Skill Checklists

Nurse Practitioner

This checklist was electronically signed on (Today’s date)

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

Emergency

Urgent Care

Private Practice

HMO

MD Office

Schools

Health Department

Ambulatory Clinic

Rural Health Clinic

Psychiatric Facility

Correctional Facility

Mobile Medical Unit

Corporate Worksite

Occupational Health

Rehabilitation

Nursing Home/ Long-term Care Facility

Women's Health Clinic

Government Health Agency

Hospice/Palliative Care

Experience With

Diabetes

Contractures

Bedridden residents

Splinting of extremities

Local infiltration

Comprehensive physical assessment

Acute disease condition

Differential diagnosis

Order, may perform, & interpret screening & diagnostic test

Central line management

Disorders – Emergencies

Anaphylaxis

Cardiac arrest

Seizures

Minor head injuries

Animal bites

Ingestions and poisonings

Overdose of sedative, hypnotics, opiates

Snake bites

Minor burns

Shock

Collaboration

Family, support system, community resources

Consulting with Physicians

Consulting with Pharmacists

Consulting with Speech Therapist

Consulting with Dietician and Diet Aide

Consulting with Occupational Therapist

Referral to Pastoral Services

Respiratory

Croup

Influenza

Tracheobronchitis

Bronchitis

COPD (chronic obstructive pulmonary disease)

Asthma

URI (upper respiratory infection)

Obstructive Sleep Apnea

Respiratory - Pneumonia:

Viral

Bacterial

Respiratory - Sinusitis:

Bacterial

Nonbacteria

Oxygen administration

Liquid oxygen

IPPB machine use

Tracheotomies

Interpret ABG (blood gases)

Intubations

Sputum Collection

Cardiovascular System

Congestive heart failure

Chronic obstructive pulmonary disease

Stasis ulcer of lower extremities

Angina

Pericarditis

Coronary artery disease

Functional murmurs

Congenital heart disease

Hypertension

ASHD (arteriosclerotic heart disease)

Dyslipidemia

PVD (peripheral vascular disease)

Peripheral neuropathy

Interpreting 12 lead EKG’s

OB/GYN

Candida vaginitis

Dysmenorrhea

Abnormal pap smear findings

Pap smears

Trichomonal vaginitis

Atrophic vaginitis

Fibrocystic breast disease

Menopause

Intrapartum medications

Bartholin's cyst/abscess

Preparation for childbirth

Pregnancy - diagnosis and referral

Pain relief in active phase of labor

Medications in the third stage

Dysfunctional uterine bleeding

Medications in the postpartum phase

Rh blood factor

Mastitis

Birth control methods

Prenatal care

Fetal well-being

Nausea and vomiting with pregnancy

Pap smears

Pregnancy test kits

GI System

Constipation

Diarrhea (simple)

Acute gastroenteritis

Cholecystitis

Pyloric stenosis

Colic

Appendicitis

Naso-gastric tubes

Gastrostomy Care

Skin

Warts

Basal cell carcinoma

Scabies

Impetigo

Diaper dermatitis

Acne

Folliculitis

Furuncles

Carbuncles

Herpes Simplex

Herpes Zoster

Malignant melanoma

Pityriasis Rosea

Contact dermatitis

Tinea corporis

Tinea pedis

Staph infections

Wound care

Single layer wound closure

Incision and drainage

Excisions

Ears, Nose and Throat

Epistaxis

Otitis externa

Serous otitis media

Acute purulent otitis media

Allergic rhinitis

Pharyngitis

Oral candidiasis

Eye

Conjunctivitis

Strabismus

Chalazion

Stye

Visual acuity

Audiometry

Tympanometry

Musculoskeletal

Osteoporosis

Osteomyelitis

Rheumatoid arthritis

Juvenile diabetes

Gout

Minor sprains and strains

Osteoarthritis

Carpal tunnel syndrome

Scoliosis

Tendonitis

Bursitis

Muscular dystrophy

Parasitic Infections

Pinworms

Ascariasis

Pediculosis

Genitourinary System

Syphilis

Chlamydia

Herpes

Cystitis

Pyelonephritis

Urinary tract infection

Benign prostatic hypertrophy

Vulvovaginitis

Hypospadias

Hydrocele

Gonococcal infections

Prostatitis

Catheter Care

Incontinence care-bowel

Dermal ulcers

Enemas/ Suppositories/ Fecal

Urine collection

Nervous System

Vasovagal syncope

Migraine headaches

Multiple sclerosis

Headaches

Head injury

Tension

Anxiety

Parkinson’s

Alzheimer’s

Bell’s Palsy

TIA (transient ischemic attacks)

Trigeminal neuralgia

Endocrine

Type I diabetes mellitus

Type II diabetes mellitus

Graves disease

Addison's disease

Juvenile diabetes

Hypoglycemia

Hypothyroidism

Hematological

Folic acid deficiency anemia

Aplastic anemia

Iron deficiency

Sickle cell anemia

Pernicious anemia

Hemoglobinmeter

Psychosocial

Depression

Suicide

Obesity

Grief

Anxiety

Anorexia

Bulimia

Drug Therapy

Prescription

Over the counter (OTC)

Herbal drugs

Knowledge of pharmacology

Knowledge of pharmacokinetics

Knowledge of drug interactions

Knowledge of side effects

Drug Therapy - Knowledge of potential adverse reactions:

Allergic reactions

Anaphylaxis reaction

TPN/Lipid Management

Management/Titration of IV Therapies

IV/PO Antibiotic Therapy and understanding of cultures

Dispensing Medication

Monitoring drug therapy

Management of controlled substances

Injections

Non-Pharmacologic Interventions

Medical nutrition therapy

Exercise

Cessation of substance abuse (alcohol, tobacco)

Mental health issues (stress management, depression)

Obesity management

Tube Feeding Management

Miscellaneous

Public health and health promotion

Research

Quality assurance

Leadership and teaching skills

Legal and ethical issues

Confidentiality

Cultural awareness

Self evaluation to improve patient care

Continuing education

Working within scope of practice

Discharge planning / collaboration

Suturing

Cell biopsy

Starting IV

Casting and splinting

Radiographic interpretation (initial)

Informed consent

Explanation to patient/family

Documentation

Venipuncture

Ultrasounds

Programs

OSHA (Occupational Safety and Health Administration)

Medicare and Medicaid

CLIA waiver (Clinical Laboratory Improvement Amendments)

TJC (The Joint Commission)

HEDIS (Health Plan Employer Data and Information Set)

DQIP (Diabetes Quality Improvement Program)

HIPAA (Health Insurance Portability & Accountability Act)

HCAHPS

Age Specific Competencies

Newborn/neonate (birth-30 days)

Infant (31 days-1 year)

Toddler (ages 2-3 years)

Preschool (ages 4-5 years)

School age (ages 6-12 years)

Adolescents (ages 13-21 years)

Young adult (ages 22-39 years)

Adults (ages 40-64 years)

Older adult (ages 65-79 years)

Elderly (ages 80+ years)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.