GENERAL INFORMATION

Note: * Denotes a required field.

Please enter your full name as it appears on your Social Security Card: First Name   Middle Name   Last Name  * Please enter the Last Four digits of your Social Security Number:  -   -   *       Please check here if you do not hold a valid social security card. Please provide your contact information: Phone Number  * E-mail Address  * Confirm E-mail Address  * Type your e-mail address again above.

This profile is for use by healthcare professionals in the Labor and Delivery discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

WORK SETTINGS

1

2

3

4

L and D

LDRP

Antepartum

Mother Baby

ANTEPARTUM

1

2

3

4

Diabetes

Fetal Demise

HELLP Syndrome

Hyperemesis

Immunologic Disorder

Infectious Disease

Multiple Gestation

Placenta Previa/Abruptio

Pre-Term Labor

Premature Rupture of Membranes

SPECIAL PROCEDURES

1

2

3

4

Conduct Stress Test

Conduct Non-Stress Test

Assist with External Version

Assist with Umbilical Blood Sampling

Use of Nitrazine/Fern Test

PAIN MANAGEMENT

1

2

3

4

Epidural Anesthesia

General Anesthesia

Spinal Anesthesia

Response to Pain Management

FETAL MONITORING

1

2

3

4

External

IUPC Placement/Monitoring

Spiral Electrode Placement

Identify, Document & Treat Abnormal FHR Patterns

LABOR MANAGEMENT

1

2

3

4

Auscultate Fetal Heart Tones

Determine Fetal Position

Assess Contraction Characteristics

Assess Status of Membranes

Assess Station/Dilation/Effacement

Positioning

Leopold's Maneuver

Assess for Reflexes/Clonus

Bladder Catheterization

Amnioinfusion (Assist or Perform)

Recognize Complications of AROM

DELIVERY MANAGEMENT

1

2

3

4

Delivery Table Set Up

Circulate Vaginal Delivery

Circulate C - Section

Scrub C - Section

NEONATAL MANAGEMENT

1

2

3

4

Radiant Warmer

APGAR Scores

Neonatal Vital Signs

Neonatal Resuscitation

Naso/Oropharyngeal Suctioning

Bulb Syringe Suction

COMPLICATIONS

1

2

3

4

Placenta Previa/Abruptio

Asthma

Cardiac Disease

Chorioamnionitis

Diabetes

Pregnancy Induced Hypertension

HELLP

Hemolytic Anemia

Hemorrhage

HIV Positive

HBV Disease

Malpresentations

Multiple Gestation

Pre-Term Labor

Fetal Demise

Rh Disease

POST PARTUM CARE

1

2

3

4

Vaginal Delivery

Cesarean Section

Anesthesia - General

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

MEDICATIONS

1

2

3

4

Antibiotics/Antivirals

Antihypertensives

Antiseizure

Betamethasone

Insulin

Magnesium Sulfate

Methergine

Opioids and Reversal Agents

Pitocin

Terbutaline

IV THERAPY

1

2

3

4

Start IVs

IV Management

Blood Product Administration

NEWBORN CARE

1

2

3

4

Newborn Assessment

Infant Vital Signs

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

Jaundice/Bilirubin

Phototherapy

Thermoregulation

PROFESSIONAL KNOWLEDGE AND SKILLS

1

2

3

4

National Patient Safety Goals/Core Measures

Experience in a "Baby Friendly" Facility

Fall Risk Assessment/Prevention

Restraints/Use of Least Restrictive Device

Parent/Family Teaching

Age Specific/Population-Based Care

Isolation Precautions

Infection Prevention

Charge Experience

Interpretation and Communication of Lab Values

EMR

1

2

3

4

EPIC

Cerner

Eclipsys

McKesson

Meditech

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication Administration

EMR Conversion

Yes

No

Certifications

1

2

3

4

BLS

NRP

S.T.A.B.L.E.

ACLS

AWHONN FHM Intermediate

AWHONN FHM Advanced

NCC - EFM

Please read and agree to the statements below by marking the checkbox. You will not be able to submit until you have marked the checkbox. * 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. I hereby authorize Hudson Staffing to release this Labor and Delivery Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.

Privacy Note: Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (54.90.204.233) which will be used as a digital signature.