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Labor and Delivery RN

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.

  • 0 = Not Applicable
  • 1 = No Experience
  • 2 = Some Experience
  • 3 = Intermittent Experience
  • 4 = Experienced
  • 5 = Very Experienced
*Required
n/a
1
2
3
4
5

* Required

Age of Patients Cared For

Newborn/Neonate (birth to 30 days)*

Infant (1 month to 1 year)*

Toddler (1 year to 3 years)*

Preschooler (3 years to 5 years)*

School Age Child (5 years to 12 years)*

Adolescents (12 years to 18 years)*

Young Adults (18 years to 39 years)*

Middle Adults (39 years to 64 years)*

Older Adults (64 years to 79 years)*

Elderly Adults (over 79+ years)*

General Skills

Patient and Family Teaching*

Coaching Needs*

Universal Precautions*

Isolation Precautions*

Care of the Patient in restraints*

Cardiac Monitoring*

Pulse Oximetry*

Ventilator Management (Adult)*

Ventilator Management (Newborn)*

Prep and Administration of Emergency Meds*

Infant/ Neonatal Cardiac/ Respiratory Arrest*

Adult Cardiac/ Respiratory Arrest*

End of Life Care*

Fetal Monitoring- Basic*

Fetal Monitoring- Advanced*

IV Therapy*

Administration of Blood/ Blood Products.*

Knowledge of Normal Lab Values*

Newborn*

Labor Patient*

Pain Management*

Automated Med Dispensing System*

Electronic Documentation*

Care of Patients with Pre-Existing Conditions/High Risk OB

Cardiac Disease*

Neurological Disease*

Seizure Disorder*

Chronic Diabetes Mellitus*

Pregnancy Induced Diabetes Mellitus*

Asthma*

Chronic Hypertension*

Gestational Hypertension*

Infectious Disease*

HBV*

HIV*

Sickle Cell Disease*

RH Incompatibilities*

Hemolytic Anemia*

Collagen Vascular Disease*

Hemorrhage*

Drug Addiction/ Withdrawal*

Pyelonephritis*

Abruptio Placenta*

Placenta Previa*

Placenta Acreta*

Preeclampsia*

Eclampsia*

Premature Labor*

Malpresentations*

Breech*

Transverse Lie/ Shoulder*

Face Presentation*

Brow Presentation*

Multiple Gestation*

PROM*

Chorioamnionitis*

Poly/ Oligohydramnios*

Prior Tubal Ligation*

VBAC Management/ Trial of Labor*

Uterine Rupture*

Incompetent Cervix (Shirodkar Suture/ Cerclage)*

Spontaneous Abortions- Complete/ Incomplete*

Intrauterine Growth Restriction (IUGR)*

Postdate Pregnancy*

HELLP Syndrome*

DIC*

Fetal Demise*

Antepartum

Triage of Obstetrical Patients*

Assessment of Birth Plan*

Perform Admission Risk Assessment*

Non- Stress Test (NST)*

Induction of Labor*

Oxytocin Challenge Tests (OCT)*

Biophysical Profile*

Assist with Sonogram*

Perform Sonogram*

Assist with Amniocentesis*

Normal Perinatal Vital Signs*

Deep Tendon Reflex Checks (DTR’s)*

Edema Assessment*

Clonus*

Assess for Comfort*

Breathing/ Relaxation Techniques*

Coaching*

Positioning*

Medications

Ritodrine*

Magnesium Sulfate*

Terbutaline*

Indomethacin*

Procardia*

Pitocin*

Oxytocin*

Cervidil*

Cytotec*

Prostin Suppositories*

Assist with Prostin Gel*

Antibiotics*

Antihypertensives*

Heparin*

Stadol*

Nubain*

Morphine*

Demerol*

Fentanyl*

Insulin Drips*

Insulin Pumps*

Insulin SC*

AZT/ Other Antiviral Medications*

Rhogam*

IV Therapy/Procedures

Starting PIV’s*

PICC Lines- Care and Maintenance*

Central Venous Lines- Care and Maintenance*

Invasive Hemodynamic Monitoring*

Blood Draw from PICC/ CVL*

Administration of Blood/ Blood Products*

IV Infusion Pumps*

Blood/ Fluid Warmers*

Labor Assessment/Procedures: Maternal

Normal Vital Signs- Baseline*

Identify Common Cardiac Arrhythmias*

Assist with Sterile Speculum Exam*

Perform Sterile Speculum Exam*

Vaginal Exam- Manual*

Status of Membranes*

Assist with Rupture of Membranes*

Fern Test*

Nitrazine*

Presence of Clonus*

DTR’s*

Edema*

Progression Of Labor*

Dilation*

Effacement*

Fetal Position*

Fetal Presentation*

Station*

Contraction Characteristics*

Determination of Fetal Head Position*

Documentation of Labor Status and Interventions*

Labor Suppressants*

Collection of Blood Specimens*

Collect Urine Specimens*

Toxicology Studies*

Collect Vaginal Cultures*

Fluid*

Herpes*

Chlamydia*

Group B Strep*

Perform Leopold’s Maneuvers*

Amnioinfusion (assist or perform) for:

