NEONATAL INTENSIVE CARE SKILLS CHECKLIST
DATE: ________________________
Applicant’s Name: __________________________________________________________________________________
FIRST
MIDDLE INITIAL
LAST
To IITR Professionals:
The purpose of the following checklist is to assist in matching your skills and interests with available assignments, thus meeting your needs and the needs
of our clients as much as possible. Your employment is not dependant upon responses given in this checklist.
**Please make sure this Skills checklist is signed and dated.
The information I have given is true and accurate to the best of my knowledge
Signature___________________________________________________________________________ Date ___________________________
To IITR:
IITR has developed unique skills checklist for each nursing specialty. This checklist is not necessarily a valid indicator of clinical skills and should not be
utilized as the sole measure of the ability of an individual to perform the duties of a registered nurse or therapist in your facility. It is intended to be used
only as a guide in your screening procedures and in orientation to procedure within your institution.
PLEASE MARK YOUR LEVEL OF EXPERIENCE X
Self-Assessed Experience Rating Scale
Limited Experience
A. Medication Administration
1.
2.
3.
4.
5.
B
1
1
2
Mark One
2 3 4
3
4
C
Very Experienced
Evaluation and
Management of Infant Post
Delivery
Unit Dose
IV Push Medication
IV Drip Medications
Calculations of Neonatal Doses
Administration of Eye Medications
1.
2.
IV Therapy
3.
4.
5.
Apgar Scoring
Thermoregulation:
a. Temperature (Axillary, Rectal, Skin)
b. Use of Isolette
c. Use of Radiant Warmer
d. Use of Warming Lights
Gestational Age Assessment Tool
Transport of Neonate to Nursery
Initial Neonatal Physical Assessment
1.
2.
3.
4.
Starting IV’s
Mixing IV’s
Regulating IV’s
IV Infusion Pumps
5.
6.
CVP Lines
Umbilical Artery Line (Maintenance and
D/C)
Umbilical Venous Line (maintenance and
D/C)
Percutaneous Arterial Line (maintenance
and D/C)
Blood/Blood Products Administration
Exchange Transfusion
IV Hyperalimentation/Intralipid
a. Central
b. Peripheral
c. Dressings
1.
2.
Cardiac/Apnea Monitor
Taking EKG Rhythm Strip
3.
Taking EKG- 12 lead
4.
Neonatal Cardiopulmonary
Resuscitation
Preparation of Emergency Drugs
Defiberation
Care of an Infant with:
a. PDA Ligation
b. Cyanotic Hart Disease
c. Acyanotic Heart Disease
12.
Broviac (Implanted) Lines
8.
13.
Double Lumen Catheters
7.
8.
9.
10.
11.
D
Infants with Cardiovascular
Problems
5.
6.
7.
Assessment of:
1. Pulses
2. Perfusions
3. Heart sounds
1
Mark One
2 3 4
NICU Skills Checklist
Limited Experience
Self Assessed Experience Rating Scale
1
2
3
4
Very Experienced
1
9.
.10.
11.
12.
Blood Pressure
a. Doppler
b. Palpation
15.
16.
F
b. IV
c. IM
Intracardiac Line
4.
15.
16.
Measurement of CVP
Parent/Child Teaching
5.
6.
7.
8.
G
Infants with Respiratory Problems
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Assessment of Breath Sounds
Silverman Anderson Retraction Score
Assisting with Intubation
Obtaining Blood Gases/Lab tests:
a. Heelstick (Capillary)
b. Umbilical Artery Line
c. Peripheral (Percutaneous) Line
d. Peripheral Arterial Stick
Interpretation of Blood Gases
Care of an Infant Ventilator
Chest Physiotherapy/Suction
Care of an Infant with:
a. Respiratory Distress Syndrom
b. Persistent Fetal Circulation
c. Diaphragmatic Hernia
d. Broncho-Pulmonary Dysplasia
e. Massive Aspiration Syndrome
f. Persistent Pulmonary Hypertension
Chest Tube (Pleurovacs)
a. Assisting with Insertion and Set-up
b. Maintenance Care
Oximeters/Transcutaneous Oxygen
Monitor
Ventilation with Anesthesia Bag
Assessment of Pneumothorax by
transillimination
Use if Respiratory Assistance Equipment
ECMO (Extracorporeal Membrane
Oxygenation)
Assessment of LOC
Assessment of Fontanels
Assessment of Pupil Size and
Response
Care of an Infant with;
a. Seizures
b. Disorders of Head, Spine, and
Nervous/System
c. Drug Addiction/Drug Exposure
Assisting with Lumbar Puncture
Administration of:
a. Anticonvulsive Medications
b. Steroids
c. Anticoagulants
Maintaining a Neutral Thermal
Environment
Parent Teaching
Infants with Gastrointestinal
Problems
1.
