Limited Experience Experienced Highly Experienced Assist with Chest Tube Placement* N/A Inexperienced Limited Experience Experienced Highly Experienced Chest Tube Management/Removal* N/A Inexperienced Limited Experience Experienced Highly Experienced ECMO (Extracorporeal Membrane Oxygenation)* N/A Inexperienced Limited Experience Experienced Highly Experienced Surfactant Therapy* N/A Inexperienced Limited Experience Experienced Highly Experienced Thoracentesis* N/A Inexperienced Limited Experience Experienced Highly Experienced O2 Therapy Delivery-Non Ventilator* N/A Inexperienced Limited Experience Experienced Highly Experienced Bag and Mask* N/A Inexperienced Limited Experience Experienced Highly Experienced Nasal Cannula/Oxyhood/Tent* N/A Inexperienced Limited Experience Experienced Highly Experienced Trach Collar* N/A Inexperienced Limited Experience Experienced Highly Experienced Vapotherm* N/A Inexperienced Limited Experience Experienced Highly Experienced Ventilator* N/A Inexperienced Limited Experience Experienced Highly Experienced CPAP/PEEP* N/A Inexperienced Limited Experience Experienced Highly Experienced High Frequency/Jet Ventilator* N/A Inexperienced Limited Experience Experienced Highly Experienced Oscillating Ventilator* N/A Inexperienced Limited Experience Experienced Highly Experienced IMV/SIMV* N/A Inexperienced Limited Experience Experienced Highly Experienced Partial Liquid Ventilation* N/A Inexperienced Limited Experience Experienced Highly Experienced Pressure/Volume Ventilator* N/A Inexperienced Limited Experience Experienced Highly Experienced Inhaled NO* N/A Inexperienced Limited Experience Experienced Highly Experienced End Tidal CO2 Monitoring* N/A Inexperienced Limited Experience Experienced Highly Experienced Obtain ABGs/Other Labs* N/A Inexperienced Limited Experience Experienced Highly Experienced Arterial* N/A Inexperienced Limited Experience Experienced Highly Experienced Capillary* N/A Inexperienced Limited Experience Experienced Highly Experienced Umbilical Line* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Apnea* N/A Inexperienced Limited Experience Experienced Highly Experienced Bronchopulmonary Dysplasia* N/A Inexperienced Limited Experience Experienced Highly Experienced Diaphragmatic Hernia* N/A Inexperienced Limited Experience Experienced Highly Experienced Fresh Tracheostomy* N/A Inexperienced Limited Experience Experienced Highly Experienced Meconium Aspiration* N/A Inexperienced Limited Experience Experienced Highly Experienced Persistent Pulmonary Hypertension* N/A Inexperienced Limited Experience Experienced Highly Experienced Pneumonia* N/A Inexperienced Limited Experience Experienced Highly Experienced Pulmonary Edema* N/A Inexperienced Limited Experience Experienced Highly Experienced Respiratory Distress Syndrome/Failure* N/A Inexperienced Limited Experience Experienced Highly Experienced Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Bronchodilators* N/A Inexperienced Limited Experience Experienced Highly Experienced Steroids* N/A Inexperienced Limited Experience Experienced Highly Experienced Caffeine* N/A Inexperienced Limited Experience Experienced Highly Experienced NEUROLOGICALAssessment* N/A Inexperienced Limited Experience Experienced Highly Experienced Neuro Status/Normal Reflexes* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Brain Death/Organ Procurement* N/A Inexperienced Limited Experience Experienced Highly Experienced Hydrocephalus* N/A Inexperienced Limited Experience Experienced Highly Experienced Increased ICP* N/A Inexperienced Limited Experience Experienced Highly Experienced Intraventricular Hemorrhage* N/A Inexperienced Limited Experience Experienced Highly Experienced Meningitis* N/A Inexperienced Limited Experience Experienced Highly Experienced Meningocele/Myelomeningocele* N/A Inexperienced Limited Experience Experienced Highly Experienced Seizures* N/A Inexperienced Limited Experience Experienced Highly Experienced Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Anticonvulsants* N/A Inexperienced Limited Experience Experienced Highly Experienced GASTROINTESTINALAssessment* N/A Inexperienced Limited Experience Experienced Highly Experienced Abdominal Girth* N/A Inexperienced Limited Experience Experienced Highly Experienced Palate* N/A Inexperienced Limited Experience Experienced Highly Experienced Equipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Placement of NG/OG Tubes* N/A Inexperienced Limited Experience Experienced Highly Experienced Placement of Gastric Tubes* N/A Inexperienced Limited