Pediatric Care

A Competency Checklist

Is your pediatric home health nurse ready for the assignment?

By Anna Zimmerman

Before assigning a nurse to a child with complex needs such as feeding tube care or ventilator support, how does an agency know whether that nurse has the relevant skills and is properly prepared? Onboarding provides some of that information, but a new assignment might involve equipment or procedures the nurse hasn’t used before.

Pediatric home health agencies face this question regularly, while agencies that primarily care for adults encounter it less often and might have fewer nurses with recent pediatric experience. In either setting, clinical leaders can use the competency checklist below to review readiness for the assignment.

The following steps explain how to use the competency checklist to guide education, assess skills and determine where further preparation is needed.

Skills the Child’s Care Requires

Nursing training programs typically cover the basics of pediatric care, such as developmental milestones and common childhood illnesses. Caring for medically complex children often requires additional education and supervised practice in procedures like feeding tube care, central line care and tracheostomy management. The competency checklist identifies core skills for all new pediatric registered nurse (RN) hires as well as additional skills to assess based on the individual child.

Clinical leaders should start with the child’s care plan and identify the procedures and equipment the nurse will encounter. A nurse with feeding tube experience might still need training on an unfamiliar pump, while an assignment involving a tracheostomy requires skills such as airway care and emergency response, along with device-specific training if the child uses a ventilator. Record the relevant skills so the nurse and preceptor know what needs to be assessed.

Standardized Procedure Guidance

Using the same approved procedure references gives nurses and preceptors a shared basis for instruction and feedback. Choose up-to-date, evidence-based resources that cover pediatric care techniques and pair them with the manufacturer’s instructions for equipment used in the home.

Device training is an important focus because familiarity with one model doesn’t necessarily mean that a nurse will be prepared to use a different one. For example, the American Thoracic Society recommends that professional caregivers complete training on the specific type of ventilator used in the child’s home.

Keep approved resources accessible after orientation so nurses can easily and quickly review infrequently used procedures before providing care. Ensure that nurses are able to directly route questions about a child’s care plan or the procedures involved to a preceptor or clinical supervisor.

Putting Learning Into Practice

Ask nurses about their experience and which skills they feel unsure about performing. Use their answers to help guide preparation. From there, observe their performance to determine whether they can carry out the procedure safely and correctly.

Preceptors often begin by demonstrating a procedure and discussing the steps with the nurse. The nurse then needs an opportunity to perform it under supervision, with the preceptor assessing performance against approved guidance. Shadowing provides helpful exposure, but it’s important to also assess the nurse’s own ability. Document which required skills the nurse has demonstrated and which need further assessment or practice, following agency policy.

If More Preparation Is Needed

What if a nurse can describe how to use an infusion pump but needs repeated prompts during supervised setup? The preceptor should identify where assistance was needed and arrange further review and practice. The next assessment should establish whether the nurse can perform the required steps without those prompts.

That record should explain the remaining preparation and supervision needed until competency is validated. A nurse who doesn’t feel confident in a skill might benefit from additional shadowing before practicing, while someone who makes a process error needs feedback on the specific step. From there, reassess competency and record the result before authorizing independent performance.

Matching Skills to the Assignment

Before making an assignment, review the child’s care plan alongside the nurse’s competency record to confirm that each required skill has been assessed and validated. Provide further preparation for any skills that remain unassessed or need more practice before the nurse provides that care independently. Reassess readiness when the child’s condition, care plan, procedures or equipment changes.

As agencies prepare nurses to care for medically complex children at home, they need a clear way to connect training with the care each child requires. The checklist below offers a starting point that you can adapt to your agency’s policies, the nurse’s scope of practice and applicable requirements.

Competency Checklist: Core & Patient-Specific Skills for RNs

You can use this sample pediatric home health and private duty nursing competency checklist as a starting point for assessing the competencies a new pediatric RN needs before independent practice. Core skills apply to every new pediatric RN; patient-specific skills are validated before the nurse is assigned to a child who needs them. Provide relevant education for each skill, then confirm competency through field demonstration.

For device-related skills, include manufacturer training for the equipment the patient uses. Confirm scope of practice against your state Nurse Practice Act and agency policy.

Competency Checklist: Core & Patient-Specific Skills for RNs

For device-related skills, include manufacturer training for the equipment the patient uses. Confirm scope of practice against your state Nurse Practice Act and agency policy.

Anna Zimmerman, senior program manager of home health and hospice at Medbridge, leads post-acute care education at Medbridge, partnering with subject matter experts and many of the largest home health and hospice agencies in the U.S. to build learning programs that improve clinical practice, support regulatory readiness and deliver measurable results for agencies and their patients. She works across product, marketing, sales and production to bring these programs from concept to launch as part of the team that develops engaging, evidence-based online education for clinicians.

Before Medbridge, Zimmerman built strategic partnerships and managed public health initiatives in community health, an experience that grounds her focus on care that works for patients and families at home. She holds a master’s degree in social work from the University of Washington and a bachelor’s degree from the University of Puget Sound.