NICU Skills Checklist Name* First Last Email* Phone*Proficiency: 1 = Minimal Experience 2 = Limited Experience 3 = Competent 4 = Highly SkilledCardiovascularAuscultation (Rate, Rhythm, Volume)* 1 2 3 4 Blood Pressure / Invasive (Arterial Line)* 1 2 3 4 Blood Pressure / Non-Invasive* 1 2 3 4 Heart Sounds / Murmurs* 1 2 3 4 Perfusion* 1 2 3 4 Pulses* 1 2 3 4 EKG Interpretation* 1 2 3 4 Defibrillation / Cardioversion* 1 2 3 4 Invasive Hemodynamic Monitoring* 1 2 3 4 Central Venous Pressure* 1 2 3 4 Cardiac Arrest* 1 2 3 4 Cardiac Transplant* 1 2 3 4 Cardiomyopathy* 1 2 3 4 Congenital Heart Disease / Defects* 1 2 3 4 Hemodynamic Instability* 1 2 3 4 Hypovolemic Shock* 1 2 3 4 Post Cardiac Surgery* 1 2 3 4 Post Interventional Cardiac Cath* 1 2 3 4 Dobutamine* 1 2 3 4 Dopamine* 1 2 3 4 Epinephrine* 1 2 3 4 Nipride* 1 2 3 4 Sodium Bicarbonate* 1 2 3 4 PulmonaryBreath Sounds* 1 2 3 4 Rate and Work of Breathing* 1 2 3 4 Interpretation of Blood Gases* 1 2 3 4 Interpretation of X-Ray Results* 1 2 3 4 Airway Management* 1 2 3 4 Assist with Intubation* 1 2 3 4 Bulb Syringe* 1 2 3 4 CPAP (Nasal Prongs)* 1 2 3 4 Endotracheal Tube Suctioning* 1 2 3 4 In-Line Suction* 1 2 3 4 Open ET Catheter Suction* 1 2 3 4 Extubation* 1 2 3 4 Intubation* 1 2 3 4 Nasal Airway / Suctioning* 1 2 3 4 Oral Airway / Suctioning* 1 2 3 4 Tracheostomy / Suctioning* 1 2 3 4 Apnea Monitor* 1 2 3 4 Cardiac Resuscitation* 1 2 3 4 Chest Tube (Assist with)* 1 2 3 4 Insertion* 1 2 3 4 Removal* 1 2 3 4 This field is hidden when viewing the formThis field is hidden when viewing the formSet-up* 1 2 3 4 ECMO (Extracorporeal Membrane Oxygenation)* 1 2 3 4 O2 Therapy Delivery Systems* 1 2 3 4 Bag (Anesthesia) & Mask* 1 2 3 4 Bag (Self-Inflating) & Mask* 1 2 3 4 Nasal Cannula* 1 2 3 4 Nebulizer* 1 2 3 4 Tent* 1 2 3 4 Trach Collar* 1 2 3 4 Obtaining Blood Gases* 1 2 3 4 Arterial* 1 2 3 4 Heelstick* 1 2 3 4 Peripheral* 1 2 3 4 Umbilical Line* 1 2 3 4 Thoracentesis* 1 2 3 4 Use of Artificial Surfactant* 1 2 3 4 Ventilator Care* 1 2 3 4 CPAP / PEEP* 1 2 3 4 High Frequency Jet Ventilator* 1 2 3 4 Home Ventilator* 1 2 3 4 IMV* 1 2 3 4 Oscillating* 1 2 3 4 Pressure Ventilator* 1 2 3 4 Volume Ventilator* 1 2 3 4 Weaning* 1 2 3 4 Bronchopulmonary Dysplasia (BPD)* 1 2 3 4 Cardiogenic / Hypovolemic Shock* 1 2 3 4 Diaphragmatic Hernia* 1 2 3 4 Fresh Tracheostomy* 1 2 3 4 Meconium Aspiration* 1 