E.
Jet Ventilators or Oscillators
Use of Artificial Surfactant
Infants with Neurological
Problems
1.
2.
3.
14.
13.
1
c. Non-Invasive Machine (Dinamap)
Administration of Cardiac drugs
a. Oral
Care of Infant in Shock
a. Cardiogenic
b. Septic
c. Hypovolemic
Care of an Infant:
a. Pre/Post-Op Cardiac Surgery
Measurement of Arterial Pressure
.
Mark One
2 3 4
2.
3.
4.
5.
6.
7.
8.
9.
H
Assessment of GI Status
a. Measurement of Abdominal
b. Assessment of Bowel Sounds
c. Feeding Tolerance
Stool Tests
Nasogastric Tube, Sump Tube,
Intermittent & Continuous Suctioning
Gastrostomy Tube
Gavage Feeding
a. Nasogastric
b. Nasojejunal
Colostomy/Ileostomy Care
Phototherapy Treatment
Care of an Infant with:
a. Tracheoesophogeal Fistula
b. Omphalocele
c. Gastrochisis
d. Inguinal Hernia
e. Necrotizing Enterocolitis
f. Cleft Palate/Lip
Parent Teaching
Infants with renal/GU Problems
1.
2.
3.
Peritoneal Dialysis
Insertion of urinary Catheter
Collection of Urine Specimen
4.
Care of Infant with;
a. Disorders of External Organs
(Bladder Atresia)
b. Malformation of GU Tract, Kidney
Test and Interpret Urine
Abnormalities
5.
Mark One
2 3
4
NICU Skills Checklist
Applicants Name_______________________________________
Self Assessed Experience Rating Scale
Limited Experience
1
2
3
4
Very Experienced
Mark One
1 2 3 4
I
Infants with Orthopedic Problems
1.
2.
J
Assistance with Devices (Splints, Casts,
Traction)
Range of Motion Exercises
Infants with Electrolyte and
Endocrine System Disorders
1.
2.
3.
K
Normal Electrolyte/mineral Values
Blood Glucose Levels via
Dextrostix/Glucometer
Care of infant of a Diabetic Mother (IDM)
Infants with Wound or Skin Problems
1.
2.
3.
4.
5.
L.
Assessment of Wound Healing
Prevention of Impaired Skin Integrity
Assessment of Color Change of Skin
a. Jaundice
b. Cyanosis
c. Mottling
D Petechiae
Care of Infant with Neonatal Sepsis
Collection of Culture Specimens
Other
1.
3.
4.
5.
6.
7.
Pain management –Post-OP and Post
Procedure
Developmental Interventions and
Assessment
Care of Extremely Low Birth Weight Infant
Bereavement Support
Universal Precautions
Isolation Techniques and Procedures
Blood Glucose Monitor type:
8.
OSHA TB Fit Test Mask type:
9.
Computer Charting Type
2.
Mark One
1 2 3
M
Age of Patients Cared For:
1.
Infants and Toddlers (ages0-3)
2.
3.
4.
5.
6.
7.
8.
Young Children (ages 2-6)
Older Children (ages 7-12)
Adolescents (ages 13-20)
Young Adults (ages 21-39)
Middle Adults (ages 40-64)
Older Adults (ages 65-79)
Adults (age 80 and over)
4