Click to enter Home PageClick to enter Corporate pageClick to Enter Service pageClick to enter Career pageClick to enter Healthcare pageClick to enter why health care pageClick to enter links pageClick to enter travel staffing pageClick to enter International page

   

My responses in this checklist represent a true reflection of my experience and comfort level.

Please self-rate your comfort level in performing tasks in connection with the below checklist. Rate your level of comfort for each line item by following the below ranking system. Simply fill in the appropriate option immediately following the rating number.
 
 
 
 
 
 Signature                  :
     
 
 Date                   :
     
          Phone                  :
   
   My Recruiting Professional at Health Source Group is:
   *
          Level of Comfort/Experience

          N/A=Non-applicable

          1=Inexperienced in this area

          
2=Limited comfort/experience in this area

          
3=Comfortable/experienced in this area

          
4= comfortable/highly experienced in this area

 

Area

Not Applicable

Inexperienced

Limited

Experienced

Highly Experienced

CARDIOVASCULAR

 

 

 

 

 

Auscultation (rate, rhythm, volume)

N/A  

1

2

3

4

Blood pressure/invasive (arterial-line)

N/A  

1

2

3

4

Blood pressure/non-invasive

N/A  

1

2

3

4

Heart sounds/murmurs

N/A  

1

2

3

4

Perfusion

N/A  

1

2

3

4

Pulses

N/A  

1

2

3

4

EKG interpretation

N/A  

1

2

3

4

Cardioversion/Defibrillation

N/A  

1

2

3

4

Invasive hemodynamic monitoring

N/A  

1

2

3

4

Central venous pressure

N/A  

1

2

3

4

Cardiac arrest

N/A  

1

2

3

4

Congenital heart disease/defects

N/A  

1

2

3

4

Hemodynamic instability

N/A  

1

2

3

4

Hypovolemic shock

N/A  

1

2

3

4

Post cardiac surgery

N/A  

1

2

3

4

Dobutamine

N/A  

1

2

3

4

Dopamine

N/A  

1

2

3

4

Epinephrine

N/A  

1

2

3

4

Nipride

N/A  

1

2

3

4

Sodium bicarbonate

N/A  

1

2

3

4

 

PULMONARY

 

 

 

 

 

Breath sounds

N/A  

1

2

3

4

Rate and work of breathing

N/A  

1

2

3

4

Apnea monitor use

N/A  

1

2

3

4

Assist with intubation

N/A  

1

2

3

4

Bulb syringe

N/A  

1

2

3

4

CPAP (nasal cannula)

N/A  

1

2

3

4

Endotracheal tube stabilation

N/A  

1

2

3

4

Endotracheal tube suctioning

N/A  

1

2

3

4

Extubation

N/A  

1

2

3

4

Nasal airway/ suctioning

N/A  

1

2

3

4

Oral airway/suctioning

N/A  

1

2

3

4

Tracheostomy care and suctioning

N/A  

1

2

3

4

Assist with chest tube insertion/removal/set-up

N/A  

1

2

3

4

Oxygen therapy delivery systems:

N/A  

1

2

3

4

Anesthesia bag and mask

N/A  

1

2

3

4

Self-inflating bag and mask

N/A  

1

2

3

4

Nasal cannula

N/A  

1

2

3

4

Nebulizer

N/A  

1

2

3

4

Oxyhood

N/A  

1

2

3

4

Tent

N/A  

1

2

3

4

Trach collar

N/A  

1

2

3

4

Arterial

N/A  

1

2

3

4

Heelstick (Capillary)

N/A  

1

2

3

4

Peripheral

N/A  

1

2

3

4

Umbilical line

N/A  

1

2

3

4

Interpretation of blood gases

N/A  

1

2

3

4

Thoracentesis

N/A  

1

2

3

4

Use of artificial surfactant

N/A  

1

2

3

4

CPAP/PEEP

N/A  

1

2

3

4

High frequency jet ventilator

N/A  

1

2

3

4

Home ventilator

N/A  

1

2

3

4

IMV

N/A  

1

2

3

4

Oscillating

N/A  

1

2

3

4

Pressure ventilator

N/A  

1

2

3

4

Volume ventilator

N/A  

1

2

3

4

Weaning from ventilator

N/A  

1

2

3

4

Bronchopulmonary dysplasia (BPD)

N/A  

1

2

3

4

Cardiogenic shock

N/A  

1

2

3

4

Diaphragmatic hernia

N/A  

1

2

3

4

Drug addiction/withdrawal

N/A  

1

2

3

4

Fresh tracheostomy

N/A  

1

2

3

4

Mechonium aspiration

N/A  

1

2

3

4

Persistent pulmonary hypertension (PPHN)

N/A  

1

2

3

4

Pneumothorax

N/A  

1

2

3

4

Respiratory distress syndrome (RDS)

N/A  

1

2

3

4

Systemic infection

N/A  

1

2

3

4

Respiratory failure

N/A  

1

2

3

4

Tetralogy of fallot

N/A  

1

2

3

4

Aminophylline

N/A  

1

2

3

4

Prostaglandin

N/A  

1

2

3

4

 

NEUROLOGICAL

 

 

 

 

 

Assessment of neurological status

N/A  

1

2

3

4

Intracranial pressure monitoring

N/A  

1

2

3

4

Care of the neonate with:

N/A  

1

2

3

4

Brain death/organ procurement

N/A  

1

2

3

4

External VP shunts/reservoirs

N/A  

1

2

3

4

Increased intracranial pressure

N/A  

1

2

3

4

Seizures

N/A  

1

2

3

4

Anticonvulsant medication use

N/A  

1

2

3

4

 

GASTROINTESTINAL

 

 

 

 

 

Abdominal girth

N/A  

1

2

3

4

Bowel sounds

N/A  

1

2

3

4

Palate

N/A  

1

2

3

4

Suck/swallow

N/A  

1

2

3

4

Care of gastrostomy tube

N/A  

1

2

3

4

Placement of Jejunal tube

N/A  

1

2

3

4

Placement of nasogastric (NG) tube

N/A  

1

2

3

4

Test for occult blood

N/A  

1

2

3

4

Assist with breast feeding

N/A  

1

2

3

4

Bottle

N/A  

1

2

3

4

Breast milk handling/storage

N/A  

1

2

3

4

Gavage

N/A  

1

2

3

4

Electric breast pump use

N/A  

1

2

3

4

Cleft lip/palate

N/A  

1

2

3

4

Colostomy/ileostomy

N/A  

1

2

3

4

Gastroschisis/omphalocele

N/A  

1

2

3

4

GI bleeding

N/A  

1

2

3

4

Inguinal hernia

N/A  

1

2

3

4

Necrotizing enterocolitis

N/A  

1

2

3

4

Post abdominal surgery

N/A  

1

2

3

4

Reflux precautions

N/A  

1

2

3

4

Tracheoesophageal fistula

N/A  

1

2

3

4

 

ENDOCRINE/METABOLIC

 

 

 

 

 

Finnegan

N/A  

1

2

3

4

Fluid and electrolyte balance

N/A  

1

2

3

4

Interpret bilirubin lab result

N/A  

1

2

3

4

Interpret urine lab results

N/A  

1

2

3

4

Collect of urine specimens:

N/A  

1

2

3

4

Assist with supra pubic tap

N/A  

1

2

3

4

Catheter

N/A  

1

2

3

4

Diaper/bag

N/A  

1

2

3

4

Blood glucose testing and interpretation

N/A  

1

2

3

4

Phototherapy for jaundice

N/A  

1

2

3

4

Post circumcision care

N/A  

1

2

3

4

Acute renal failure

N/A  

1

2

3

4

DIC (Disseminated intra vascular coagulation)

N/A  

1

2

3

4

Hypo/hyperkalemia

N/A  

1

2

3

4

Hypo/hypernatremia

N/A  

1

2

3

4

IDM (infant of diabetic mother) Hypo and hyperglycemia

N/A  

1

2

3

4

Malformations of GU tract and kidney

N/A  

1

2

3

4

Peritoneal dialysis

N/A  

1

2

3

4

 

INFECTIOUS DISEASES

 

 

 

 

 

CBC/differential

N/A  

1

2

3

4

Culture reports

N/A  

1

2

3

4

Maternal lab results

N/A  

1

2

3

4

Hepatitis surface antigen positive mother

N/A  

1

2

3

4

HIV positive mother

N/A  

1

2

3

4

Neonatal sepsis

N/A  

1

2

3

4

Assist with lumbar puncture

N/A  

1

2

3

4

Collect culture specimens

N/A  

1

2

3

4

Immunization administration

N/A  

1

2

3

4

Isolation techniques

N/A  

1

2

3

4

Universal precautions

N/A  

1

2

3

4

 

IV THERAPY

 

 

 

 

 

Cryoprecipitate

N/A  

1

2

3

4

Packed red blood cells

N/A  

1

2

3

4

Plasma/albumin

N/A  

1

2

3

4

Whole blood

N/A  

1

2

3

4

Hyperalimentation /TPN

N/A  

1

2

3

4

Intralipid

N/A  

1

2

3

4

IV pump

N/A  

1

2

3

4

Syringe pump

N/A  

1

2

3

4

Drawing blood from central line

N/A  

1

2

3

4

Drawing venous blood

N/A  

1

2

3

4

Starting IV’s

N/A  

1

2

3

4

Angiocath

N/A  

1

2

3

4

Butterfly

N/A  

1

2

3

4

Heparin lock

N/A  

1

2

3

4

Managing IV therapy (Site and patency assessment, dressing and tubing change, discontinuing IV)

N/A  

1

2

3

4

Broviac

N/A  

1

2

3

4

Groshong

N/A  

1

2

3

4

Hickman

N/A  

1

2

3

4

Portacath

N/A  

1

2

3

4

Quinton

N/A  

1

2

3

4

Percutaneous arterial line

N/A  

1

2

3

4

Percutaneuos venous line

N/A  

1

2

3

4

PICC (peripherally inserted central catheter)

N/A  

1

2

3

4

Umbilical artery line

N/A  

1

2

3

4

Umbilical venous line

N/A  

1

2

3

4

 

OTHER NURSING RESPONSIBLITIES

 

 

 

 

 

Apgar scoring

N/A  

1

2

3

4

Eye exam to rule out retinopathy

N/A  

1

2

3

4

Gestational age/Ballard

N/A  

1

2

3

4

Gestational age/Dubowitz

N/A  

1

2

3

4

Maternal history

N/A  

1

2

3

4

Pain level assessment

N/A  

1

2

3

4

Screen for hearing loss

N/A  

1

2

3

4

Bereavement/post mortem care

N/A  

1

2

3

4

Calculation of medication dosage for the neonate

N/A  

1

2

3

4

Consent use for procedures and treatment

N/A  

1

2

3

4

Cord care

N/A  

1

2

3

4

Neonatal skin care

N/A  

1

2

3

4

Obtain weight (bed scale, scale)

N/A  

1

2

3

4

Positioning devices

N/A  

1

2

3

4

Preparation for transport or transfer

N/A  

1

2

3

4

Isolette with humidity

N/A  

1

2

3

4

Radiant warmer

N/A  

1

2

3

4

Temperature (axillary, rectal, skin)

N/A  

1

2

3

4

Weaning to open crib/bassinet

N/A  

1

2

3

4