NEONATAL INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

NAME:       DIRECTIONS: Please indicate your level of experience by

ID #:       placing a check (√) in the box. Experience level:
DATE:       1 NO EXPERIENCE
2 MINIMAL EXPERIENCE-requires supervision/assistance
This Skills Checklist is for use by nurses with more than 3 MODERATELY EXPERIENCED-requires initial review,
one year experience in their discipline and specialty. then performs independently
Please be accurate with your assessment. 4 VERY EXPERIENCED- proficient

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
NEUROLOGICAL: (3) Oxyhood
1. Assessment: (4) Tent
a. Intracranial pressure monitoring (5) Trach collar
b. Neurological status f. Obtaining blood gases:
2. Care of the neonate with: (1) Arterial
a. Brain death/organ procurement (2) Heelstick
b. Externalized VP Shunt/reservoirs (3) Peripheral
c. Increased intracranial pressure (4) Umbilical line
d. Seizures g. Thoracentesis
PULMONARY h. Use of artificial surfactant
1. Assessment: i. Ventilator care:
a. Breath sounds (1) CPAP/PEEP
b. Rate and work of breathing (2) IMV
2. Equipment & procedures: (3) Oscillating
a. Airway management (4) Pressure ventilator
(1) Assist with intubation (5) Volume ventilator
(2) bulb syringe j. Weaning
(3) CPAP (nasal prongs) 3. Care of the neonate with:
(4) Endotracheal tube stabilization a. Bronchopulmonary dysplasia (BPD)
(5) Endotracheal tube suctioning b. Cardiogenic/Hypovolemic shock
(6) Extubation c. Diaphrogmatic hernia
(7) Intubation d. Drug addiction/withdrawal
(8) Nasal airway/suctioning e. Fresh tracheostomy
(9) Oral airway/suctioning f. Meconium aspiration
(10) Tracheostomy/suctioning g. Persistent pulmonary hypertension (PPHN)
b. Apnea monitor h. Pneumothorax
c. Cardiac resuscitation i. Respiratory distress syndrome (RDS)
d. Chest tube (assist with): j. Systemic infection
(1) Insertion k. Respiratory failure
(2) Removal l. Tetralogy of fallot
(3) Set-up 4. Medications:
e. O2 therapy delivery systems: a. Aminophylline
(1) Bag & mask b. Prostaglandin
(2) Nasal cannula

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 NEONATAL INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

Name:       ID #:      

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
CARDIOVASCULAR 3. Care of the neonate with:
1. Assessment: a. Cleft palate
a. Auscultation (rate, rhythm, volume) b. Colostomy/Ileostomy
b. Blood pressure/invasive (arterial line) c. Gastroschisis/omphalocele
c. Blood pressure/non-invasive d. GI Bleeding
d. Heart sounds/murmurs e. Inguinal hernia
2. Equipment & procedures: f. Necrotizing enterocolitis (NEC)
a. EKG interpretation g. Post abdominal surgery
b. Defibrillation/Cardioversion h. Reflux precautions
(1) Efibrillation i. Tracheoesophageal fistula (TEF)
c. Invasive hemodynamic monitoring ENDOCRINE/METABOLIC
d. Central venous pressure 1. Assessment:
3. Care of the neonate with: a. Finnegan
a. Cardiac arrest b. Fluid & electrolyte balance
b. Congenital heart disease/defects 2. Equipment & procedures:
c. Hemodynamic instability a. Collection of urine specimens:
d. Hypovolemic shock (1) Assist with supra-pubic tap
e. Post cardiac surgery (2) Catheter
4. Medications: (3) Diaper/bag
a. Dobutamine b. Phototherapy for jaundice
b. Dopamine c. Post circumcision care
c. Epinephrine 3. Care of the neonate with:
d. Nipride a. Acute renal failure
e. Sodium bicarbonate b. DIC (disseminated intravascular coagulation)
GASTROINTESTINAL c. Drug addiction/withdrawal
1. Assessment: d. Hypo/hyperkalemia
a. Abdominal girth e. Hypo/hypernatremia
b. Bowel sounds f. IDM (infant of a diabetic mother):
c. Palate (1) Hyperglycemia
d. Suck/swallow (2) Hypoglycemia
2. Equipment & procedures: g. Malformations of the GU tract, kidney
a. Care of gastrostomy tube h. Peritoneal dialysis
b. Feedings: INFECTIOUS DISEASES
(1) Assist with breast feeding 1. Equipment & procedures
(2) Bottle a. Assist with lumbar puncture
(3) Gavage B. Isolation techniques
c. Electric breast pump 2. Care of the neonate with:
d. Placement of intestinal tubes: a. Hepatitis surface antigen + mother
(1) Jejunal gastro b. HIV positive mother
(2) Nasogastric/Orogastric c. Neonatal sepsis
e. Test of occult blood

