PEDIATRIC INTENSIVE CARE SKILLS CHECKLIST                                                                                                   

This profile is for use by Pediatric Intensive Care nurses with more than one year experience in their discipline and specialty. It will not be a determining factor for the Advantage RN program.

Please enter your full legal name as it appears on your Social Security Card.

First Name:  Last Name: email:

Please check the boxes below for each age group for which you have provided age appropriate nursing care:

My experience is primarily in:  (please indicate number of years)

  Pediatric Intensive Care       year(s)

  Pediatric stepdown             year(s)

  General pediatrics              year(s)

Please indicate your level of experience:   A.  Theory, no practice     B.  Intermittent     C.  One- Two Years Current Experience   D.  Two plus years experience, can function independently