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: