Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)
Age Of Patients Cared For Newborn/Neonate (birth to 30 days) Infant (31 days to 12 months) Toddler/Preschool (13 months to 5 years) School Age Child/adolescent (6 years to 18 years) Young Adults/Middle Adult (19 years to 64 years) Older Adults/Elderly (65+ years) General Skills Automated Med Dispensing Systems Electronic Documentation IV Pumps Peripheral IV Insertion, Care and Maintenance Access/Management of Implanted Ports Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.) End of Life Care Care of Patient in Restraints Patient and Family Teaching Knowledge of "Do Not Use Abbreviations" Coaching Needs: Physical and Emotional Fetal Monitoring - Basic Fetal Monitoring - Advanced Adult Cardiac/Respiratory Arrest Infant/Neonatal Cardiac/Respiratory Arrest Administration of Blood/Blood Products Knowledge of Normal Lab Values(Newborn) Knowledge of Normal Lab Values(Labor Patient) Do you have charge/supervisor experience? Knowledge of current Joint Commission National Patient Safety Goals Knowledge/familiarity with HCAHPS scores Care Of The Patient W/ Pre-existing Conditions/high Risk Ob Cardiac Disease Neurological Disease Pregnancy Induced Diabetes Mellitus Asthma Chronic Hypertension Pregnancy-Induced Hypertension Infectious Disease HBV HIV Sickle Cell Disease RH Incompatibilities Hemolytic Anemia Collagen Vascular Disease Hemorrhage Drug Addiction/Withdrawal Pyelonephritis Abruptio Placenta Placenta Previa Placenta Acreta Preeclampsia Eclampsia HELLP Syndrome DIC Premature Labor Malpresentations Breech Transverse Lie/Shoulder Face Presentation Brow Presentation Multiple Gestation PROM Chorioamnionitis Poly/Oligohydramnios Prior Tubal Ligation VBAC Management/Trial of Labor Uterine Rupture Incompetent Cervix (Shirodkar Suture/Cerclage) Spontaneous Abortions - Complete/Incomplete Intrauterine Growth Retardation (IUGR) Postdate Pregnancy Fetal Demise Antepartum: Triage of Obstetrical Patients Assessment of Birth Plan Perform Admission Risk Assessment Non-Stress Test (NST) Induction of Labor Oxytocin Challenge Tests (OCT) Assist with Amniocentesis Deep Tendon Reflex Checks (DTR's) Edema Assessment Clonus Breathing/Relaxation Techniques Knowledge And Use Of Analgesics Ritodrine Magnesium Sulfate Terbutaline Indomethacin Procardia Pitocin Cervidil Cytotec Prostin Suppositories Assist with Prostin Gel Antibiotics Antihypertensives Heparin Insulin Drips Insulin Pumps Insulin SC AZT/Other Antiviral Medications Rhogam Iv Therapy/procedures Invasive Hemodynamic Monitoring Blood/Fluid Warmers Labor Assessment/procedures (Maternal): Assist with Sterile Speculum Exam Perform Sterile Speculum Exam Vaginal Exam - Manual Status of Membranes Assist with Rupture of Membranes Fern Test Nitrazine Presence of Clonus DTR's Edema Progression Of Labor Assess Station/Dilation/Effacement Determine Fetal Position/Presentation Contraction Characteristics Determination of Fetal Head Position Documentation of Labor Status and Interventions Labor Suppressants Collect And Label Vaginal Cultures Fluid Herpes Chlamydia Group B Strep Perform Leopold's Maneuvers Amnioinfusion (assist or perform) for: Variable Decelerations Meconium Prolapsed Cord Vasa Previa Catheter Insertion Labor Assessment/procedures (Fetal): Fetal Heart Rate - Doppler Fetal Heart Rate - Auscultate Fetal Heart Rate Patterns (Identify & Treat): Variability Variable Decelerations Early Decelerations Late Decelerations Prolonged Decelerations External Fetal Monitor Application Internal Fetal Monitor Application (Assist) Internal Fetal Monitor Application (Perform) Spiral Electrode Intrauterine Pressure Catheter (IUPC) Placement Calibration Fluid Filled Transducer Tipped Delivery/c-section Assist with Vaginal Delivery Forceps Extraction Vacuum Extraction Assist with High Risk Delivery Shoulder Dystocia Hemorrhage/Shock Emergency Delivery Perineal Prep Circulate for C-Section Scrub for C-Section Patient with General Anesthesia Patient with Epidural Anesthesia Circulate for Tubal Ligation Scrub for Tubal Ligation Assist with Placenta Delivery Assist with Cervical Laceration Repair Assist with Uterine Laceration Repair Assist with Episiotomy Repair Immediate Care Of Newborn In Delivery Room Newborn Assessment Ballard Dubowitz Finnegan/Abstinence Scoring Apgar Scores Initial Care Bulb Delee Wall Meconium Aspiration Collect Cord Samples Assist with UAC/UVC Insertion Insertion of IV, Including Scalp IV Radiant Warmer/Thermoregulation Interventions for LGA, SGA, IUGR Interventions for Infant of Diabetic Mother Oxygen Administration Bag/Mask Ventilation of the Newborn Assist with Intubation Transport Isolette Heelstick Glucose Postpartum Care Fundal Height Fundal Massage Lochia Episiotomy Care Maternal Vital Signs Recovering Post-Op C-Section Patient Recovering Post-Op Tubal Ligation Patient Fluid Balance Assessment for DVT Couplet Care Breastfeeding Newborn Care Cord Care Assist With Breastfeeding Latch on Positioning Care Of The Infant With Assist with Lumbar Puncture Administration of IV Antibiotics Drug Addiction/Withdrawal Cystic Fibrosis Meconium Aspiration Pulmonary Edema RDS NEC Cardiac Anomalies Neuromuscular Disease Spina Bifida Seizure Activity Tracheoesophageal Fistula Sepsis Sickle Cell Disease Low Birth Weight Infants Pain Management/anesthesia Assess Pain Level/Acceptable Level of Pain Intranasal Pain Medications Oral Pain Medications IV Pain Medications PCA IV Moderate/Conscious Sedation Epidural Pain Management Intervention for Anesthesia Toxicity Assist With Epidural Insertion Positioning of Patient Signs of a Dural Puncture Coaching Patient Fluid Challenge Hypotension Intrathecal Narcotics My Experience Fetal Monitoring Course - Basic? Fetal Monitoring Course - Intermediate? Fetal Monitoring Course - Advanced?