Pediatric ICU Skills Checklist

Skills Checklist

Let’s assess your clinical skills and experience. Fill out this checklist to get one step closer to your next opportunity.

1

= No theory and/or experience
2

= Limited Experience
3

= Experienced/minimal support needed to perform
4

= Proficient

Age of Patients Cared For
Newborn/Neonate (birth to 30 days)*
- 1
- 2
- 3
- 4
Infant (1 month to 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 year to 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 years to 5 years)*
- 1
- 2
- 3
- 4
School Age Child (5 years to 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 years to 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 years to 39 years)*
- 1
- 2
- 3
- 4
General Skills
Standard Precautions*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 1
- 2
- 3
- 4
Pediatric Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
Adult Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
Crash Carts*
- 1
- 2
- 3
- 4
Defibrillators*
- 1
- 2
- 3
- 4
Care of Patient Restraints*
- 1
- 2
- 3
- 4
Automated Med Dispensing Systems*
- 1
- 2
- 3
- 4
List Types:
Automated Med Dispensing Systems*
- 1
- 2
- 3
- 4
List Types:
Care Planning & Discharge Planning*
- 1
- 2
- 3
- 4
Patient/Family Education*
- 1
- 2
- 3
- 4
Electronic Documentation*
- 1
- 2
- 3
- 4
List Types:
Patient Head to Toe Assessment*
- 1
- 2
- 3
- 4
Cardiovascular General Skills
Auscultation (rate, rhythm, volume)*
- 1
- 2
- 3
- 4
Blood Pressure/Invasive (arterial line)*
- 1
- 2
- 3
- 4
Heart Sounds/Murmurs*
- 1
- 2
- 3
- 4
Perfusion*
- 1
- 2
- 3
- 4
Central Venous Pressure*
- 1
- 2
- 3
- 4
INVASIVE HEMODYNAMIC MONITORING:
Interpretation of Lab Results - CBC/Electrolytes*
- 1
- 2
- 3
- 4
Defibrillation/Cardiover*
- 1
- 2
- 3
- 4
EKG Interpretation (Basic and Advanced)*
- 1
- 2
- 3
- 4
CARDIOVASCULAR - CARE OF THE CHILD WITH:
Bacterial Endocarditis*
- 1
- 2
- 3
- 4
Congenital heart Disease / Defects Cardiac Arrest*
- 1
- 2
- 3
- 4
Cardiac Transplant*
- 1
- 2
- 3
- 4
Cardiogenic Shock*
- 1
- 2
- 3
- 4
Cardiomyopathy*
- 1
- 2
- 3
- 4
Hypovolemic Shock*
- 1
- 2
- 3
- 4
Myocarditis*
- 1
- 2
- 3
- 4
Post Cardiac Surgery*
- 1
- 2
- 3
- 4
Post Interventional Cardiac Cath*
- 1
- 2
- 3
- 4
MEDICATIONS KNOWLEDGE AND USE OF
Dobutamine (Dobutrex)*
- 1
- 2
- 3
- 4
Dopamine (Intropin)*
- 1
- 2
- 3
- 4
Epinephrine (Adrenalin)*
- 1
- 2
- 3
- 4
Nipride (Nitroprusside)*
- 1
- 2
- 3
- 4
Nitroglycerine (Tridil)*
- 1
- 2
- 3
- 4
Sodium Bicarbonate*
- 1
- 2
- 3
- 4
Antiarrhythmics*
- 1
- 2
- 3
- 4
RESPIRATORY GENERAL SKILLS
Breath Sounds/Work of Breathing*
- 1
- 2
- 3
- 4
OBTAINING BLOOD GASES:
Arterial*
- 1
- 2
- 3
- 4
Heelstick*
- 1
- 2
- 3
- 4
Peripheral*
- 1
- 2
- 3
- 4
Interpretation of ABG's*
- 1
- 2
- 3
- 4
Oximeter*
- 1
- 2
- 3
- 4
AIRWAY MANAGEMENT
Assist with Intubation*
- 1
- 2
- 3
- 4
Assist with Extubation*
- 1
- 2
- 3
- 4
SUCTIONING
Bulb Syringe*
- 1
- 2
- 3
- 4
Nasal Airway/Suctioning*
- 1
- 2
- 3
- 4
Oral Airway/Suctioning*
- 1
- 2
- 3
- 4
In-Line Suction*
- 1
- 2
- 3
- 4
Open ET Catheter Suction*
- 1
- 2
- 3
- 4
Apnea Monitor*
- 1
- 2
- 3
- 4
Tracheostomy/Suctioning*
- 1
- 2
- 3
- 4
Chest Physiotherapy*
- 1
- 2
- 3
- 4
CHEST TUBE (ASSIST WITH):
Insertion*
- 1
- 2
- 3
- 4
Removal*
- 1
- 2
- 3
- 4
ECMO (Extracorporeal Membrane Oxygenation)*
- 1
- 2
- 3
- 4
End Tidal CO2*
- 1
- 2
- 3
- 4
O2 THERAPY
Nasal Cannula*
- 1
- 2
- 3
- 4
Bag & Mask*
- 1
- 2
- 3
- 4
Isolette*
- 1
- 2
- 3
- 4
Oxyhood*
- 1
- 2
- 3
- 4
Tent*
- 1
- 2
- 3
- 4
Trach Collar*
- 1
- 2
- 3
- 4
Thoracentesis*
- 1
- 2
- 3
- 4
VENTILATORS
CPAP/PEEP/BIPAP*
- 1
- 2
- 3
- 4
High Frequency Jet Ventilator*
- 1
- 2
- 3
- 4
Home Ventilator*
- 1
- 2
- 3
- 4
IMV*
- 1
- 2
- 3
- 4
Pressure Ventilator*
- 1
- 2
- 3
- 4
Volume Ventilator*
- 1
- 2
- 3
- 4
Weaning*
- 1
- 2
- 3
- 4
RESPIRATORY - CARE OF CHILD WITH:
Bronchiolitis (RSV)*
- 1
- 2
- 3
- 4
Pneumonia*
- 1
- 2
- 3
- 4
Croup*
- 1
- 2
- 3
- 4
Chronic Respiratory Disease*
- 1
- 2
- 3
- 4
Status Asthmaticus*
- 1
- 2
- 3
- 4
Lung Transplant*
- 1
- 2
- 3
- 4
Epiglottitis*
- 1
- 2
- 3
- 4
Fresh Tracheostomy*
- 1
- 2
- 3
- 4
Foreign Body Aspiration*
- 1
- 2
- 3
- 4
Flail Chest*
- 1
- 2
- 3
- 4
Hemothorax*
- 1
- 2
- 3
- 4
Pneumothorax*
- 1
- 2
- 3
- 4
Respiratory Distress Syndrome (RDS)*
- 1
- 2
- 3
- 4
Respiratory Failure*
- 1
- 2
- 3
- 4
MEDICATIONS KNOWLEDGE AND USE OF
Steroids*
- 1
- 2
- 3
- 4
Bronchodilators*
- 1
- 2
- 3
- 4
Racemic Epinephrine*
- 1
- 2
- 3
- 4
NEURO GENERAL SKILLS
Glasgow Coma Scale*
- 1
- 2
- 3
- 4
Neurological Status*
- 1
- 2
- 3
- 4
Assist with Lumbar Puncture*
- 1
- 2
- 3
- 4
Seizure Precautions*
- 1
- 2
- 3
- 4
Intracranial Pressure Monitoring*
- 1
- 2
- 3
- 4
NEURO - CARE OF CHILD WITH:
Head Trauma*
- 1
- 2
- 3
- 4
Post Neurosurgery*
- 1
- 2
- 3
- 4
Spinal Cord Injury*
- 1
- 2
- 3
- 4
Status Epilepticus*
- 1
- 2
- 3
- 4
Coma*
- 1
- 2
- 3
- 4
Brain Death/Organ Procurement*
- 1
- 2
- 3
- 4
Encephalitis*
- 1
- 2
- 3
- 4
Meningitis*
- 1
- 2
- 3
- 4
Externalized VP Shunt/Reservoirs*
- 1
- 2
- 3
- 4
Neuromuscular Disease*
- 1
- 2
- 3
- 4
MEDICATIONS KNOWLEDGE AND USE OF
Mannitol*
- 1
- 2
- 3
- 4
Sedatives*
- 1
- 2
- 3
- 4
Anticonvulsants*
- 1
- 2
- 3
- 4
GASTROINTESTINAL GENERAL SKILLS
Abdominal Assessment*
- 1
- 2
- 3
- 4
Interpretation of Lab Results - Serum Electrolytes*
- 1
- 2
- 3
- 4
Feedinggs (Storage and Prep of)*
- 1
- 2
- 3
- 4
Bottle*
- 1
- 2
- 3
- 4
Breast*
- 1
- 2
- 3
- 4
Gavage*
- 1
- 2
- 3
- 4
TPN*
- 1
- 2
- 3
- 4
PPN*
- 1
- 2
- 3
- 4
GASTROSTOMY/BUTTON
J-Tubes*
- 1
- 2
- 3
- 4
NG to Suction*
- 1
- 2
- 3
- 4
Placement of Naso/Orogastric Tube*
- 1
- 2
- 3
- 4
Test for Occult Blood*
- 1
- 2
- 3
- 4
GASTROINTESTINAL - CARE OF CHILD WITH:
Anal Fissure*
- 1
- 2
- 3
- 4
Cleft Lip/Palate*
- 1
- 2
- 3
- 4
New Colostomy*
- 1
- 2
- 3
- 4
New Ileostomy*
- 1
- 2
- 3
- 4
Diaphragmatic Hernia*
- 1
- 2
- 3
- 4
Severe Failure to Thrive (FTT)*
- 1
- 2
- 3
- 4
Pyloric Stenosis Repair*
- 1
- 2
- 3
- 4
GE Reflux*
- 1
- 2
- 3
- 4
GI Bleeding*
- 1
- 2
- 3
- 4
Crohn's Disease*
- 1
- 2
- 3
- 4
Ulcerative Colitis*
- 1
- 2
- 3
- 4
Intestinal Parasites*
- 1
- 2
- 3
- 4
Severe Gastroenteritis/Dehydration*
- 1
- 2
- 3
- 4
Necrotizing Enterocolitis (NEC)*
- 1
- 2
- 3
- 4
Surgical Abdomen*
- 1
- 2
- 3
- 4
Liver Transplant*
- 1
- 2
- 3
- 4
Small Bowel Transplant*
- 1
- 2
- 3
- 4
MEDICATIONS KNOWLEDGE AND USE OF
Antiemetics*
- 1
- 2
- 3
- 4
RENAL/GENITOURINARY GENERAL SKILLS
Interpretation Of Lab Results (UA/BUN/Creatinine)*
- 1
- 2
- 3
- 4
Glucose*
- 1
- 2
- 3
- 4
Test Urine and Interpret*
- 1
- 2
- 3
- 4
Labstix*
- 1
- 2
- 3
- 4
Occult Blood*
- 1
- 2
- 3
- 4
pH*
- 1
- 2
- 3
- 4
Specific Gravity*
- 1
- 2
- 3
- 4
COLLECTION OR URINE SPECIMENS
Assist with Suprapubic Tap*
- 1
- 2
- 3
- 4
Catheter*
- 1
- 2
- 3
- 4
Diaper / Bag*
- 1
- 2
- 3
- 4
Insertion & Care Of Straight And Foley Catheter*
- 1
- 2
- 3
- 4
Suprapubic*
- 1
- 2
- 3
- 4
RENAL/GENITOURINARY - CARE OF CHILD WITH:
Acute Renal Failure*
- 1
- 2
- 3
- 4
Peritoneal Dialysis*
- 1
- 2
- 3
- 4
CAVH*
- 1
- 2
- 3
- 4
Hemodialysis*
- 1
- 2
- 3
- 4
Hemolytic Uremic Syndrome (HUS)*
- 1
- 2
- 3
- 4
Nephritis*
- 1
- 2
- 3
- 4
Nephrotic Syndrome*
- 1
- 2
- 3
- 4
Renal Transplant*
- 1
- 2
- 3
- 4
Syndrome Inappropriate ADH (SIADH)*
- 1
- 2
- 3
- 4
ENDOCRINE / METABOLIC GENERAL SKILLS
Electrolyte Balance*
- 1
- 2
- 3
- 4
