Previous Experience Instruction, Review, or Skill Demonstration For Repeat Review Review of Skill Skills Pediatric Procedures D A B C E of Date and (complete if applicable) Date and Done Initials Complete Initials Needed Nutritional assessment Competency Competency PO feeding premature infant Feeding infant with cleft lip/palate Intradermal medication administration Subcutaneous medication administration Intramuscular medication administration Medication administration management Use of phototherapy equipment: Case Lights Bili lights Overhead *Tracheostomy care and change *Ventilator care, type: State specific requirements: Supervisor/Preceptor Comments: Previous Experience Instruction, Review, or Skill Demonstration For Repeat Equipment/ Review Review of Skill Skills D Location Specific A B C E of Date and Date and Done Initials Items Complete Initials (complete if applicable) Needed Fetal monitor Competency Competency Apnea monitor Chest physiotherapy Other: specifics: Supervisor/Preceptor Comments: Date Initials Print Name Signature Title (m/d/yyyy)
Previous Experience Instruction, Review, or Skill Demonstration Pediatric Procedures (complete if applicable) A B C D E Review of Needed Review of Complete Skill Done Date and Initials Competency For Repeat Skills Date and Initials Competency Nutritional assessment PO feeding premature infant Feeding infant with cleft lip/palate Intradermal medication administration Subcutaneous medication administration Intramuscular medication administration Medication administration management Use of phototherapy equipment: Case Lights Bili lights Overhead *Tracheostomy care and change *Ventilator care, type: State specific requirements: Supervisor/Preceptor Comments: Previous Experience Instruction, Review, or Skill Demonstration Equipment/ Location Specific Items (complete if applicable) A B C D E Review of Needed Review of Complete Skill Done Date and Initials Competency For Repeat Skills Date and Initials Competency Fetal monitor Apnea monitor Chest physiotherapy Other: specifics: Supervisor/Preceptor Comments: Initials Print Name Signature Title Date (m/d/yyyy)
Nursing+-+RN+Skills+Experience+Check+List+2016+.docx