Nurse Practitioner Skills Checklist

    Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

    Proficiency Scale: 1 = No Experience, 2 = Need Training, 3 = Able to perform with supervision, 4 = Able to perform independently

    AREAS WORKED:

    EXPERIENCE WITH:

    DISORDERS – EMERGENCIES:

    COLLABORATION:

    RESPIRATORY:

    Pneumonia:

    Sinusitis:

    CARDIOVASCULAR SYSTEM:

    OB/GYN:

    GI SYSTEM:

    SKIN:

    EARS, NOSE AND THROAT:

    EYE:

    MUSCULOSKELETAL:

    PARASITIC INFECTIONS:

    GENITOURINARY SYSTEM:

    NERVOUS SYSTEM:

    ENDOCRINE:

    HEMATOLOGICAL:

    PSYCHOSOCIAL:

    DRUG THERAPY:

    Knowledge of potential adverse reactions:

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    DISPENSING MEDICATION:

    NON-PHARMACOLOGIC INTERVENTIONS:

    MISCELLANEOUS:

    PROGRAMS:

    AGE SPECIFIC COMPETENCIES:

    PLEASE LIST ANY ADDITIONAL SKILLS:

    ADDITIONAL TRAINING:

    ADDITIONAL EQUIPMENT:

    CERTIFICATIONS