Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 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
    Care of Patient in Restraints
    Automated Med Dispensing Systems
    Other Automated Med Dispensing Systems:
    Electronic Documentation
    Other Electronic Documentation:
    IV Pumps
    Other IV Pumps:
    Peripheral IV Insertion, Care and Maintenance
    Access/Management of Implanted Ports
    Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
    Cardiac Monitoring/Interpretation
    PCA/Epidural pumps
    Titration of drips
    Administration of Blood/Blood Products
    Administration of Chemotherapy
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores
    CARDIOVASCULAR GENERAL SKILLS
    Hemoglobin & Hematocrit Interpretation
    Basic EKG Interpretation
    Non-Invasive Cardiac Monitoring
    CARDIOVASCULAR-Care of Child with:
    Cardiomyopathy
    Congenital Heart Disease/Defects
    Congestive Heart Failure
    Bacterial Endocarditis
    Rheumatic Fever
    Post cardiac cath
    Pre/Post Cardiac Surgery
    Shock
    RESPIRATORY GENERAL SKILLS
    Arterial Blood Gas Interpretation
    Apnea Monitor
    Airway Management Devices/Suctioning
    Bulb Syringe
    Chest Physiotherapy
    Chest Tubes
    Nasal/Oral Airway/Suctioning
    Tracheostomy/Suctioning
    Face Mask
    Hood/Tent
    Pulse Oximeter
    Isolette
    Nasal Cannula
    Trach Collar
    RESPIRATORY-Care of Child With:
    Asthma
    Bronchopulmonary Dysplasia (BPD)
    Croup
    Cystic Fibrosis
    ENT Surgery
    Epiglottitis
    Esphogeal Atresia
    RSV
    Home Ventilator Therapy
    Pertussis
    Pneumonia
    Tonsillitis
    Tuberculosis
    NEURO GENERAL SKILLS
    Assessment - Level of Consciousness
    Assist with Lumbar Puncture
    ICP Monitoring
    NEURO-Care of Child with:
    Closed Head Trauma
    Encephalitis
    Febrile Seizures
    Meningitis
    Multiple Sclerosis
    Near Drowning
    Neuromuscular Disease
    Spinal Cord Injury
    Traction - Halo/General
    VP Shunt - Internal/External
    GASTROINTESTINAL GENERAL SKILLS
    Bottle Feeding
    Breast Feeding
    Gavage
    Gastrostomy/Button
    J-Tubes
    NG to Suction
    Placement of Naso/Orogastric Tube
    GASTROINTESTINAL-Care of Child With:
    Anal Fissure
    Cleft Lip/Palate
    Colostomy/Ileostomy
    Gastroenteritis/Dehydration
    Diaphragmatic Hernia
    Failure to Thrive (FTT)
    Pyloric Stenosis
    GE Reflux
    GI Bleeding
    Inflammatory Bowel Disease
    Intestinal Parasites
    Necrotizing Enterocolitis (NEC)
    Surgical Abdomen
    RENAL GENERAL SKILLS
    RENAL-Care of Child With:
    Renal Failure
    Circumcision
    Dialysis
    Kidney Transplant
    HUS (Hemolytic Uremic Syndrome)
    Insertion/management of catheters
    Pyelonephritis/UTI
    Glomerulonephritis
    Testicular Torsion
    Wilm's Tumor
    ORTHOPEDIC GENERAL SKILLS
    Assessment of C/M/S
    Casts/Splints
    Traction
    Use of Assistive Devices
    ORTHOPEDIC-Care of Patient With:
    Fractures
    Osteogenesis Imperfecta
    Osteomyelitis
    Club Foot
    Assessment - Pain Level Using Age Appropriate Scales
    ENDOCRINE/METABOLIC GENERAL SKILLS
    Knowledge of Lab work-Thyroid Studies
    Blood Glucose Testing
    ENDOCRINE/METABOLIC-Care of Child With:
    Adrenal Disorders
    Cushing's Syndrome
    Diabetes Mellitus
    Diabetic Ketoacidosis
    Indwelling Insulin Pumps
    Bili Bed
    Pituitary Disorders
    Thyroid Malfunction
    HEMATOLOGY/ONCOLOGY-Care of Child With:
    Anemia
    Bone Marrow Transplant
    Depressed Immune System
    Disseminated Intravascular Coagulation (DIC)
    Hemophilia
    Hodgkin's Disease
    Infectious Mononucleosis
    Leukemia
    Malignant Tumors
    Sickle Cell Anemia
    Spleen Trauma/Splenectomy
    Solid Tumors
    INFECTIOUS DISEASES GENERAL SKILLS
    INFECTIOUS DISEASES-Care of Child With:
    Fever
    HIV/AIDS
    Common Childhood Communicable Diseases
    Cytomegalovirus (CMV)
    CRE
    VRE
    MRSA
    C Difficile
    Hepatitis
    Kawasaki Disease
    Lyme Disease
    MEDICATION KNOWLEDGE AND USE OF
    Calculation of Pediatric Doses
    Eye/Ear Installations
    Metered Dose Inhaler
    Anticoagulants
    Antiemetics
    Anti Seizure Medication
    Benzodiazepines
    Bronchodilators
    Corticosteroids
    Chemotherapy
    Digoxin
    Diuretics
    Growth Hormone
    Inhaled Medications
    Insulin
    Narcotics/Opioid Analgesics ( IV/Oral/Injection)
    Non-Opioid Analgesics
    Procedural Sedation
    Reversal Agents
    Steroids ( IV/Oral/Inhaled)
    Thyroid Medications
    MISCELLANEOUS
    Normal Growth & Development
    Recognize Signs of Abuse or Neglect
    Immunization Schedule
    WOUND MANAGEMENT
    Assessment-Skin for Impending Breakdown
    1st Degree Burns
    2nd Degree Burns
    3rd Degree Burns
    Pressure Sores
    Staged Decubitus Ulcers
    Stasis Ulcers
    Sterile Dressing Changes
    Surgical Wound Healing
    Surgical Wounds with Drain(s)
    Drains
    Penrose
    JP
    Traumatic Wound Care
    Use of Air Fluidized, Low Airloss Beds
    Wound Care/Irrigations