Blood Glucose Testing*
- 1
- 2
- 3
- 4
Knowledge of Lab work-Thyroid Studies*
- 1
- 2
- 3
- 4
ENDOCRINE/METABOLIC CARE OF CHILD WITH:
Diabetes Mellitus*
- 1
- 2
- 3
- 4
Diabetic Ketoacidosis*
- 1
- 2
- 3
- 4
Diabetic Coma*
- 1
- 2
- 3
- 4
Hyper/Hypocalcemia*
- 1
- 2
- 3
- 4
Hyperbilirubinemia*
- 1
- 2
- 3
- 4
Thyroid Dysfunction*
- 1
- 2
- 3
- 4
MEDICATIONS KNOWLEDGE AND USE OF
Insulin*
- 1
- 2
- 3
- 4
Thyroid Medications*
- 1
- 2
- 3
- 4
Growth Hormone*
- 1
- 2
- 3
- 4
ORTHOPEDICS GENERAL SKILLS
Specialized Orthopedic Bed*
- 1
- 2
- 3
- 4
ORTHOPEDICS - CARE OF CHILD WITH:
Cervical Traction*
- 1
- 2
- 3
- 4
Pinned Fractures*
- 1
- 2
- 3
- 4
Post Vertebral Surgery*
- 1
- 2
- 3
- 4
WOUND MANAGMENT
Assessment of Skin Status*
- 1
- 2
- 3
- 4
Stasis Ulcers*
- 1
- 2
- 3
- 4
Surgical Wound Healing*
- 1
- 2
- 3
- 4
Air Fluidized, Low Airloss Beds*
- 1
- 2
- 3
- 4
Sterile Dressing Changes*
- 1
- 2
- 3
- 4
Wound Care/Irrigations*
- 1
- 2
- 3
- 4
JP*
- 1
- 2
- 3
- 4
Penrose*
- 1
- 2
- 3
- 4
Hemovac*
- 1
- 2
- 3
- 4
BURNS
First Degree*
- 1
- 2
- 3
- 4
Second Degree*
- 1
- 2
- 3
- 4
Third Degree*
- 1
- 2
- 3
- 4
Pressure sores*
- 1
- 2
- 3
- 4
Staged Decubitus Ulcers*
- 1
- 2
- 3
- 4
Surgical Wounds with Drain(s)*
- 1
- 2
- 3
- 4
Traumatic Wounds*
- 1
- 2
- 3
- 4
ONCOLOGY GENERAL SKILLS
Reverse Isolation*
- 1
- 2
- 3
- 4
Nutritional Status*
- 1
- 2
- 3
- 4
INTERPRETATION OF LAB RESULT
Blood Chemistry*
- 1
- 2
- 3
- 4
Blood Counts*
- 1
- 2
- 3
- 4
ONCOLOGY - CARE OF CHILD WITH:
Malignant Tumors*
- 1
- 2
- 3
- 4
Fresh Oncologic Surgery*
- 1
- 2
- 3
- 4
Acute Tumor Lysis Syndrome*
- 1
- 2
- 3
- 4
Leukemia*
- 1
- 2
- 3
- 4
Bone Marrow Transplant*
- 1
- 2
- 3
- 4
Disseminated Intravascular Coagulation*
- 1
- 2
- 3
- 4
Inpatient Chemotherapy*
- 1
- 2
- 3
- 4
Radiation Implant*
- 1
- 2
- 3
- 4
MEDICATIONS KNOWLEDGE AND USE OF
Chemotherapeutic Agents*
- 1
- 2
- 3
- 4
INFECTIOUS DISEASES GENERAL SKILLS
Interpretation of Lab Results*
- 1
- 2
- 3
- 4
Cultures (Including Sensitivities)*
- 1
- 2
- 3
- 4
CBC/differential (shift)*
- 1
- 2
- 3
- 4
OBTAIN CULTURE SPECIMENS
Blood*
- 1
- 2
- 3
- 4
Swab*
- 1
- 2
- 3
- 4
Urine*
- 1
- 2
- 3
- 4
Sputum*
- 1
- 2
- 3
- 4
INFECTIOUS DISEASES - CARE OF CHILD WITH
Cytomegalovirus (CMV)*
- 1
- 2
- 3
- 4
HIV/AIDS*
- 1
- 2
- 3
- 4
Septic Shock*
- 1
- 2
- 3
- 4
Tuberculosis*
- 1
- 2
- 3
- 4
Hepatitis*
- 1
- 2
- 3
- 4
Common Childhood Communicable Diseases*
- 1
- 2
- 3
- 4
PHLEBOTOMY / IV THERAPY
