Skills Checklist – Labor and Delivery

CARE OF PATIENTS (INFANTS) WITH*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
a. IDM Protocol
b. AGA Protocol
c. LGA Protocol
d. SGA Protocol
Multiple Gestation
NSVD
Placentia Previa
Preeclampsia
Premature Labor
Prolapsed Cord
Rh Disease/Incompatibilities
Seizure
Stillborn
Substance Abuse
Vacuum Extraction Delivery
VBAC

ANTEPARTUM CARE/PROCEDURES*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Triage of Obstetrical Patients
Non Stress Tests (NST)
Oxytocin Challenge Tests (OCT)
Assist with Ultrasound
Assist with Amniocentesis
Assist with Sterile Speculum Exam
Reflex Checks/Edema Assessment
Pelvimetry

POSTPARTUM CARE/PROCEDURES*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Couplet Care
Parent/Infant Bonding/Teaching
Breast Feeding Education/Support
Bereavement Support
Post Anesthesia Recovery Care
Emergency Interventions
Hemorrhage.

MEDICATION ADMINISTRATION*

EQUIPMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Breast Pump
Infusion Pumps (specific brands)
Infusion Pump Brand #1
Infusion Pump Brand #2
Infusion Pump Brand #3
Infusion Pump Brand expertise
Rarely Some Experience Proficient Trainer / Preceptor N/A
Infusion Pump Brand #1
Infusion Pump Brand #2
Infusion Pump Brand #3
EQUIPMENT - PHOTOTHERAPY EQUIPMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Bili Lights
Bili Meter
Transport Incubator

ASSESSMENT/OTHER*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Isolation Precautions
Assess Breath Sounds
Assess Heart Sounds
Infection Prevention
Charge Nurse responsibilities
Circulation Checks
Interpretation of Lab Values
Fontanel Assessment
Head circumference measurement
Neurological Assessments
Pain assessment using pain scales
Patient Teaching

Do you speak any languages other than English?*
- No
If yes, enter languages above, separated by commas.

Age Group Experience*

Confirmation*
- I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
Signature
Date
MM slash DD slash YYYY

Origin Travel Nurses has earned the Joint Commission's Gold Seal of Approval

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Sterile Vaginal Exams
Ruptured Membrane Testing
Fetal Scalp Electrode Placement
Oxygen Therapy

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Blood/Blood Products Transfusion
Central Line Maintenance
Peripheral insertion/maintenance
Saline/Heparin Lock
Specimen Collection

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Narcotic Agents
Non-narcotic agents
Non-pharmacological measures
CARE OF NEWBORN
Infant Feedings
Specimen Collection.
Temperature