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Hiring Interview Appointment

Personal imformation

Name *

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Last

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Phone

No experience: requires education, training and supervision
Intermittent experience: may need support or supervise
Proficient: consistent experience, independent
Expert level: can teach/supervise others.

Work settings

NICU IV

1
2
3
4

NICU III

1
2
3
4

NICU II

1
2
3
4

Level 1 Nursery

1
2
3
4

Mother/Baby

1
2
3
4

Neonates 24-28 weeks

1
2
3
4

Neonates 29-34 weeks

1
2
3
4

Neonates > 34 weeks

1
2
3
4

CARDIOVASCULAR

Blood pressure/invasive (arterial line)

1
2
3
4

Cardiac Arrest/CPR

1
2
3
4

Cardiac transplant

1
2
3
4

Cardiomyopathy

1
2
3
4

Central Venous Pressure

1
2
3
4

CHF/Pulmonary Edema

1
2
3
4

Congenital Heart Disease/Defects

1
2
3
4

Defibrillation/Cardioversion

1
2
3
4

Dysrhythmia Interpretation/Management

1
2
3
4

Invasive Hemodynamic monitoring

1
2
3
4

Post Cardiac Surgery

1
2
3
4

Post interventional cardiac catheterization

1
2
3
4

Pre-Cardiac Surgery

1
2
3
4

ENDOCRINE/METABOLIC

Blood glucose monitoring

1
2
3
4

Diabetes - Hypo/Hyperglycemia

1
2
3
4

Diabetic care/education

1
2
3
4

Diabetic Ketoacidosis

1
2
3
4

Finnegan score

1
2
3
4

Hyperbilirubinemia

1
2
3
4

Indwelling Insulin Pumps

1
2
3
4

Insulin administration

1
2
3
4

IV Insulin Pumps

1
2
3
4

Pancreas transplant

1
2
3
4

Phototherapy

1
2
3
4

Thyroid malfunction

1
2
3
4

GASTROINTESTINAL

GASTROINTESTINAL

1
2
3
4

Colostomy/Ileostomy care

1
2
3
4

Feedings (bottle, breast, gavage)

1
2
3
4

Gastric Emptying

1
2
3
4

Gastroschisis/Omphalocele

1
2
3
4

GI Bleeding

1
2
3
4

Inguinal hernia

1
2
3
4

Necrotizing Enterocolitis

1
2
3
4

Occult blood testing

1
2
3
4

Placement/Management of oral/nasogastric/nasojejunal tubes

1
2
3
4

Post Abdominal Surgery

1
2
3
4

INFECTIOUS DISEASE

HIV positive mother

1
2
3
4

Infection Prevention

1
2
3
4

Isolation Precautions

1
2
3
4

Neonatal Sepsis

1
2
3
4

Sepsis Work Up

1
2
3
4

IV THERAPY

Administration of Blood and Blood Products

1
2
3
4

Arterial line management

1
2
3
4

Central Line Blood Draw

1
2
3
4

Central Line/Implanted Line Care

1
2
3
4

IV Pumps- Guardrails

1
2
3
4

PICC Lines

1
2
3
4

Starting and maintaining IVs

1
2
3
4

UAC (Umbilical Artery Catheter)

1
2
3
4

UVC (Umbilical Vein Catheter)

1
2
3
4

MEDICATIONS/EMERGENCY MEDICATIONS

Automated Medication Dispensing Systems

1
2
3
4

Omnicell

1
2
3
4

Pyxis

1
2
3
4

Accudose

1
2
3
4

Bar Code Medication Administration

1
2
3
4

Neonatal Dosage Calculations

1
2
3
4

Antibiotics/Antivirals

1
2
3
4

Anti-Seizure Medications

1
2
3
4

Bronchodilators

1
2
3
4

Conscious Sedation

1
2
3
4

Caffeine

1
2
3
4

Digoxin

1
2
3
4

IV Vasopressors

1
2
3
4

Immunizations

1
2
3
4

Prostaglandin

1
2
3
4

Surfactants

1
2
3
4

Steroids

1
2
3
4

NEUROLOGIC

Assist with lumbar puncture

1
2
3
4

Ballard/Dubowitz

1
2
3
4

Brain death/organ procurement

1
2
3
4

Hydrocephalus

1
2
3
4

Increased Intracranial Pressure

1
2
3
4

Intracranial Pressure Monitoring

1
2
3
4

Intraventricular Hemorrhage

1
2
3
4

Meningocele/Myelomeningocele

1
2
3
4

Neonatal Abstinence Syndrome

1
2
3
4

Reflexes for Gestational Age

1
2
3
4

Seizure Disorders

1
2
3
4

Ventricular Peritoneal (VP) Shunts

1
2
3
4

Ophthalmology

Eye exams

1
2
3
4

Retinopathy of Prematurity (ROP)

1
2
3
4

Professional Topic and Skills

APGAR scoring

1
2
3
4

Bereavement Care

1
2
3
4

Charge Experience

1
2
3
4

Interpretation and communication of lab values

1
2
3
4

National Patient Safety Goals

1
2
3
4

National Patient Safety Goals/Core Measures

1
2
3
4

National Patient Safety Goals/Core Measures

1
2
3
4

Pain assessment and management

1
2
3
4

Patient/family teaching

1
2
3
4

Phlebotomy

1
2
3
4

Restraints/Use of Least Restrictive Device

1
2
3
4

Skin Care

1
2
3
4

Thermoregulation

1
2
3
4

RESPIRATORY

Apnea Monitor

1
2
3
4

Assist with Intubation/Extubation

1
2
3
4

Bronchopulmonary Dysplasia

1
2
3
4

Bubble CPAP

1
2
3
4

Diaphragmatic Hernia

1
2
3
4

ECMO

1
2
3
4

Endotracheal Tube Suctioning

1
2
3
4

High Flow Nasal Cannula (HFNC)

1
2
3
4

High Frequency Ventilation

1
2
3
4

Inhaled Nitric Oxide

1
2
3
4

Interpretation of Blood Gases

1
2
3
4

Management of Chest Tubes

1
2
3
4

Meconium Aspiration

1
2
3
4

Oral/nasal Suctioning

1
2
3
4

Oscillators

1
2
3
4

Oxygen Delivery Systems

1
2
3
4

Persistent Pulmonary Hypertension

1
2
3
4

Pneumonia

1
2
3
4

Pneumothorax

1
2
3
4

Respiratory Distress Syndrome

1
2
3
4

RSV (Respiratory syncytial virus)

1
2
3
4

Tracheostomy Management

1
2
3
4

Vapotherm

1
2
3
4

Ventilator management (AC/PC/SINMV/CPAP/BIPAP/PEEP)

1
2
3
4

RENAL/GENITOURINARY

Circumcision

1
2
3
4

Exchange Transfusion

1
2
3
4

Genetic Disorders

1
2
3
4

Hyperbilirubinemia

1
2
3
4

Hypo/Hyperglycemia

1
2
3
4

Malformations of GU Tract / Kidney

1
2
3
4

Renal Failure

1
2
3
4

COMPUTERIZED CHARTING

Allscripts

1
2
3
4

Cerner

1
2
3
4

EPIC

1
2
3
4

McKesson

1
2
3
4

Meditech

1
2
3
4

Other:

1
2
3
4

If other, please specify

Age specific competency

Neonate

1
2
3
4

Infant

1
2
3
4

Child

1
2
3
4

Adolescent

1
2
3
4

Young Adult

1
2
3
4

Middle Adult

1
2
3
4

Older Adult

1
2
3
4

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