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Skills Assessment - LD/LDRP
 
The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.
 
First Name:
Middle Initial:
Last Name:
SSN: - -
E-mail Address:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
City:
State:
 
 
0. Theory, no practice   1. Limited   2. Confident   3. Very Confident
 
Labor and Delivery: Experience:
Assist with vaginal delivery 0   1   2   3  
Assist with forceps vaginal delivery 0   1   2   3  
Emergency delivery 0   1   2   3  
Assist with high risk delivery 0   1   2   3  
Assist with vacuum delivery 0   1   2   3  
Circulate for C-section 0   1   2   3  
Abdominal shave/perineal prep/scrub prep 0   1   2   3  
Internal monitor, lead connection and calibration 0   1   2   3  
Assist with placement of intrauterine pressure cathter 0   1   2   3  
Assist with fetal scalp blood sampling 0   1   2   3  
Sterile vaginal exams 0   1   2   3  
Fundal assessment/height 0   1   2   3  
Use of Doppler/fetoscope 0   1   2   3  
Interpretation of fetal monitoring 0   1   2   3  
Identify FHR Patterns 0   1   2   3  
Care of Patient in premature labor 0   1   2   3  
Care of Patient with pregnancy induced hypertension 0   1   2   3  
Care of Patient with preeclampsia 0   1   2   3  
Care of Patient with multiple gestation 0   1   2   3  
Care of Patient with placenta previa 0   1   2   3  
Care of Patient with abruptio placenta 0   1   2   3  
Care of Patient with malpresentations 0   1   2   3  
Care of Patient with diabetes mellitus 0   1   2   3  
Care of Patient with drug addiction/withdrawal 0   1   2   3  
Care of Patient with HIV 0   1   2   3  
Care of Patient with RH incompatibilities 0   1   2   3  
Administration of Pitocin 0   1   2   3  
Administration of magnesium sulfate therapy 0   1   2   3  
Administration of insulin drips 0   1   2   3  
Administration of labetalol 0   1   2   3  
 
Immediate Care of Baby in the Delivery Room:
Apgar scored 0   1   2   3  
Suctioning 0   1   2   3  
Eye prophylaxis 0   1   2   3  
Collect cord samples 0   1   2   3  
 
Postpartum Care:
Fundus consistency 0   1   2   3  
Lochia 0   1   2   3  
Bladder distention 0   1   2   3  
Episiotomy 0   1   2   3  
Post-op C-Section 0   1   2   3  
Postpartum assessment 0   1   2   3  
Breastfeeding assistance 0   1   2   3  
Care of Patient with diabetes mellitus 0   1   2   3  
Care of Patient with sickle cell disease 0   1   2   3  
Care of Patient with infectious disease 0   1   2   3  
Care of Patient with cardiac disease 0   1   2   3  
Care of Patient with neurological disease 0   1   2   3  
Care of Patient with tubal irrigation 0   1   2   3  
 
Newborn Care In Delivery Room:
Transfer to newborn nursery 0   1   2   3  
Obtain specimen for UAC and UVC 0   1   2   3  
Radiant warmers 0   1   2   3  
Apnea monitoring 0   1   2   3  
Cord Care 0   1   2   3  
Transfer to Neonatal ICU 0   1   2   3  
Neonatal resuscitation 0   1   2   3  
 
Pain Management and Anesthesia:
Assessment of pain level/tolerance 0   1   2   3  
Care of the patient with Epidural anesthesia/analgesia 0   1   2   3  
Care of the patient with IV conscious sedation 0   1   2   3  
Care of the patient with Patient controlled analgesia (PCA pump) 0   1   2   3  
 
Age-Specific Practice Criteria:
Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Newborn/Neonate (birth - 30 days)  
Infant (30 days-1year)  
Toddler (1 - 3 years)  
Preschooler (3 - 5 years)  
School age children (5-12 years)  
Adolescents (12-18 years)  
Young adults (18-39 years)  
Middle adults (39-64 years)  
Older adults (64+)  
 
Experience With Age Groups:
Calculate body weight to verify correct dosing of medication 0   1   2   3  
Assess immunization status for pediatric, and adolescent 0   1   2   3  
Set age-appropriate short-term and long-term goals in care planning 0   1   2   3  
Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years 0   1   2   3  
 
 
 
 


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