Peripheral IV Insertion, Care and Maintenance*
- 1
- 2
- 3
- 4
Central Line Care and Maintenance*
- 1
- 2
- 3
- 4
PICC Line Care and Maintenance*
- 1
- 2
- 3
- 4
Drawing Blood from Central Line/PICC Line*
- 1
- 2
- 3
- 4
Drawing Venous Blood*
- 1
- 2
- 3
- 4
Administration of Blood/Blood Products*
- 1
- 2
- 3
- 4
Cryoprecipitate*
- 1
- 2
- 3
- 4
Packed Red Blood Cells*
- 1
- 2
- 3
- 4
Whole Blood*
- 1
- 2
- 3
- 4
PHLEBOTOMY / IV - CARE OF CHILD WITH:
Central Line*
- 1
- 2
- 3
- 4
Port-A-Cath*
- 1
- 2
- 3
- 4
PICC*
- 1
- 2
- 3
- 4
Cutdown Line*
- 1
- 2
- 3
- 4
Peripheral Line*
- 1
- 2
- 3
- 4
Arterial Line*
- 1
- 2
- 3
- 4
PAIN MANAGEMENT GENERAL SKILLS
Assessment - Pain Level Using Age Appropriate Scales*
- 1
- 2
- 3
- 4
PAIN MANAGEMENT - CARE OF CHILD WITH:
Epidural Analgesia*
- 1
- 2
- 3
- 4
PCA*
- 1
- 2
- 3
- 4
IV Conscious Sedation*
- 1
- 2
- 3
- 4
MEDICATION KNOWLEDGE AND USE OF
Analgesics*
- 1
- 2
- 3
- 4
Sedatives*
- 1
- 2
- 3
- 4
Reversal Agents*
- 1
- 2
- 3
- 4
MISCELLANEOUS
Normal Growth And Development*
- 1
- 2
- 3
- 4
Normal Laboratory Values*
- 1
- 2
- 3
- 4
Recognize Signs of Abuse or Neglect*
- 1
- 2
- 3
- 4
MISCELLANEOUS - CARE OF CHILD WITH:
Craniofacial Reconstruction*
- 1
- 2
- 3
- 4
Anorexia/Bulimia*
- 1
- 2
- 3
- 4
Depression*
- 1
- 2
- 3
- 4
HEENT Surgery*
- 1
- 2
- 3
- 4
Ingestion of Foreign Body*
- 1
- 2
- 3
- 4
Ingestion of Poison or Toxins*
- 1
- 2
- 3
- 4
Plastic Surgery*
- 1
- 2
- 3
- 4
Suicide Attempt*
- 1
- 2
- 3
- 4
Multiple Trauma*
- 1
- 2
- 3
- 4
Near Drowning*
- 1
- 2
- 3
- 4
MEDICATION ADMINISTRATION FOR CHILDREN
Calculation of Pediatric Doses*
- 1
- 2
- 3
- 4
Titration of IV Drips*
- 1
- 2
- 3
- 4
Eye/Ear Installations*
- 1
- 2
- 3
- 4
Metered Dose Inhaler*
- 1
- 2
- 3
- 4
Intravenous Medications (IV)*
- 1
- 2
- 3
- 4
Subcutaneous (SQ) Injections*
- 1
- 2
- 3
- 4
Z Track Injections*
- 1
- 2
- 3
- 4
Knowledge of Emergency Drug Action and Reaction*
- 1
- 2
- 3
- 4
Pediatric Drug Actions and Reactions*
- 1
- 2
- 3
- 4
YEARS OF EXPERIENCE IN EACH OF THE FOLLOWING PEDIATRIC AREAS
MEDICAL/SURGICAL
TELEMETRY
ONCOLOGY
NEUROLOGY
PSYCHIATRY
REHABILITATION
OTHER (SPECIFY)
TOTAL YEARS IN PEDIATRIC NURSING
Please list the EMR systems you have used
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I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*
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Name*
First Last
Email*
Phone*
TODAY'S DATE*
MM slash DD slash YYYY

