Nurse Practitioner Skills Checklist

Fill Out and Submit your Skills Checklist

    (Nurse Practitioner)

    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

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Experience With

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Disorders – Emergencies

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Collaboration

    0

    0

    0

    0

    0

    0

    0

    Respiratory

    0

    0

    0

    0

    0

    0

    0

    0

    Pneumonia:

    0

    0

    Sinusitis:

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Cardiovascular System

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    OB/GYN

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    GI System

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Skin

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Ears, Nose and Throat

    0

    0

    0

    0

    0

    0

    0

    Eye

    0

    0

    0

    0

    0

    0

    0

    0

    Musculoskeletal

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Parasitic Infections

    0

    0

    0

    Genitourinary System

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Nervous System

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Endocrine

    0

    0

    0

    0

    0

    0

    0

    Hematological

    0

    0

    0

    0

    0

    0

    Psychosocial

    0

    0

    0

    0

    0

    0

    0

    Drug Therapy

    0

    0

    0

    0

    0

    0

    0

    Knowledge of Potential Adverse Reactions:

    0

    0

    0

    0

    0

    Dispensing Medication

    0

    0

    0

    Non-Pharmacologic Interventions

    0

    0

    0

    0

    0

    0

    Miscellaneous

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Programs

    0

    0

    0

    0

    0

    0

    0

    0

    Age Specific Competencies

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Please list any Additional Skills

    Additional training:

    Additional equipment: