Skill Checklists
Pediatric Intensive Care Unit
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
PICU
Pediatric CVICU
Pediatric Step Down
Pediatric PACU
Congenital Heart Disease/Repair
Post Cardiac Surgery (Directly from OR)
Post Cardiac Surgery (NOT Directly from OR)
Post Diagnostic/Interventional Cardiac Cath
Heart Failure/Cardiogenic Shock
Cardiac Transplant
Hemodynamic Monitoring
Arrhythmia Interpretation
Pacemaker - Temporary/Permanent
SVO2 Monitoring
Intra-Aortic Balloon Pump
ECMO
Respiratory Distress Syndrome/Resp. Failure
Reactive Airway Disease
ENT Surgery
Epiglottis
Cystic Fibrosis
Tuberculosis
Intubation/Extubation
Endotracheal Tube Management
Tracheostomy Management
Modes of Ventilation: AC/PC/SIMV/CPAP
Modes of Ventilation: Jet/Oscillator
Nitric Oxide
Hemo/Pneumothorax
Brain Injury
Craniotomy
Spinal Cord Injury
Seizure Disorders
ICP Monitoring
VP Shunt
Meningitis
Neuromuscular Disease
Post Vertebral Surgery
Traction - General
Traction - Halo
Acute Surgical Abdomen
GI Bleeding
Pancreatitis
Hepatic Failure
Ostomy Management
Management of Gastric Tubes
Breast Milk Handling/Storage
Nephrotic Syndrome
Renal Transplant
Renal Replacement Therapy
Peritoneal Dialysis
Diabetes - Hypo/Hyperglycemic Crisis
Diabetic Ketoacidosis
IV Insulin Pumps
Indwelling Insulin Pumps
Blunt/Penetrating Trauma
Burns
Craniofacial Reconstruction
Near Drowning
Poison Ingestion/Overdose
Bites-Animal/Snake/Human
Suicide Precautions
Wound Management/VAC
Specialty Beds
Bone Marrow Transplant
Immunosuppressive Disorder
Hemophilia Crisis
Sickle Cell Crisis
Pediatric Dosage Calculations
Anti-Arrhythmics
Anticoagulants (IV, Oral and Injection)
Anti-Hypertensives
Anti-Seizure Medications
Benzodiazepines
Continuous IV Paralytics
Continuous IV Sedation
Procedural Sedation - Administration
Diuretics
Emergency Medication
Inhaled Medications
Insulin
IV Vasopressors
Narcotics/Opioid Analgesics (IV, Oral and Injection)
Non-Opioid Analgesics (IV, Oral and Injection)
Reversal Agents
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Starting Ivs
Central Line Blood Draw
Central Line/Implanted Line Care
TPN/Lipids
Blood Product Administration
Administration of Chemotherapy
Dysrhythmia Interpretation
Dysrhythmia Management
Management of Cardiac Arrest
Shock Management
Malignant Hyperthermia
Multisystem Organ Failure
National Patient Safety Goals/Core Measures
Recognize/Report Signs of Abuse
EMTALA
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Normal Growth and Development
Age Specific/Population Based Care
Patient Family Teaching
Isolation Precautions
Infection Prevention
Reporting Communicable Diseases
Pain Assessment And Management
Charge Experience
Interpretation and Communication of Lab Values
Infant (Birth - 1 year
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
Epic
Cerner
Eclipsys(RSV)
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
EMR Conversion
BLS
PALS
ACLS
PEARS
ENPC
CEN
TNCC
Other: Specify
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