2 3 4 Persistent Pulmonary Hypertension (PPHN)* 1 2 3 4 Pneumothorax* 1 2 3 4 Respiratory Distress Syndrome (RDS)* 1 2 3 4 Respiratory Failure* 1 2 3 4 Aminophylline* 1 2 3 4 Prostaglandin* 1 2 3 4 NeurologicalIntracranial Pressure Monitoring* 1 2 3 4 Neurological Status* 1 2 3 4 Brain Death / Organ Procurement* 1 2 3 4 Externalized VP Shunt / Reservoirs* 1 2 3 4 Increased Intracranial Pressure* 1 2 3 4 Meningitis* 1 2 3 4 Seizures* 1 2 3 4 Medication-Anticonvulsant Medication* 1 2 3 4 GastrointestinalAbdominal Girth* 1 2 3 4 Bowel Sounds* 1 2 3 4 Palate* 1 2 3 4 Suck / Swallow* 1 2 3 4 Care of Gastronomy Tube* 1 2 3 4 Feedings* 1 2 3 4 Assist with Breast Feeding* 1 2 3 4 Bottle* 1 2 3 4 Breast Milk Handling / Storage* 1 2 3 4 Gavage* 1 2 3 4 Hospital Grade Electric Breast Pump* 1 2 3 4 Placement of Intestinal Tubes* 1 2 3 4 Jejunal / Gastro* 1 2 3 4 Nasogastric / Orogastric* 1 2 3 4 Test for Occult Blood* 1 2 3 4 Cleft Palate* 1 2 3 4 Colostomy / Ileostomy* 1 2 3 4 Gastroschisis / Omphalocele* 1 2 3 4 GI Bleeding* 1 2 3 4 Inguinal Hernia* 1 2 3 4 Necrotizing Enterocolitis (NEC)* 1 2 3 4 Post Abdominal Surgery* 1 2 3 4 Reflux Precautions* 1 2 3 4 Tracheoesophageal Fistula (TEF)* 1 2 3 4 Endocrine / MetabolicFinnegan* 1 2 3 4 Fluid & Electrolyte Balance* 1 2 3 4 Bilirubin* 1 2 3 4 Test Urine and Interpret* 1 2 3 4 Glucose* 1 2 3 4 Labstix* 1 2 3 4 Occult Blood* 1 2 3 4 pH* 1 2 3 4 Specific Gravity* 1 2 3 4 Collection of Urine Specimens* 1 2 3 4 Assist with Suprapubic Tab* 1 2 3 4 Catheter* 1 2 3 4 Diaper / Bag* 1 2 3 4 Phototherapy for Jaundice* 1 2 3 4 Post Circumcision Care* 1 2 3 4 Acute Renal Failure* 1 2 3 4 DIC (Disseminated Intravascular Coagulation)* 1 2 3 4 Disorders of Internal / External Organs* 1 2 3 4 Drug Addiction / Withdrawal* 1 2 3 4 Hypo / Hyperkalemia* 1 2 3 4 Hypo / Hypernatremia* 1 2 3 4 IDM (Infant of Diabetic Mother)* 1 2 3 4 Hyperglycemia* 1 2 3 4 Hypoglycemia* 1 2 3 4 Malformations of the GU Tract, Kidney* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 Infections DiseasesInterpretation CBC / Differential* 1 2 3 4 Culture Reports* 1 2 3 4 Maternal Lab Results* 1 2 3 4 Assist with Lumbar Puncture* 1 2 3 4 Collect Culture Specimens* 1 2 3 4 Isolation Techniques* 1 2 3 4 Standard (Universal) Precautions* 1 2 3 4 Hepatitis Surface Antigen+ Mother* 1 2 3 4 HIV Positive Mother* 1 2 3 4 Neonatal Sepsis* 1 2 3 