Professional Staffing

PEDIATRIC COMPETENCY SELF ASSESSMENT

Name
Date
Please choose your level of experience in each of the following.

GENERAL SKILLS
Advanced directives	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Patient/family teaching	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Lift/transfer devices	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Specialty beds	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
End of life care/pallative care	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Restrictive devices (restraints)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Normal growth & development	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Immunizations	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Recognize signs of abuse/neglect	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Provide safe environment for age specific care	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Recognize signs of failure to thrive	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Wound care assessment & care	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Diabetic care & education	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Blood glucose monitoring (BGM)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Insulin administration	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Calculation of pediatric dosages	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Scalp veins	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Pain assessment & management	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Moderate sedation	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Use of PCA (IV, intrathecal, epidural)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Prevention of pressure ulcers	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Isolation	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Universal precautions	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Infection control	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Minimize risk for falls	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Preparation of emergency drugs	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

IV THERAPY
Starting & maintaining peripheral IVs	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Blood draw: venous	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Blood draw: central line	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Central line care (includes PICC/Groshong/Hickman)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Care & management of ports	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
TRN & lipids	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Administration of blood & blood products	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Administration of chemotherapy	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Monitoring chemotherapy (does not initiate)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
2024 NATIONAL PATIENT SAFETY GOALS
NPSG.01.01.01 • Identify patients correctly	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
• Use patients name and date of birth	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
• Make sure correct patient gets the correct medicine and treatment	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Improve staff communication
NPSG.02.03.01 Get important test results to the right staff person on time.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Use medicines safely
NPSG.03.04.01 Before a proceedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
NPSG.03.05.01 Take extra care with patients who take medicines to thin their blood.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
NPSG.03.06.01 Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit their doctor.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Use Alarms Safely
NPSG.06.01.01 Make improvements to ensure that alarms on medical equipment are heard and responded to on time.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Prevent infection
NPSG.07.01.01 Use the hand cleaning guidelines from the Centers of Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Identify patient safety risks
NPSG.15.01.01 Reduce the risk for suicide.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Improve health care equity
NPSG.16.01.01 Improving health care equity is a quality and patient safety priority. For example, health care disparities in the patient population are identified and a written plan describes ways to improve health care equity.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Prevent mistakes in surgery
UP.01.01.01 Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
UP.01.02.01 Mark the correct place on the patients body where the surgery is to be done.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
UP.01.03.01 Pause before the surgery to make sure that a mistake is not being made.	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

COMPUTERIZED CHARTING
Health Connect	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Meditech	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cerner	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
McKesson	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
EPIC	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Camis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Affinity	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Wellsoft — ER	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
T–System — ER	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Automated medication dispensing	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Bar coding for medication administration	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

CARDIOVASCULAR
Pediatric assessment	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Apnea monitor	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cardiac monitoring & emergency care	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Obtains 12 lead EKG	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Basic EKG interpretation	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cardiac arrest/CPR/infant/child	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Administration of PALS protocols & medications	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Use of Broslow system	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Use of rapid response teams	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Antihypertensives	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Digoxin	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cardiac surgery pre-post	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

NEUROLOGICAL
Pediatric neurological assessment	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
ICP monitoring	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Assist with lumbar puncture	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Neuromuscular disease	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Spinal cord injury	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Epilepsy	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Meningitis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Seizures	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Near drowning	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
VP shunt	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Hydrocephalus	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Stimulants	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Anticonvulsants	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Steroids	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

ORTHOPEDICS
Assessment of circulation checks	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Osteomylitis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Fractures	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Traction equipment – splints, casts & braces	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Pinned traction	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Post Harrington Rod insertion	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

PULMONARY
Respiratory assessment	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Ventilator management	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
O2 (NC/mask/oxyhood)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Tracheostomy care and suctioning	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Oral/nasal suctioning	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Chest Physiotherapy (CPT)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Pulse oximeter	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Assist with chest tube insertion & management	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Brocho- Pulmonary dyplasia	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Respiratory syncytial virus (RSV)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Respiratory distress syndrome (RDS)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

RENAL — GENITAL URINARY
Assessment of fluid balance	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Peritoneal dialysis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Insertion and care of catheters	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

HEMATOLOGY/ONCOLOGY
Assist with bone marrow aspiration	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Anemia	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Sickle cell disease	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Malignant tumors	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Hodgkin’s	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Leukemia	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Bone marrow transplant	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Hemophilia	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Spleen trauma & spleenectomy	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

INFECTIOUS DISEASES
Common childhood communicable diseases	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
HIV	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Hepatitis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Kawasaki disease	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Meningitis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Aids	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

GASTROINTESTINAL
GI assessment	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Feedings	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Bottle	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Breast	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Gavage	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Placement of nasogastric tubes/suction	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Colostomy & ileostomy care	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Gastrostomy	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Nasojejunal	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

CARE OF CHILDREN WITH:
Cardiomyopathy	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Pericarditis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Rheumatic fever	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Bacterial endocarditis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Shock	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cogenital heart defects	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Congestive heart failure	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Post cardiac surgery	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Post cardiac cath	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Adrenal disorders	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Pituitary disorders	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cushing’s syndrome	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Thyroid disorders	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Asthma	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Cystic fibrosis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Croup	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Tuberculosis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Glomerular nephritis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Nephrotic syndrome	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Kidney transplant	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Wilm’s tumor	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Hemolytic uremic syndrome	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Encephalitis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
UTI	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Llial conduit ureteral	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Traumatic brain injury	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Depression	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Battered child syndrome	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Anorexia/bulimia	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

MEDICATIONS
Antidysrythmics	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Thyroid	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Growth hormone	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Aminophylline	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Ventolin	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Alupent	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Resplgam	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Synergis	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)

AGE SPECIFIC COMPETENCIES
Newborn (birth – 30 days)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Infant (30 days – 1 year)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Toddler (ages 1 – 3 years)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Preschooler (ages 3 – 5 years)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Childhood (ages 6 – 12 years)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
Adolescents (ages 12 – 21 years)	Theory Only Some Experience Experience (Performs without assistance) Very Experienced (Performs Well)
YEARS EXPERIENCE
Please indicate number of years of experience in the following disciplines.
Pediatrics	years

All the information on this page is true and accurate to the best of my knowledge. By completing this form, I am authorizing Professional Staffing to release this information to the appropriate client facilities in consideration of employment as a registry, local traveler of full traveler.

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SKILLS CHECKLIST