Nicu Nurse Skills Checklist

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Proficiency Scale & Legend

1 Theory – No Experience

2 Minimal Experience (0-12 Months)

3 Experienced/Competent (Greater than 12 Months)

4 Able to Teach/Supervise

General Nursery

Nursery Technique

Hand Washing

Gowning

Isolation Techniques

Nursery Procedures

Vital Signs

Dextrostix

Cord Care

Heelstick

Medication Administration

Calculation of Neonatal Weight

Knowledge of Routine Neonatal Drugs

Knowledge of Emergency Neonatal Drugs

IM Injections

Peripheral Venipuncture

Physical Assessment:

Level Ii And Iii Nursery

Certifications

	Expiration Date
CPR
BLS
ACLS
PALS
TNCC
Other

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.

Nicu Nurse Skills Checklist

Personal Information

Proficiency Scale & Legend

General Nursery

Nursery Technique

Nursery Procedures

Medication Administration

Physical Assessment:

Skin

Neurological

Nutrition

Methods Of Feedings

Thermoregulation

Respiratory

Evaluation Of

Level Ii And Iii Nursery

Use Of Equipment

Emergency Situations

Cardiac

Care Of The Patient With: Cardiac

Respiratory

Care Of The Patient With: Respiratory

Suctioning:

Neurology

Care Of The Patient With: Neurology

Gastrointestinal

Care Of The Patient With: Gastrointestinal

Renal

Vascular:

Sterile Dressing Changes:

Other:

Certifications