4 HBIG* 1 2 3 4 HBV* 1 2 3 4 HIB* 1 2 3 4 Polio* 1 2 3 4 DPT* 1 2 3 4 RespiGam / Synagis Prophylaxis* 1 2 3 4 Phlebotomy / IV TherapyAdministration of Blood / Blood Products* 1 2 3 4 Cryoprecipitate* 1 2 3 4 Packed Red Blood Cells* 1 2 3 4 Plasma / Albumin* 1 2 3 4 Whole Blood* 1 2 3 4 Delivery Systems* 1 2 3 4 IV Pump* 1 2 3 4 Syringe Pump* 1 2 3 4 Drawing Blood from Central Line* 1 2 3 4 Draw Venous Blood* 1 2 3 4 Hyperalimentation / TPN / PPN* 1 2 3 4 Intralipid* 1 2 3 4 Managing IV Therapy* 1 2 3 4 Discontinuing* 1 2 3 4 Dressing & Tubing Change* 1 2 3 4 Rate Calculation* 1 2 3 4 Site & Patency Assessment* 1 2 3 4 Starting IV's* 1 2 3 4 Angiocath* 1 2 3 4 Butterfly* 1 2 3 4 Heparin / Saline Lock* 1 2 3 4 Central Line / Catheter / Dressing* 1 2 3 4 Broviac* 1 2 3 4 Groshong* 1 2 3 4 Hickman* 1 2 3 4 Port-A-Cath* 1 2 3 4 Quinton* 1 2 3 4 Percutaneous Arterial Line* 1 2 3 4 Percutaneous Venous Line* 1 2 3 4 Peripheral Line / Dressing* 1 2 3 4 PICC (Peripherally Inserted Central Catheter)* 1 2 3 4 Umbilical Artery Line* 1 2 3 4 Umbilical Venous Line* 1 2 3 4 Pain ManagementAssessment of Pain Level* 1 2 3 4 Care of Neonate with Sedation* 1 2 3 4 MiscellaneousApgar Scoring* 1 2 3 4 Eye Exam (R/O Retinopathy)* 1 2 3 4 Gestational Age* 1 2 3 4 Ballard* 1 2 3 4 Dubowitz* 1 2 3 4 Maternal History* 1 2 3 4 Screen for Hearing Loss* 1 2 3 4 Bereavement / Postmortem Care* 1 2 3 4 Consents* 1 2 3 4 Immunization* 1 2 3 4 Procedural* 1 2 3 4 Treatment* 1 2 3 4 Cord Care* 1 2 3 4 Neonatal Skin Care* 1 2 3 4 Positioning Devices* 1 2 3 4 Preparation for Transport / Transfer* 1 2 3 4 Thermoregulation* 1 2 3 4 Isolette with Humidity* 1 2 3 4 Radiant Warmer* 1 2 3 4 Temperature (Auxiliary, Rectal, Skin)* 1 2 3 4 Weaning to Open Crib / Bassinet* 1 2 3 4 Weights* 1 2 3 4 Bed Scale* 1 2 3 4 Scale* 1 2 3 4 Calculation of Dosage* 1 2 3 4 Emergency Drug Action & Reaction* 1 2 3 4 Eye Prophylaxis - Vitamin K* 1 2 3 4 Neonatal Drug Action & Reactions* 1 2 3 4 Age Specific CompetencyNewborn / Neonate (Birth - 30 days)* 1 2 3 4 Infant (30 days - 1 year)* 1 2 3 4 Toddler (1 - 3 years)* 1 2 3 4 Preschooler (3 - 5 years)* 1 2 3 4 School Age Children (5 - 12 years)* 1 2 3 4 Adolescents (12 - 18 years)* 1 2 3 4 Young Adults (18 - 39 years)* 1 2 3 4 Middle Adults (39 - 64 years)* 1 2 3 4 Older Adults (64 - 79 years)* 1 2 3 4 Elderly Adults (Over 79+ years)* 1 2 3 4