Nurse Practitioner Skills Checklist

    In order to provide suitable assignments for you, this checklist is intended as a method of assessing your professional proficiency. Please rate your skill level as accurately as possible by placing a check (√) in the appropriate box.

    PROFICIENCY SCALE
    1. No experience; Theory/observed only 2. Limited competency; < 5 times per year; Needs supervision
    3. Acceptable competency; > 5 times per year 4. Competent; Performs on a daily or weekly basis; Proficient

    Specialty1234

    Anesthesiology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cardiology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Corporate Health*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Critical Care*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Dermatology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Emergency Medicine*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Ears, Nose, and Throat*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Correctional Care*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Family Practice*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Genetics*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Forensic Medicine*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Internal Medicine*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Interventional Radiology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Substance Abuse*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Ob and Gynecology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Occupational Med*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Ophthalmology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pain Medicine*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pathology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Peds*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Physical Med/Rehab*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Psychiatry*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Public Health*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Radiation Oncology*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Surgery*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Non Clinical*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Disorders Emergencies1234

    Anaphylaxis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cardiac arrest*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Seizures*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Minor head injuries*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Animal bites*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Ingestions and poisonings*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Overdose - sedative, hypnotics*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Disorders Emergencies cont.1234

    Snake bites*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Minor burns*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Shock*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Open wounds*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Respiratory1234

    Croup*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Influenza*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Tracheobronchitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bronchitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    COPD*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Asthma*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pneumonia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Viral*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bacterial*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Nonbacterial*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    URI (Upper respiratory infection)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cardiovascular system1234

    Congestive heart failure*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Chronic obstructive pulmonary disease*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Stasis ulcer of lower extremities*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Angina*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pericarditis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Coronary artery disease*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Functional murmurs*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Congenital heart disease*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hypertension*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    OB/GYN1234

    Nausea/vomiting - pregnancy*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Dysmenorrhea*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Candida vaginitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pap smears*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Abnormal pap smear findings*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Trichomonal Vaginitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Atrophic vaginitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    OB/GYN cont.1234

    Fibrocystic breast disease*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Menopause*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bartholin’s cyst/ abscess*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Preparation for childbirth*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pregnancy-diagnosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pain relief (in active phase of labor)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Intrapartum medications*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Medications in the third stage*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Dysfunctional uterine bleeding*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Rh blood factor*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Mastitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Medications in the Post-Partum*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Birth control methods*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pre-natal care*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Fetal well-being*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    GI System1234

    Constipation*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Diarrhea (simple)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Irritable bowel syndrome*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Acute gastroenteritis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hiatal hernia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hemorrhoids*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hepatitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Duodenal ulcer*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cholecystitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pyloric stenosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Colic*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Appendicitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Skin1234

    Warts*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Basal skin carcinoma*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Scabies*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Impetigo*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Diaper dermatitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Acne*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Folliculitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Furuncles*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Carbuncles*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Herpes simples*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Herpes zoster*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Malignant melanoma*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pityriasis Rosea*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Contact dermatitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Tinea corporis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Tinea pedis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Ears, Nose, and Throat1234

    Epistaxis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Otitis externa*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Serous otitis media*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Acute purulent Otitis media*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Allergic rhinitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pharyngitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Oral candidiasis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Eye1234

    Conjunctivitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Strabismus*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Chalazion*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Stye*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Musculoskeletal1234

    Osteoporosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Osteomyelitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Rheumatoid arthritis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Juvenile diabetes*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Gout*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Minor sprains and strains*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Osteoarthritis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Carpal Tunnel Syndrome*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Scoliosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Tendonitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bursitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Muscular dystrophy*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Parasitic Infections1234

    Pinworms*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Ascariasis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pediculosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Genitourinary System1234

    Syphilis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Chlamydia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Herpes*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cystitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pyelonephritis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Urinary tract infection*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Benign prostatic hypertrophy*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Vulvovaginitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hypospadias*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hydrocele*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Gonococcal infections*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Prostatitis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Nervous System1234

    Vasovagal syncope*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Migraine headaches*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Nervous System cont.1234

    Multiple sclerosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Headaches*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Head injury*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Tension*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Migraine*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Anxiety*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Parkinsons*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bells Palsy*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    TIA (transient ischemic attacks)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Trigeminal neuralgia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Multiple sclerosis*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Endocrine1234

    Type I diabetes mellitus*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Type II diabetes mellitus*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Graves’ disease*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Addison’s disease*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Juvenile diabetes*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hypoglycemia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hypothyroidism*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Hematological1234

    Folic acid deficiency anemia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Aplastic anemia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Iron deficiency*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Sickle cell anemia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Pernicious anemia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Psychosocial1234

    Depression*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Suicide*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Obesity*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Grief*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Anxiety*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Anorexia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bulimia*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Miscellaneous1234

    Suturing*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cell biopsy*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Starting IV*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Casting and splinting*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Age Appropriate Care1234

    Newborn (Birth-30days)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Infant (30 Days – 1 year)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Toddler (1-3 years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Preschooler (3-5 years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    School Age (5-12 years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Adolescents (12-18 years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Young Adult (18-39 years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Middle Adult (39-64 years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Older Adult (64 + years)*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    EMR1234

    AllScript*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Canopy*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Epic*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Cerner*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Eclipsys*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    McKesson*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Meditech*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Homecare Homebase*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Other Computerized System*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Computerized Physician Order Entry*1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent

    Bar Coding for Medication
    Administration*    1 - No Experience2 - Limited Competency3 - Acceptable competency4 - Competent