Experience Experienced Highly Experienced Feedings* N/A Inexperienced Limited Experience Experienced Highly Experienced Assist with Breast/Bottle Feedings* N/A Inexperienced Limited Experience Experienced Highly Experienced Breast Milk Handling/Storage* N/A Inexperienced Limited Experience Experienced Highly Experienced Breast Pumps* N/A Inexperienced Limited Experience Experienced Highly Experienced Gavage* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Cleft Palate* N/A Inexperienced Limited Experience Experienced Highly Experienced Colostomy/Ileostomy* N/A Inexperienced Limited Experience Experienced Highly Experienced Gastroschisis/Omphalocele* N/A Inexperienced Limited Experience Experienced Highly Experienced GI Bleeding* N/A Inexperienced Limited Experience Experienced Highly Experienced Necrotizing Enterocolitis (NEC)* N/A Inexperienced Limited Experience Experienced Highly Experienced Post Abdominal Surgery* N/A Inexperienced Limited Experience Experienced Highly Experienced Reflux Precautions* N/A Inexperienced Limited Experience Experienced Highly Experienced RENAL/ENDOCRINE/METABOLICAssessment* N/A Inexperienced Limited Experience Experienced Highly Experienced Fluid & Electrolyte Balance* N/A Inexperienced Limited Experience Experienced Highly Experienced Interpretation of Lab Tests* N/A Inexperienced Limited Experience Experienced Highly Experienced Bilirubin - Blood* N/A Inexperienced Limited Experience Experienced Highly Experienced Bilirubin - Transcutaneous* N/A Inexperienced Limited Experience Experienced Highly Experienced Glucose - Blood & Urine* N/A Inexperienced Limited Experience Experienced Highly Experienced Equipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Suprapubic Tap* N/A Inexperienced Limited Experience Experienced Highly Experienced Phototherapy for Jaundice* N/A Inexperienced Limited Experience Experienced Highly Experienced Post Circumcision Care* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Acute Renal Failure* N/A Inexperienced Limited Experience Experienced Highly Experienced Hydronephrosis* N/A Inexperienced Limited Experience Experienced Highly Experienced Hypo/Hyperglycemia* N/A Inexperienced Limited Experience Experienced Highly Experienced Hypo/Hyperkalemia* N/A Inexperienced Limited Experience Experienced Highly Experienced Hypo/Hypernatremia* N/A Inexperienced Limited Experience Experienced Highly Experienced Infant of Diabetic Mother (IDM)* N/A Inexperienced Limited Experience Experienced Highly Experienced Malformations of the GU Tract/Kidney* N/A Inexperienced Limited Experience Experienced Highly Experienced Peritoneal Dialysis* N/A Inexperienced Limited Experience Experienced Highly Experienced Urinary Tract/Kidney Infection* N/A Inexperienced Limited Experience Experienced Highly Experienced INFECTIOUS DISEASESInterpretation of Lab Tests* N/A Inexperienced Limited Experience Experienced Highly Experienced CBC/Differential* N/A Inexperienced Limited Experience Experienced Highly Experienced Culture Reports* N/A Inexperienced Limited Experience Experienced Highly Experienced Maternal Lab Results* N/A Inexperienced Limited Experience Experienced Highly Experienced Equipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Assist with Lumbar Puncture* N/A Inexperienced Limited Experience Experienced Highly Experienced Collect Culture Specimens* N/A Inexperienced Limited Experience Experienced Highly Experienced Septic Work-up* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced HIV Positive Mother* N/A Inexperienced Limited Experience Experienced Highly Experienced Neonatal Sepsis* N/A Inexperienced Limited Experience Experienced Highly Experienced Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Aminoglycosides* N/A Inexperienced Limited Experience Experienced Highly Experienced Cephalosporins* N/A Inexperienced Limited Experience Experienced Highly Experienced Immunizations* N/A Inexperienced Limited Experience Experienced Highly Experienced PHLEBOTOMY/IV THERAPYEquipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Administration of Blood & Blood Products* N/A Inexperienced Limited Experience Experienced Highly Experienced IV Pumps* N/A Inexperienced Limited Experience Experienced Highly Experienced Syringe Pumps* N/A Inexperienced Limited Experience Experienced Highly Experienced Managing IV Therapy* N/A Inexperienced Limited Experience Experienced Highly Experienced Starting IVs* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Central Line Catheter/Dressing* N/A Inexperienced Limited Experience Experienced Highly Experienced