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NICU RN
Neonatal Intensive Care
Name
*
Full Name
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale:
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Cardiovascular
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Ausculation (rate, rhythm, volume)
Assessment - Blood pressure/invasive (A-line)
Assessment - Blood pressure/non-invasive
Assessment - Heart sounds/murmurs
Assessment -Perfusion
Assessment - Pulses/circulation
Care of neonate - Cardiac arrest
Care of neonate - Cardiomyopathy
Care of neonate - Congenital heart defects
Care of neonate - Hemodynamic instability
Care of neonate - Hypovolemic shock
Care of neonate - Post cardiac surgery
Care of neonate - Post interventional cardiac cath
Monitoring - CVP
Monitoring - EKG interpretation
Perform - Cardiac resuscitation
Perform - Emergency defibrillation
Pulmonary
No Experience
Limited Experience
Experienced
Highly Skilled
Airway Management - Endotracheal/suctioning
Airway Management - Nasal/suctioning
Airway Management - Tracheostomy/suctioning
Assessment - Breath sounds
Assessment - Rate and work of breathing
Assist with extubation
Assist with intubation
Assist with removal of chest tube
Assist with setup/insertion of chest tube
Assist with thoracentisis
Care of neonate - Bronchopulmonary dysplasia (BPD)
Care of neonate - Cardiogenic/hypovolemic shock
Care of neonate - Diaphragmatic hernia
Care of neonate - Fresh tracheostomy
Care of neonate - Meconium aspiration
Care of neonate - Persistent pulmonary hypertension (PPHN)
Care of neonate - Pneumothorax
Care of neonate - Respiratory distress syndrome
Care of neonate - Respiratory failure
Interpret - Arterial blood gases
Obtain ABG's - Arterial line
Obtain ABG's - Heel stick
Obtain ABG's - Peripheral
Obtain ABG's - Umbilical line
Oxygen therapy and medication delivery via bag and mask
Oxygen therapy and medication delivery via bulb syringe
Oxygen therapy and medication delivery via ET tube
Oxygen therapy and medication delivery via face mask
Oxygen therapy and medication delivery via nasal canula
Oxygen therapy and medication delivery via nebulizer
Oxygen therapy and medication delivery via oxyhood
Oxygen therapy and medication delivery via tent
Oxygen therapy and medication delivery via trach collar
Use of artificial surfactant
Ventilator care - CPAP/PEEP
Ventilator care - High frequency jet ventilator
Ventilator care - Home ventilator
Ventilator care - IMV
Ventilator care - Oscillating
Ventilator care - Pressure ventilator
Ventilator care - Volume ventilator
Ventilator care - Weaning
Neurological
No Experience
Limited Experience
Experienced
Highly Skilled
Care of neonate - Brain death/organ procurement
Care of neonate - Externalized VP shunt/reservoirs
Care of neonate - Increased intracranial pressure
Care of neonate - Meningitis
Care of neonate - Seizures
ICP Management - Monitoring
Monitoring - Intracranial pressure
Gastrointestinal
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Abdominal girth
Assessment - Abdominal/bowel sounds
Assessment - Palate
Assessment - Suck/swallow
Care of neonate - Cleft palate
Care of neonate - Colostomy/ileostomy
Care of neonate - Castrochisis/omphalocele
Care of neonate - GI bleeding
Care of neonate - Inguinal hernia
Care of neonate - Necrotizing enterocolitis (NEC)
Care of neonate - Post abdominal surgery
Care of neonate - Tracheoesophogeal fistula
Feedings - Bottle
Feedings - Breast milk handling/storage
Feedings - Gavage
Monitoring - Gastrostomy tube
Monitoring - Jejunostomy tube
Perform - Placement of NG tube
Perform - Test for occult blood
Renal/Genitourinary
No Experience
Limited Experience
Experienced
Highly Skilled
Perform - Urine specimen collection (catheter)
Perform - Urine specimen collection (diaper/bag)
Endocrine/Metabolic
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Finnegan
Assessment - Fluid and electrolyte balance
Assist with supra-pubic tap
Care of neonate - Acute renal failure
Care of neonate - Disorders of internal/external organs
Care of neonate - Drug addiction/withdrawal
Care of neonate - Hypo/hyperglycemia
Care of neonate - Hypo/hyperkalemia
Care of neonate - Hypo/hypernatremia
Care of neonate - Malfunction of the GU tract
Care of neonate - Peritoneal dialysis
Collect and Interpret - Labstix
Collect and Interpret - Occult blood
Collect and Interpret - Urine glucose
Collect and Interpret - Urine pH
Collect and Interpret - Urine specific gravity
Monitor - Phototherapy for jaundice
Infectious Disease
No Experience
Limited Experience
Experienced
Highly Skilled
Care of neonate - Hepatitis surface antigen+ mother
Care of neonate - HIV+ mother
Care of neonate - Neonatal sepsis
Interpret - CBC/differential
Interpret - Culture reports
Interpret - Maternal lab results
Medications - RespiGam
Perform - Assist with lumbar puncture
Perform - Collect culture specimens
Perform - Isolation
Pain Management
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Pain level/tolerance
Care of neonate - With sedation
Care of patient - Narcotic analgesia
Phlebotomy/IV Therapy
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Site and patency
Care of neonate - Peripheral line/dressing
Care of neonate - Portacath
Care of neonate - Umbilical artery line
Care of neonate - Umbilical venous line
Equipment - Syringe pump
Perform - Administer hyperalimentation/TPN
Perform - Administer packed RBC's
Perform - Draw blood from central line
Perform - Rate calculation
Perform - Start IV (heparin lock)
Miscellaneous
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - APGAR score
Assessment - Eye exam (r/o retinopathy)
Assessment - Maternal history
Assessment - Screening for hearing loss
Assessment - Weight (bed scale, scale)
Bereavement/postmortem care
Medications - Neonatal drug actions and reaction
Perform - Neonatal skin care
Thermoregulation - Isolette with humidity
Thermoregulation - Radiant warmer
Thermoregulation - Temperature (axillary, rectal, skin)
Thermoregulation - Wean to open crib/bassinet
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