Nurse Practitioner Skills Checklist
  Nurse Practitioner Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to FILL IN THE BLANK 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.  
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

 
       
Rating Stars (Click) Areas Worked 1 2 3 4  
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   
Rating Stars (Click) Experience With 1 2 3 4  
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  
Rating Stars (Click) Disorders – Emergencies 1 2 3 4  
Anaphylaxis  
Cardiac arrest  
Seizures  
Minor head injuries  
Animal bites  
Ingestions and poisonings  
Overdose of sedative, hypnotics, opiates  
Snake bites  
Minor burns  
Shock  
Open wounds  
Rating Stars (Click) Collaboration 1 2 3 4  
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  
Rating Stars (Click) Respiratory 1 2 3 4  
Croup  
Influenza  
Tracheobronchitis  
Bronchitis  
COPD (chronic obstructive pulmonary disease)  
Asthma  
URI (upper respiratory infection)  
Obstructive Sleep Apnea  
  Pneumonia:  
Viral  
Bacterial  
  Sinusitis:  
Bacterial  
Nonbacteria  
Oxygen administration  
Liquid oxygen  
IPPB machine use  
Tracheotomies  
Interpret ABG (blood gases)  
Intubations  
Sputum Collection  
Rating Stars (Click) Cardiovascular System 1 2 3 4  
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  
Rating Stars (Click) OB/GYN 1 2 3 4  
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  
Rating Stars (Click) GI System 1 2 3 4  
Constipation  
Diarrhea (simple)  
Acute gastroenteritis  
Cholecystitis  
Pyloric stenosis  
Colic  
Appendicitis  
Naso-gastric tubes  
Gastrostomy Care  
Rating Stars (Click) Skin 1 2 3 4  
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  
Rating Stars (Click) Ears, Nose and Throat 1 2 3 4  
Epistaxis  
Otitis externa  
Serous otitis media  
Acute purulent otitis media  
Allergic rhinitis  
Pharyngitis  
Oral candidiasis  
Rating Stars (Click) Eye 1 2 3 4  
Conjunctivitis  
Strabismus  
Chalazion  
Stye  
Visual acuity  
Fluorescein staining of eyes  
Audiometry  
Tympanometry  
Rating Stars (Click) Musculoskeletal 1 2 3 4  
Osteoporosis  
Osteomyelitis  
Rheumatoid arthritis  
Juvenile diabetes  
Gout  
Minor sprains and strains  
Osteoarthritis  
Carpal tunnel syndrome  
Scoliosis  
Tendonitis  
Bursitis  
Muscular dystrophy  
Rating Stars (Click) Parasitic Infections 1 2 3 4  
Pinworms  
Ascariasis  
Pediculosis  
Rating Stars (Click) Genitourinary System 1 2 3 4  
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  
Rating Stars (Click) Nervous System 1 2 3 4  
Vasovagal syncope  
Migraine headaches  
Multiple sclerosis  
Headaches  
Head injury  
Tension  
Anxiety  
Parkinson’s  
Alzheimer’s  
Bell’s Palsy  
TIA (transient ischemic attacks)  
Trigeminal neuralgia  
Rating Stars (Click) Endocrine 1 2 3 4  
Type I diabetes mellitus  
Type II diabetes mellitus  
Graves disease  
Addison's disease  
Juvenile diabetes  
Hypoglycemia  
Hypothyroidism  
Rating Stars (Click) Hematological 1 2 3 4  
Folic acid deficiency anemia  
Aplastic anemia  
Iron deficiency  
Sickle cell anemia  
Pernicious anemia  
Hemoglobinmeter  
Rating Stars (Click) Psychosocial 1 2 3 4  
Depression  
Suicide  
Obesity  
Grief  
Anxiety  
Anorexia  
Bulimia  
Rating Stars (Click) Drug Therapy 1 2 3 4  
Prescription  
Over the counter (OTC)  
Herbal drugs  
Knowledge of pharmacology  
Knowledge of pharmacokinetics  
Knowledge of drug interactions  
Knowledge of side effects  
  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  
Rating Stars (Click) Dispensing Medication 1 2 3 4  
Monitoring drug therapy  
Management of controlled substances  
Injections  
Rating Stars (Click) Non-Pharmacologic Interventions 1 2 3 4  
Medical nutrition therapy  
Exercise  
Cessation of substance abuse (alcohol, tobacco)  
Mental health issues (stress management, depression)  
Obesity management  
Tube Feeding Management  
Rating Stars (Click) Miscellaneous 1 2 3 4  
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  
Rating Stars (Click) Programs 1 2 3 4  
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  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
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