Broviac Catheter/Dressing* N/A Inexperienced Limited Experience Experienced Highly Experienced PICC (Peripherally Inserted Central Catheter)* N/A Inexperienced Limited Experience Experienced Highly Experienced Umbilical Artery Catheter* N/A Inexperienced Limited Experience Experienced Highly Experienced Umbilical Venous Catheter* N/A Inexperienced Limited Experience Experienced Highly Experienced PAIN MANAGEMENTAssessment of Pain Level in the Neonate* N/A Inexperienced Limited Experience Experienced Highly Experienced Assessment of Response to Pain Management Interventions* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with Sedation* N/A Inexperienced Limited Experience Experienced Highly Experienced MISCELLANEOUSNational Patient Safety Goals* N/A Inexperienced Limited Experience Experienced Highly Experienced Computerized Charting* N/A Inexperienced Limited Experience Experienced Highly Experienced Cerner* N/A Inexperienced Limited Experience Experienced Highly Experienced Eclipsys* N/A Inexperienced Limited Experience Experienced Highly Experienced Epic* N/A Inexperienced Limited Experience Experienced Highly Experienced GE* N/A Inexperienced Limited Experience Experienced Highly Experienced McKesson* N/A Inexperienced Limited Experience Experienced Highly Experienced Meditech* N/A Inexperienced Limited Experience Experienced Highly Experienced Other* N/A Inexperienced Limited Experience Experienced Highly Experienced Assessment - Standard* N/A Inexperienced Limited Experience Experienced Highly Experienced APGAR Score* N/A Inexperienced Limited Experience Experienced Highly Experienced Gestational Age (Ballard/Dubowitz)* N/A Inexperienced Limited Experience Experienced Highly Experienced Neonatal Abstinence Score/Syndrome* N/A Inexperienced Limited Experience Experienced Highly Experienced Maternal History* N/A Inexperienced Limited Experience Experienced Highly Experienced Equipment & Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Attend High Risk Delivery* N/A Inexperienced Limited Experience Experienced Highly Experienced Bereavement/Postmortem Care* N/A Inexperienced Limited Experience Experienced Highly Experienced Neonatal Skin Care* N/A Inexperienced Limited Experience Experienced Highly Experienced Positioning Devices* N/A Inexperienced Limited Experience Experienced Highly Experienced Preparation for Transport* N/A Inexperienced Limited Experience Experienced Highly Experienced Transport to Another Facility* N/A Inexperienced Limited Experience Experienced Highly Experienced Thermoregulation* N/A Inexperienced Limited Experience Experienced Highly Experienced Isolette - Skin - Air Mode* N/A Inexperienced Limited Experience Experienced Highly Experienced Charge Experience* N/A Inexperienced Limited Experience Experienced Highly Experienced Preceptor Experience* N/A Inexperienced Limited Experience Experienced Highly Experienced Pyxis Medication Admin. System* N/A Inexperienced Limited Experience Experienced Highly Experienced Other Medication Admin. System* N/A Inexperienced Limited Experience Experienced Highly Experienced Care of the Neonate with* N/A Inexperienced Limited Experience Experienced Highly Experienced Disseminated Intravascular Coagulation (DIC)* N/A Inexperienced Limited Experience Experienced Highly Experienced Fetal Alcohol Syndrome (FAS)* N/A Inexperienced Limited Experience Experienced Highly Experienced Genetic Disorders* N/A Inexperienced Limited Experience Experienced Highly Experienced Retinopathy of the Newborn* N/A Inexperienced Limited Experience Experienced Highly Experienced Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced IM/Subcutaneous Administration* N/A Inexperienced Limited Experience Experienced Highly Experienced IV Administration* N/A Inexperienced Limited Experience Experienced Highly Experienced Calculation of Neonatal Dosages* N/A Inexperienced Limited Experience Experienced Highly Experienced Emergency Drug Actions* N/A Inexperienced Limited Experience Experienced Highly Experienced My experience is in the following settingsLevel II NICU: Level III NICU: Level IV NICU: PICU: Neonatal Transport: Certifications/Licensures/RegistrationsBLS: MM slash DD slash YYYY NCC: MM slash DD slash YYYY NRP: MM slash DD slash YYYY PALS: MM slash DD slash YYYY S.T.A.B.L.E.: MM slash DD slash YYYY Neonatal CCRN: MM slash DD slash YYYY Other MM slash DD slash YYYY Areas of Expertise:Consent* By submitting this form, I agree to all terms and conditions and agree to authorize consent NameThis field is for validation purposes and should be left unchanged.