Variable Decelerations*

Meconium*

Prolapsed Cord*

Vasa Previa*

Catheter Insertion

Straight Cath*

Foley*

Labor Assessment/Procedures: Fetal

Fetal Heart Rate- Doppler*

Fetal Heart Rate- Auscultate*

Document Fetal Position*

Fetal Heart Rate Patterns: Identify & Treat Baseline

Variability*

Variable Decelerations*

Early Decelerations*

Late Decelerations*

Prolonged Decelerations*

External Fetal Monitor Application*

Internal Fetal Monitor Application (Assist)*

Internal Fetal Monitor Application (Perform)*

Spiral Electrode*

Intrauterine Pressure Catheter (IUPC)

Placement*

Calibration*

Fluid Filled*

Transducer Tipped*

Delivery/C-Section

Assist with Vaginal Delivery*

Forceps Extraction*

Vacuum Extraction*

Assist with High Risk Delivery*

Shoulder Dystocia*

Hemorrhage/ Shock*

Emergency Delivery*

Abdominal Shave/ Scrub Prep*

Perineal Prep*

Circulate for C-Section*

Scrub for C-Section*

Patient with General Anesthesia*

Patient with Epidural Anesthesia*

Circulate with Tubal Ligation*

Scrub for Tubal Ligation*

Assist with Placenta Delivery*

Fundus Massage*

Assist with Cervical Laceration Repair*

Assist with Uterine Laceration Repair*

Assist with Episiotomy Repair*

Immediate Care of Newborn in Delivery Room

Newborn Assessment

Ballard*

Dubowitz*

Finnegan/ Abstinence Scoring*

Apgar Scores*

Initial Vital Signs*

Bulb Suctioning*

Delee Suctioning*

Wall Suctioning*

Meconium Aspiration*

Collect Cord Samples*

Assist with UAC/ UVC Insertion*

Insertion of IV, Including Scalp IV*

Radiant Warmer/ Thermoregulation*

Interventions for LGA, SGA, IUGR*

Interventions for Infant of Diabetic Mother*

Oxygen Administration*

Bag/ Mask Ventilation of the Newborn*

Assist with Intubation*

Transport Isolette*

Heelstick Glucose*

Eye Prophylaxis*

Vitamin K*

Hepatitis B*

ID/ Security Banding*

Promote Bonding Behaviors*

Lead Placement for Cardiac Monitor*

Apnea Monitoring*

Oxyhood*

Postpartum Care

Fundal Height*

Fundal Massage*

Lochia*

Episiotomy Care*

Perineum Care*

Maternal Vital Signs*

Recovering Post-Op C-Section Patients*

Recovering Post-Op Tubal Ligation Patient*

Fluid Balance*

Assessment for DVT*

Breast Care*

Breastfeeding*

Newborn Care

Cord Care*

Newborn Vital Signs*

Assist with Breastfeeding

Latch On*

Positioning*

Care of Infants With

Cardiac Anomalies*

Drug Addiction/ Withdrawal*

Cystic Fibrosis*

Meconium Aspiration*

Pneumonia*

Pulmonary Edema*

RDS*

NEC*

Neuromuscular Disease*

Spina Bifida*

Seizure Activity*

Tracheoesophageal Fistula*

Sepsis*

Sickle Cell Disease*

Low Birth Weight Infants*

Pain Management/Anesthesia

Assess Pain Level*

Assess Acceptable Level of Pain*

Intranasal Pain Medications*

Oral Pain Medications*

IV Pain Medications*

PCA*

IV Conscious Sedation*

Epidural Pain Management*

Intervention for Anesthesia Toxicity*

Assist with Epidural Insertion

Positioning of Patient*

Signs of Dural Puncture*

Fluid Challenge*

Hypotension*

Intrathecal Narcotics*

Misc.

Experience with ventilators?**

Experience with cardiac monitors?*

NRP current?*

STABLE current?*

Fetal monitoring course - basic?*

Fetal monitoring course - intermediate?*

Fetal monitoring course - advanced?*

My experience is mostly in… (list number of years in each setting)

Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

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