Skills Checklist

Age of Patients Cared For

General Skills

Cardiovascular General Skills

INVASIVE HEMODYNAMIC MONITORING:

CARDIOVASCULAR - CARE OF THE CHILD WITH:

MEDICATIONS KNOWLEDGE AND USE OF

RESPIRATORY GENERAL SKILLS

OBTAINING BLOOD GASES:

AIRWAY MANAGEMENT

SUCTIONING

CHEST TUBE (ASSIST WITH):

O2 THERAPY

VENTILATORS

RESPIRATORY - CARE OF CHILD WITH:

MEDICATIONS KNOWLEDGE AND USE OF

NEURO GENERAL SKILLS

NEURO - CARE OF CHILD WITH:

MEDICATIONS KNOWLEDGE AND USE OF

GASTROINTESTINAL GENERAL SKILLS

GASTROSTOMY/BUTTON

GASTROINTESTINAL - CARE OF CHILD WITH:

MEDICATIONS KNOWLEDGE AND USE OF

RENAL/GENITOURINARY GENERAL SKILLS

COLLECTION OR URINE SPECIMENS

RENAL/GENITOURINARY - CARE OF CHILD WITH:

ENDOCRINE / METABOLIC GENERAL SKILLS

ENDOCRINE/METABOLIC CARE OF CHILD WITH:

MEDICATIONS KNOWLEDGE AND USE OF

ORTHOPEDICS GENERAL SKILLS

ORTHOPEDICS - CARE OF CHILD WITH:

WOUND MANAGMENT

BURNS

ONCOLOGY GENERAL SKILLS

INTERPRETATION OF LAB RESULT

ONCOLOGY - CARE OF CHILD WITH:

MEDICATIONS KNOWLEDGE AND USE OF

INFECTIOUS DISEASES GENERAL SKILLS

OBTAIN CULTURE SPECIMENS

INFECTIOUS DISEASES - CARE OF CHILD WITH

PHLEBOTOMY / IV THERAPY

PHLEBOTOMY / IV - CARE OF CHILD WITH:

PAIN MANAGEMENT GENERAL SKILLS

PAIN MANAGEMENT - CARE OF CHILD WITH:

MEDICATION KNOWLEDGE AND USE OF

MISCELLANEOUS

MISCELLANEOUS - CARE OF CHILD WITH:

MEDICATION ADMINISTRATION FOR CHILDREN

YEARS OF EXPERIENCE IN EACH OF THE FOLLOWING PEDIATRIC AREAS