[checklist name="L&D" mailto="[email protected]" templatedoc="1LB4x1hGlXbQPkrEsrfe13RXnNx7vGgqwoCzl2tE9jWI" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="L&D"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Patient Rights"] [checklistInput type="scale"]Communicates and obtains information while respecting the rights and privacy and confidentiality of information[/checklistInput] [checklistInput type="scale"]Involves the patient and family and respects their role in determining the nature of care to be provided, including Advanced Directives[/checklistInput] [checklistInput type="scale"]Complies with nursing staff responsibility include in the hospital policy related to Organ Donation[/checklistInput] [checklistInput type="scale"]Meets patient and families needs regarding communication, including interpreter services[/checklistInput] [checklistInput type="scale"]Provides accurate information to patient and families in a timely manner[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Labor & Delivery"] [checklistInput type="scale"]Assess cervical dilation[/checklistInput] [checklistInput type="scale"]Assess labor status[/checklistInput] [checklistInput type="scale"]Speculum examination[/checklistInput] [checklistInput type="scale"]Obtaining vaginal/cervical cultures[/checklistInput] [checklistInput type="scale"]Application of external ECG/TOCO EFM[/checklistInput] [checklistInput type="scale"]Application of internal ECG[/checklistInput] [checklistInput type="scale"]Interpretation of external/internal ECG[/checklistInput] [checklistInput type="scale"]Assisting with insertion of IUPC[/checklistInput] [checklistInput type="scale"]Conducting NST/BSST[/checklistInput] [checklistInput type="scale"]IV insertion[/checklistInput] [checklistInput type="scale"]Pitocin Titration for induction/augmentation[/checklistInput] [checklistInput type="scale"]Assist with epidural[/checklistInput] [checklistInput type="scale"]Assist/monitor amnioinfusion[/checklistInput] [checklistInput type="scale"]Assist with scalp pH test[/checklistInput] [checklistInput type="scale"]Assist with vacuum delivery[/checklistInput] [checklistInput type="scale"]Assist with forceps delivery[/checklistInput] [checklistInput type="scale"]Assist with vaginal delivery[/checklistInput] [checklistInput type="scale"]Circulate for cesarean section delivery[/checklistInput] [checklistInput type="scale"]Emergency cesarean section set up[/checklistInput] [checklistInput type="scale"]Assist with twin deliveries[/checklistInput] [checklistInput type="scale"]Assist with breech[/checklistInput] [checklistInput type="scale"]Management of D&C[/checklistInput] [checklistInput type="scale"]Management of fetal demise/stillborn[/checklistInput] [checklistInput type="scale"]Adoption procedures[/checklistInput] [checklistInput type="scale"]Management of diabetic mother[/checklistInput] [checklistInput type="scale"]Diabetic mother[/checklistInput] [checklistInput type="scale"]PIH[/checklistInput] [checklistInput type="scale"]Pre-eclamptic[/checklistInput] [checklistInput type="scale"]Preterm labor[/checklistInput] [checklistInput type="scale"]Prolapsed cord[/checklistInput] [checklistInput type="scale"]Abruption[/checklistInput] [checklistInput type="scale"]Placenta previa[/checklistInput] [checklistInput type="scale"]Retained placenta[/checklistInput] [checklistInput type="scale"]Herpes[/checklistInput] [checklistInput type="scale"]Uterine prolapse[/checklistInput] [checklistInput type="scale"]Hemorrhage[/checklistInput] [checklistInput type="scale"]Shoulder dystocia[/checklistInput] [checklistInput type="scale"]DIC[/checklistInput] [checklistInput type="scale"]Accretia[/checklistInput] [checklistInput type="scale"]Episiotomy[/checklistInput] [checklistInput type="scale"]Delivery table set-up[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Medication"] [checklistInput type="scale"]Magnesium[/checklistInput] [checklistInput type="scale"]Pitocin[/checklistInput] [checklistInput type="scale"]Terbutaline[/checklistInput] [checklistInput type="scale"]Antibiotics[/checklistInput] [checklistInput type="scale"]Narcotics[/checklistInput] [checklistInput type="scale"]Hemabate[/checklistInput] [checklistInput type="scale"]Methergine[/checklistInput] [checklistInput type="scale"]Narcan[/checklistInput] [checklistInput type="scale"]Insulin[/checklistInput] [checklistInput type="scale"]Heparin[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Maternity"] [checklistInput type="scale"]Obtain cord blood gas[/checklistInput] [checklistInput type="scale"]Postpartum care[/checklistInput] [checklistInput type="scale"]Nipple care[/checklistInput] [checklistInput type="scale"]Episiotomy care[/checklistInput] [checklistInput type="scale"]PIH[/checklistInput] [checklistInput type="scale"]Pre-eclamptic[/checklistInput] [checklistInput type="scale"]Postpartum hemorrhage[/checklistInput] [checklistInput type="scale"]Care of newborn[/checklistInput] [checklistInput type="scale"]Breastfeeding[/checklistInput] [checklistInput type="scale"]Bottle feeding[/checklistInput] [checklistInput type="scale"]Infant formulas[/checklistInput] [checklistInput type="scale"]D10W[/checklistInput] [checklistInput type="scale"]PKU Testing[/checklistInput] [checklistInput type="scale"]Stabilize/admit to nursery[/checklistInput] [checklistInput type="scale"]Care of newborn with anomaly[/checklistInput] [checklistInput type="scale"]Heel sticks/dorsal sticks[/checklistInput] [checklistInput type="scale"]Blood glucose monitoring[/checklistInput] [checklistInput type="scale"]Phototherapy[/checklistInput] [checklistInput type="scale"]Set up/care of newborn receiving phototherapy[/checklistInput] [checklistInput type="scale"]Set up/assist with circumcision[/checklistInput] [checklistInput type="scale"]Discharge of mother/baby[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Experience Areas"] [checklistInput type="scale"]Post Partum[/checklistInput] [checklistInput type="scale"]MB – Mother Baby[/checklistInput] [checklistInput type="scale"]L&D – Labor and Delivery[/checklistInput] [checklistInput type="scale"]Nursery level 1 – Well Baby[/checklistInput] [checklistInput type="scale"]Nursery level 2 – Sick Baby[/checklistInput] [checklistInput type="scale"]Nursery level 3 – Premature/Critically ill baby[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]