NICU / Neonatal Skills Checklist

Name

First Last

Title

Date

Certification Dates

BCLS

ACLS

Chemo

PALS

Level of Proficiency

1 = Knowledgeable
2 = Experienced
3 = Very Experienced

Charge Duties

LEVEL I Newborn Normal Nursery

1
2
3

LEVEL II

1
2
3

LEVEL III Neonatal ICU

1
2
3

LEVEL IV Neonatal ICU

1
2
3

At Delivery to Receive Newborn

1
2
3

Admission / Assessment

Maternal History

1
2
3

Regular Preparation for Transport

1
2
3

Reverse Interfacility Emergency Transport

1
2
3

Enteric Identifying Infant

1
2
3

Gestational Age

1
2
3

Urine Output

1
2
3

Weight-Scale / Bed Scale

1
2
3

Universal Collect Cord Blood Samples

1
2
3

Skin Care / Cord Care

1
2
3

Blood Pressure

1
2
3

Temperature

1
2
3

Respiratory Monitor

1
2
3

CVP Lines and Dressing Changes Head, Chest, Length, Abdominal Measures

1
2
3

Apgar Scoring

1
2
3

FOC

1
2
3

Silverman Scoring

1
2
3

Administration Assessment of Parent-Infant attachment

1
2
3

Fontanels

1
2
3

Computer Charting / Documentation

1
2
3

Skin

Identification of Jaundice

1
2
3

Pediatric Identification of Cyanosis

1
2
3

Identification of Dehydration

1
2
3

Administration of Silver Nitrate

1
2
3

Administration of Vitamin K

1
2
3

Chemstrip / Dextrostic

1
2
3

Vital Signs

Temperature (Ear)

1
2
3

Shock Management Apical Pulse

1
2
3

Blood Pressure:

Locations

1
2
3

Electronic

1
2
3

Doppler

1
2
3

Respiratory

Suctioning with Bulb Syringe

1
2
3

Suction with Suction Cather

1
2
3

Identification of Respiratory Distress

1
2
3

Use of Oxygen with:

Mask & Bag

1
2
3

Hood

1
2
3

Ventilator (CPAP/PEEP/IMV/Jet Vent)

1
2
3

Continuous Positive Airway Pressure

1
2
3

Pulse Oximeter

1
2
3

Oxygen Analyzer

1
2
3

Knowledge of Surfactant

1
2
3

Chest Physiotherapy

1
2
3

Apnea Records

1
2
3

Assessment of Retractions & Nasal Flaring

1
2
3

Blood Gasses

Set Up CVP Line Peripheral Arterial Venipuncture

1
2
3

Care of CVP Line Arterialized Capillary

1
2
3

Obtaining CVP Reading Endotracheal Intubation

1
2
3

Recognize Abnormal Measurement Reinsertion of Tracheostomy Tubes

1
2
3

Discontinuing a Central Line Needle / Syringe Aspiration of Pleural Cavity to R/O Pneumothorax

1
2
3

Chest Tubes

Care of Tubes

1
2
3

Assist w/ Emergency Insertion

1
2
3

Medical Administration

Reconstitution of Powdered Meds

1
2
3

Calculation of Safe Dosage Range

1
2
3

Calculation of Neonatal Dosages

1
2
3

Method, Interactions, Incompatibilities and Side Effects

1
2
3

Eye Prophylaxis

1
2
3

Routine Neonatal Drugs

1
2
3

Emergency Neonatal Drugs

1
2
3

Insertion of Scalp Vein IV

1
2
3

Intramuscular Injections

1
2
3

IV Push

1
2
3

IV Piggyback

1
2
3

Intravenous Therapy

1
2
3

Peripheral Venipuncture

1
2
3

Umbilical Artery / Venous Line

1
2
3

Total Parenteral Nutrition Including Intralipids

1
2
3

Infusion Pumps

1
2
3

Blood and Blood Component Therapy

1
2
3

Nutrition

Fresh MI Basic Requirements

1
2
3

GI Bleed Breast Feeding

1
2
3

Bottle Feeding

1
2
3

Gavage Feeding

1
2
3

Insertion of Feeding Tubes

1
2
3

Evaluation Of

Cardiac Monitor

1
2
3

Laboratory Values

1
2
3

Respiratory Monitor

1
2
3

X-Ray Reports

1
2
3

Use of Radiant Warmer

1
2
3

Genitourinary

Dioxin Insertion of Foley Cath

1
2
3

Circumcision

1
2
3

Urostomy

1
2
3

Disorders of External Organs

1
2
3

Malformation of GU Tract / Kidney

1
2
3

Gastrointestinal

Assess Bowel Sounds

1
2
3

Bowel Obstruction

1
2
3

Stool Test

1
2
3

Cleft Lip / Cleft Palate

1
2
3

Respiratory / Cardiac Emergencies and Arrests

1
2
3

Post-abdominal Surgery

1
2
3

Colostomy / Ileostomy

1
2
3

GI Bleeding

1
2
3

Feeding Dysfunction

1
2
3

Major Birth Defects

1
2
3

Neurological

Management of Neonate w/ Seizures

1
2
3

Management of Neonate under Sedation

1
2
3

Assess Neurological Status

1
2
3

Assess Hearing

1
2
3

Assess Eyes

1
2
3

Assess Pain

1
2
3

Brain Death / Organ Procurement

1
2
3

Spina Bifida

1
2
3

Meningitis

1
2
3

Other

Parent / Infant Bonding

1
2
3

Consents - Procedural / Treatment

1
2
3

Consents - Immunization

1
2
3

Preoperative Care

1
2
3

Postoperative Care

1
2
3

Discharge Training

1
2
3

Bereavement / Postmortem Care

1
2
3

Age Specific Skills

Newborn (Birth - 30 days)

1
2
3

Infant (30 days - 1 year)

1
2
3

Toddler (1 - 3 years)

1
2
3

School Age (5 - 12 years)

1
2
3

Adolescents (12 - 18 years)

1
2
3

Young Adults (18 - 39 years)

1
2
3

Middle Adults (39 - 64 years)

1
2
3

Older Adults (64 & Older)

1
2
3