Nurse Practitioner Skills Checklist

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Name*

Directions for Completing Skills Checklist


The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate the level of experience/proficiency with each and, where applicable, the types of equipment and/or systems with which you are familiar.

Use the following KEY as a guideline:
A) Theory Only/No Experience - Didactic instruction only, no hands-on experience.
B) Limited Experience - Knows procedure/has used equipment, but has done so infrequently or not within the last six months.
C) Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.
D) Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.

AREAS WORKED

ABCD
Emergency
Urgent care
Private practice
HMO
MD office
Schools
Health department
Ambulatory clinic
Rural health clinic
Psychiatric facility
Cardiology
Mobile medical unit
Corporate worksite
Health department
Health department
Nursing home/Long term care facility
Women’s health clinic
Government health agency
Correctional facility
Other

SPECIALTY

ABCD
ASHD (arteriosclerotic heart disease)
Dyslipidemia
Osteomyelitis
PVD (peripheral vascular disease)
HTN (hypertension)
Peripheral neuropathy
Diabetes
Orthopaedic
Emergency department
Other

EXPERIENCE WITH

ABCD
Oxygen administration
Liquid oxygen
Naso-gastric tubes
IPPB machine use
Diabetes
Catheter care
Contractures
Gastrostomy care
Incontinence care-bowel
Dermal ulcers
Enemas/ Suppositories/ Fecal
Injections
Staph infections
Tracheotomies
Wound care
Bedridden residents
Pap smears
Visual acuity
Audiometry
Tympanometry
Splinting of extremities
Interpreting 12 lead EKG’s
Interpret ABG (blood gases)
Local infiltration
Single layer wound closure
Fluorescein staining of eyes
Radiographic interpretation (initial)
Incision and drainage
Excisions
Intubations
Comprehensive physical assessment
Acute disease condition
Chronic disease condition
Differential diagnosis
Order, may perform, and interpret screening and diagnostic test
Informed consent
Explanation to patient/family
Documentation
Venipuncture
Urine Collection
Sputum Collection
Pregnancy test kits
Hemoglobinmeter
Ultrasounds

COLLABORATION

ABCD
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
Other

DRUG THERAPY

ABCD
Prescription
Over the counter (OTC)
Herbal drugs
Knowledge of pharmacology
Knowledge of pharmacokinetics
Knowledge of drug interactions
Knowledge of side effects
ABCD
Allergic reactions
Anaphylaxis reaction

DISPENSING MEDICATIONS

ABCD
Monitoring drug therapy
Management of controlled substances

NON-PHARMACOLOGIC INTERVENTIONS

ABCD
Medical nutrition therapy
Exercise
Cessation of substance abuse (alcohol, tobacco)
Mental health issues (stress management,depression)
Obesity management
Other

MISCELLANEOUS:

ABCD
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

PROGRAMS

ABCD
Medicare and Medicaid
CLIA waiver (Clinical Laboratory Improvement Amendments)
Joint Commission on Accreditation Healthcare Organizations
HEDIS (Health Plan Employer Data and Information Set)
DQIP (Diabetes Quality Improvement Program)
HIPAA (Health Insurance Portability and Accountability Act)
DNV- Accreditation
OSHA (Occupational, Safety and Health Administration)
Other

Age Specific:

ABCD
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)
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