Pediatric Rn Skills Checklist

Proficiency Scale & Legend

1 No Experience

2 Need Training

3 Able to perform with supervision

4 Able to perform independently

Work Settings

1

2

3

4

Pediatric MedSurg

Pediatric Step Down/Telemetry

Pediatric Oncology

Pediatric Ortho

Pediatric Neuro

Cardiovascular

1

2

3

4

Pulmonary

1

2

3

4

Neurologic/orthopedic

1

2

3

4

Gastrointestinal

1

2

3

4

Renal/genitourinary

1

2

3

4

Endocrine/metabolic

1

2

3

4

Oncology

1

2

3

4

Infectious Disease

1

2

3

4

Medications

1

2

3

4

Iv Therapy

1

2

3

4

Cardiac Monitoring & Emerg. Response

1

2

3

4

Professional Knowledge And Skills

1

2

3

4

Emr

1

2

3

4

Age Specific Competencies

1

2

3

4

Certifications

	Expiration Date
BLS
PALS
CPHON
Chemo Certification: Specify
PICC Certification: Specify
Other: Specify

Please list any additional skills/training/equipment:

Skills

Training

Equipment

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.

Personal Information