CYNET_SYSTEMS_MAIN_LOGO.gif   REGISTERED NURSE POST PARTUM 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  
Couplet Care  
Antepartum  
Postpartum  
Newborn Nursery  
LDRP  
Rating Stars (Click) POST PARTUM 1 2 3 4  
Vaginal Deliver  
Cesarian Section  
Anesthesia - General  
Anesthesia - Local  
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  
Tubal Ligation  
Rating Stars (Click) ANTEPARTUM 1 2 3 4  
Amniocentesis  
Cardiac Disorders  
Diabetes  
Hyperemesis  
Multiple Gestation  
Non-Stress Test  
PIH/HELLP  
Placenta Previa/Abruptio  
Post- Trauma  
Pre-Term Labor/Premature Rupture of Membranes  
Substance Abuse  
FHM Interpretaton and Management  
Fetal Assessment  
Labor Assessment  
Assist with Ultrasound  
Rating Stars (Click)  MEDICATIONS 1 2 3 4  
Antibiotics/Antivirals  
Antihypertensives  
Antiseizure  
Cervical Ripening Agents  
Immunizations - Mother  
Insulin  
Magnesium Sulfate  
Methergine  
Opioids and Reversal Agents  
Pitocin  
Terbutaline  
Rating Stars (Click) IV THERAPY 1 2 3 4  
Starting Ivs  
IV Management  
Blood Product Administration  
Rating Stars (Click) NEWBORN CARE 1 2 3 4  
Newborn Assessment  
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  
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  
Pressure Ulcer Risk Assessment/Prevention  
Restraints/Use of Least Restrictive Device  
Parent/Family Teaching  
Age Specific/Population-Based Care  
Isolation Precautions  
Infection Prevention  
Pain Assessment & Management - Adult  
Pain Assessment & Management - Neonate  
Charge Experience  
Interpretation and Communication of Lab Values  
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 Specific Competencies 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)  
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  
CERTIFICATIONS Expiry Date :   
BLS  
NRP  
AWHONN FHM - Intermediate  
AWHONN FHM - Advanced  
Lactation Consultant - IBCLC  
S.T.A.B.L.E  
  Other: Specify   
  Other: Specify   
  FHM - Other Specify