Nurse Practitioner Skills Checklist - Welcome to ReligStaffing

Nurse Practitioner Skills Checklist

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Nurse Practitioner Skills Checklist

Nurse Practitioner Skills Checklist

NAME LAST 4 OF SSN 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.

Areas Worked	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Anaphylaxis
Cardiac arrest
Seizures
Minor head injuries
Animal bites
Ingestions and poisonings
Overdose of sedative, hypnotics, opiates
Snake bites
Minor burns
Shock
Open wounds

Collaboration	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Croup
Influenza
Tracheobronchitis
Bronchitis
COPD (chronic obstructive pulmonary disease)
Asthma
URI (upper respiratory infection)
Obstructive Sleep Apnea
Viral(Pneumonia)
Bacterial(Pneumonia)
Bacterial(Sinusitis)
Nonbacteria(Sinusitis)
Oxygen administration(Sinusitis)
Liquid oxygen(Sinusitis)
IPPB machine use(Sinusitis)
Tracheotomies (Sinusitis)
Interpret ABG (blood gases)(Sinusitis)
Intubations(Sinusitis)
Sputum Collection(Sinusitis)

Cardiovascular System	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Congestive heart failure
Chronic obstructive pulmonary disease
Stasis ulcer of lower extremities cumcision
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Constipation
Diarrhea (simple)
Acute gastroenteritis
Cholecystitis
Pyloric stenosis
Colic
Appendicitis
Naso-gastric tubes
Gastrostomy Care

Skin	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Epistaxis
Otitis externa
Serous otitis media
Acute purulent otitis media
Allergic rhinitis
Pharyngitis
Oral candidiasis

Eye	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Conjunctivitis
Strabismus
Chalazion
Stye
Visual acuity
Fluorescein staining of eyes
Audiometry
Tympanometry

Musculoskeletal	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Osteoporosis
Osteomyelitis
Rheumatoid arthritis
Juvenile diabetes
Gout
Minor sprains and strains
Osteoarthritis
Carpal tunnel syndrome
Scoliosis
Tendonitis
Bursitis
Muscular dystrophy

Nervous System	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Vasovagal syncope
Migraine headaches
Migraine headaches
Headaches
Head injury
Tension
Anxiety
Parkinson’s
Alzheimer’s
Bell’s Palsy
TIA (transient ischemic attacks)
Trigeminal neuralgia

Endocrine	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Type I diabetes mellitus
Type II diabetes mellitus
Graves disease
Addison’s disease
Juvenile diabetes
Hypoglycemia
Hypothyroidism

Hematological	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Folic acid deficiency anemia
Aplastic anemia
Iron deficiency
Sickle cell anemia
Pernicious anemia
Hemoglobinmeter

Psychosocial	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Depression
Suicide
Obesity
Grief
Anxiety
Anorexia
Bulimia

Drug Therapy	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Prescription
Over the counter (OTC)
Herbal drugs
Knowledge of pharmacology
Knowledge of pharmacokinetics
Knowledge of drug interactions
Knowledge of side effects
Allergic reactions(Knowledge of potential adverse reactions)
Anaphylaxis reaction(Knowledge of potential adverse reactions)
TPN/Lipid Management(Knowledge of potential adverse reactions)
Management/Titration of IV Therapies(Knowledge of potential adverse reactions)
IV/PO Antibiotic Therapy and understanding of cultures(Knowledge of potential adverse reactions)

Dispensing Medication	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Monitoring drug therapy
Management of controlled substances
Injections

Non-Pharmacologic Interventions	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
Medical nutrition therapy
Exercise
Cessation of substance abuse (alcohol, tobacco)
Mental health issues (stress management, depression)
Obesity management
Tube Feeding Management

Miscellaneous	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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	No Experience	Need Traning	Able to perform with Supervision	Able to perform Independently
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)

	Please list any Additional Skills:
1
2
3
4

	Additional training:
1
2
3
4

	Additional equipment:
1
2
3
4

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

Nurse Practitioner Skills Checklist

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