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 NEONATAL INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

Name:       ID #:      

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
INFECTIOUS DISEASES (CONT) MISCELLANEOUS
3. Medications – Immunizations: 1. Assessment:
a. HBIG a. Apgar scoring
b. HBV b. Eye exam (r/o retinopathy)
c. HIB c. Gestational age:
d. Polio (1) Ballard
e. DPT (2) Dubowitz
PHLEBOTOMY/IV THERAPY (3) Other:      
1. Equipment & procedures: d. Maternal History
a. Administration of blood/blood products e. Screen for hearing loss
(1) Packed red blood cells 2. Equipment & Procedures:
(2) Plasma/albumin a. Bereavement/postmortem care
(3) Platelets b. Cord care
b. Delivery systems: c. Neonatal skin care
(1) IV pump d. Positioning devices
(2) Syringe pump e. Preparation for transport/transfer
c. Drawing blood from central line f. Thermoregulation:
d. Drawing venous blood (1) Isolette with humidity
e. Hyperalimentation/TPN (2) Radiant warmer
f. Intralipid (3) Temperature (Axillary, rectal, skin)
g. Managing IV Therapy: (4) Weaning to open crib/bassinet
(1) Rate calculation g. Weights:
(2) Site & patency assessment (1) Bed scale
h. Starting IV’s: (2) Scale
(1) Butterfly 3. Medications:
(2) Heparin lock a. Calculation of dosage
2. Care of the neonate with: b. Emergency drug action & reaction
a. Central line/catheter/dressing: c. Eye prophylaxis – Vitamin K
(1) Hickman d. Neonatal drug action & reactions
(2) Portacath 4. Interpretation of lab values:
b. Percutaneous arterial line a. Blood chemistry
c. Percutaneous venous line b. Blood hematology
d. Peripheral line/dressing c. Blood gases
e. PICC (peripherally inserted central catheter) COMPUTERIZED CHARTING
f. Umbilical artery line 1. Cerner
g. Umbilical venous line 2. Eclipsys
PAIN MANAGEMENT 3. Epic
1. Assessment of pain level 4. McKesson
2. Care of the neonate with sedation, i.e. morphine 5. Meditech
6. Other:
Type:      

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 NEONATAL INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

MY EXPERIENCE IS PRIMARILY IN:

Name:      
NEUROLOGY       years
Please check the boxes below for each age group for PULMONARY       years
which you have expertise in providing age-appropriate SURGICAL       years
nursing care. MEDICAL       years
CARDIAC CARE       years
A. Newborn/Neonatal (birth – 30 days) TELEMETRY       years
B. Infant (30 days – 1 year)
C. Toddler (1 – 3 years) I HAVE CURRENT CERTIFICATIONS FOR:
D. Preschool (3 – 5 years)
E. School Age Children (5 – 12 years) TYPE COURSE DATE (MM/DD/YY)
F. Adolescent (12 – 18 years) ARRHYTHMIA      
G. Young Adults (18 – 39 years) CRITICAL CARE      
H. Middles Adults (40 – 64 years) ACLS      
I. Older Adults (64 + years) BCLS      
TNCC      
EXPERIENCE WITH AGE GROUPS: NRP      
1. Able to assess age appropriate behavior, motor skills PALS      
and physiological norms. NALS      
BTLS      
A B C D E F G H I CCRN      
Other            
Other            
2. Able to adapt care according to normal growth and
development.
The information I have provided in this knowledge and
A B C D E F G H I skills checklist it true and accurate to the best of my
knowledge.

3. Able to communicate and instruct patient according to            

their age, maturity and comprehension ability. Signature (Written/Electronic) Date
ID #:      
A B C D E F G H I
This skills checklist has been reviewed and approved by
Nicole Bloxham, RN.
4. Able to provide a safe environment according to the            
specific needs of various age groups. Signature (Written/Electronic) Date
ID #:      
A B C D E F G H I
Please return to: Northwest Nurse Staffing Company, PA
ATTN: Records Dept.
Fax: (866) 352-4338

Email: records@nns-ic.com

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