Neonatal ICU Checklist


Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  PATIENT TYPES         Rating Stars (Click) 1 2 3 4
  Neonates < 28 Weeks  
  Neonates 29 - 34 Weeks  
  Neonates > 34 Weeks  
  WORK SETTINGS         Rating Stars (Click) 1 2 3 4
  Level II NICU  
  Level III NICU  
  Level IV NICU  
  CARDIOVASCULAR         Rating Stars (Click) 1 2 3 4
  Cardiac Surgery - Pre-op  
  Cardiac Surgery - Immediate Post-op  
  Congenital Heart Disease/Defects  
  CHF/Pulmonary Edema  
  Hemodynamic Instability  
  PULMONARY         Rating Stars (Click) 1 2 3 4
  Bronchopulmonary Dysplasia  
  Diaphragmatic Hernia  
  Fresh Tracheostomy  
  Meconium Aspiration  
  Persistent Pulmonary Hypertension  
  Pneumonia  
  Respiratory Distress Syndrome/Failure  
  Interpretation of ABGs  
  Assist with Intubation/Extubation  
  Endotracheal Suctioning  
  Chest Tube Placement and Management  
  Modes of Ventilation (AC/PC/SIMV/CPAP/BiPAP)  
  High Frequency Ventilation  
  Inhaled NO  
  ECMO  
  NEUROLOGIC         Rating Stars (Click) 1 2 3 4
  Ballard/Dubowitz  
  Reflexes Based on Gestational Age  
  Hydrocephalus  
  Intraventricular Hemorrhage  
  Meningocele/Myelomeningocele  
  Neonatal Abstinence Score/Syndrome  
  Seizures  
  GASTROINTESTINAL         Rating Stars (Click) 1 2 3 4
  Colostomy/Ileostomy  
  Gastroschisis/Omphalocele  
  GI Bleeding  
  Necrotizing Enterocolitis  
  Post Abdominal Procedure  
  FEEDINGS         Rating Stars (Click) 1 2 3 4
  Breast Milk Handling/Storage  
  Breast Pump  
  Gavage Feedings  
  NG/OG/NJ Tube Placement and Management  
  RENAL/ENDOCRINE/GENETIC         Rating Stars (Click) 1 2 3 4
  Circumcision Care  
  Genetic Disorders  
  Hypo/Hyperglycemia  
  Infant of Diabetic Mother  
  Malformations of the GU Tract/Kidney  
  Phototherapy  
  Renal Failure  
  INFECTIOUS DISEASES         Rating Stars (Click) 1 2 3 4
  Neonatal Sepsis  
  Septic Work Up  
  Assist with Lumbar Puncture  
  MEDICATIONS         Rating Stars (Click) 1 2 3 4
  Calculation of Neonatal Dosages  
  Antibiotics/Antivirals  
  Anticonvulsants  
  Immunizations  
  Digoxin  
  IV Vasopressors  
  Prostaglandin  
  Bronchodilators  
  Steroids  
  Caffeine  
  Surfactant  
  Automated Medication Dispensing (i.e. Pyxis  
  Omnicell)  
  IV THERAPY         Rating Stars (Click) 1 2 3 4
  Administration of Blood/Blood Products  
  Central Line Catheter/Dressings  
  Management of UAC/UVC Lines  
  Radial Arterial Lines  
  Start IVs  
  CARDIAC MONITORING & EMERG. RESPONSE         Rating Stars (Click) 1 2 3 4
  Attend High Risk Deliveries  
  Preparation for Transport  
  Transport Neonate  
  Rhythm Interpretation  
  Dysrhythmia Management  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals/Core Measures  
  Bereavement/Postmortem Care  
  Neonatal Skin Care  
  Pressure Ulcer Risk Assessment/Prevention  
  Restraints/Use of Least Restrictive Device  
  Patient/Family Teaching  
  Age Specific/Population-Based Care  
  Isolation Precautions  
  Infection Prevention  
  Pain Assessment & Management  
  Charge Experience  
  Interpretation and Communication of Lab Values  
  EMR         Rating Stars (Click) 1 2 3 4
  Epic  
  Cerner  
  Eclipsys  
  McKesson  
  Meditech  
  Other Computerized System  
  Computerized Physician Order Entry  
  Bar Coding for Medication Administration