REGISTERED NURSE LABOR AND DELIVERY CHECKLIST

		REGISTERED NURSE LABOR AND DELIVERY CHECKLIST
NAME

LAST 4 OF SSN

DATE

	I hereby certify that ALL information I have provided to IMCS Group 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.

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

Rating Stars (Click)	WORK SETTINGS		1	2	3	4
	L and D
	LDRP
	Antepartum
	Mother Baby
Rating Stars (Click)	ANTEPARTUM		1	2	3	4
	Diabetes
	Fetal Demise
	HELLP Syndrome
	Hyperemesis
	Immunologic Disorder
	Infectious Disease
	Multiple Gestation
	Placenta Previa/Abruptio
	Pre-Term Labor
	Premature Rupture of Membranes
Rating Stars (Click)	SPECIAL PROCEDURES		1	2	3	4
	Conduct Stress Test
	Conduct Non-Stress Test
	Assist with External Version
	Assist with Umbilical Blood Sampling
	Use of Nitrazine/Fern Test
Rating Stars (Click)	PAIN MANAGEMENT		1	2	3	4
	Epidural Anesthesia
	General Anesthesia
	Spinal Anesthesia
	Response to Pain Management
Rating Stars (Click)	FETAL MONITORING		1	2	3	4
	External
	IUPC Placement/Monitoring
	Spiral Electrode Placement
	Identify, Document & Treat Abnormal FHR Patterns
Rating Stars (Click)	LABOR MANAGEMENT		1	2	3	4
	Auscultate Fetal Heart Tones
	Determine Fetal Position
	Assess Contraction Characteristics
	Assess Status of Membranes
	Assess Station/Dilation/Effacement
	Positioning
	Leopold's Maneuver
	Assess for Reflexes/Clonus
	Bladder Catheterization
	Amnioinfusion (Assist or Perform)
	Recognize Complications of AROM
Rating Stars (Click)	DELIVERY MANAGEMENT		1	2	3	4
	Delivery Table Set Up
	Circulate Vaginal Delivery
	Circulate C - Section
	Scrub C - Section
Rating Stars (Click)	NEONATAL MANAGEMENT		1	2	3	4
	Radiant Warmer
	APGAR Scores
	Neonatal Vital Signs
	Neonatal Resuscitation
	Naso/Oropharyngeal Suctioning
	Bulb Syringe Suction
Rating Stars (Click)	COMPLICATIONS		1	2	3	4
	Placenta Previa/Abruptio
	Asthma
	Cardiac Disease
	Chorioamnionitis
	Diabetes
	Pregnancy Induced Hypertension
	HELLP
	Hemolytic Anemia
	Hemorrhage
	HIV Positive
	HBV Disease
	Malpresentations
	Multiple Gestation
	Pre-Term Labo
	Fetal Demise
	Rh Disease
Rating Stars (Click)	POST PARTUM CARE		1	2	3	4
	Vaginal Delivery
	Cesarean Section
	Anesthesia - General
	Anesthesia - Spinal
	Bladder Distention
	Breast Milk Collection and Storage
	Breast Pump
	Breastfeeding - Latch Score
	Breastfeeding - Supplemental Feeding
	Breastfeeding Support
	Contraceptive Education
	Epidural/PCA
	Homan's Sign
	Multiple Births
	Parent/Infant Interaction/Attachment
	Post Partum Hemorrhage
	Pregnancy Induced Hypertension
Rating Stars (Click)	MEDICATIONS		1	2	3	4
	Antibiotics/Antivirals
	Antihypertensives
	Antiseizure
	Betamethasone
	Insulin
	Magnesium Sulfate
	Methergine
	Opioids and Reversal Agents
	Pitocin
	Terbutaline
Rating Stars (Click)	IV THERAPY		1	2	3	4
	Start Ivs
	IV Management
	Blood Product Administration
Rating Stars (Click)	NEWBORN CARE		1	2	3	4
	Newborn Assessment
	Infant Vital Signs
	Ballard Scale/Dubowitz
	Car Seat Education
	Circumcision Care/Teach to Parents
	Cord Care/Teach to Parents
	Immunizations - Infant
	Infant Caretaking Skills
	Infant Identification and Security
	Metabolic Screen
	Jaundice/Bilirubin
	Phototherapy
	Thermoregulation
Rating Stars (Click)	PROFESSIONAL KNOWLEDGE AND SKILLS		1	2	3	4
	National Patient Safety Goals/Core Measures
	Experience in a "Baby Friendly" Facility
	Fall Risk Assessment/Prevention
	Restraints/Use of Least Restrictive Device
	Parent/Family Teaching
	Age Specific/Population-Based Care
	Isolation Precautions
	Infection Prevention
	Charge Experience
	Interpretation and Communication of Lab Values
Rating Stars (Click)	EMR		1	2	3	4
	Epic
	Cerner
	Eclipsys
	McKesson
	Meditech
	Other Computerized System
	Computerized Physician Order Entry
	Bar Coding for Medication Administration
	EMR Conversion
MY EXPERIENCE IS PRIMARILY IN:
Unit	No. of Years	Unit	No. of Years
BURN		POST PARTUM
CRITICAL UNIT		LABOR & DELIVERY
PACU		NEWBORN NURSERY
NEUROLOGY		LEVEL II NICU
TELEMETRY		LEVEL III NICU
MEDICAL		PICU
SURGICAL		PEDIATRICS
ONCOLOGY		OB/GYN
ORTHOPEDICS		PSYCHIATRY
OPERATING ROOM		RRT
EMERGENCY ROOM		CRT
TRAUMA CENTER LEVEL 1
COMMUNITY ER
RURAL ER
Rating Stars (Click)	AGE APPROPRIATE CARE		1	2	3	4
	Newborn/Neonatal (birth – 30 days)
	Infant (30 days-1 year)
	Toddler (1-3 years)
	Preschool (3-5 years)
	School Age Children (5-12 years)
	Adolescent (12-17 years)
	Young Adults (18-44 years)
	Middle Adults (45-64 years)
	Older Adults (>65 years)
CERTIFICATIONS			Expiry Date :
	BLS
	NRP
	S.T.A.B.L.E.
	ACLS
	AWHONN FHM Intermediate
	AWHONN FHM Advanced
	NCC - EFM
	Other: Specify