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Nurse Practitioner Skills Checklist

My responses in this checklist represent a true reflection of my experience and comfort level. Please self-rate your comfort level in performing tasks in connection with the below checklist. Rate your level of comfort for each line item by following the below ranking system. Simply fill in the appropriate option immediately following the rating number.

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Level of Comfort/Experience

N/A=Non-applicable
1=Inexperienced in this area
2=Limited comfort/experience in this area
3=Comfortable/experienced in this area
4=Very comfortable/highly experienced in this area

GENERAL NURSE PRACTITIONER	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Obtain Complete Health History	N/A	1	2	3	4
Perform Complete Physical Exam	N/A	1	2	3	4
Order/Perform Diagnostic Procedures	N/A	1	2	3	4
Order / Perform Diagnostic Tests	N/A	1	2	3	4
Interpret Clinical Findings	N/A	1	2	3	4
Develop Differential Diagnoses	N/A	1	2	3	4
Develop Health Care Problems List	N/A	1	2	3	4
Develop / Implement Plan for Client	N/A	1	2	3	4
Identify / Use Available Resources	N/A	1	2	3	4
Arrange Referrals / Consults	N/A	1	2	3	4
Prescribe Specific Medications	N/A	1	2	3	4
Prescribe Specific Therapeutic Interventions	N/A	1	2	3	4
Authorize / Coordinate Admission	N/A	1	2	3	4
Authorize / Coordinate Discharge	N/A	1	2	3	4
Coordinates Medical Follow-up	N/A	1	2	3	4
Develop / Implement Health Promotion Plan	N/A	1	2	3	4
Develop / Implement Illness Prevention Plan	N/A	1	2	3	4
Develop / Implement Injury Prevention Plan	N/A	1	2	3	4
Provide Patient Education & Counseling	N/A	1	2	3	4
Documentation to Established Standards	N/A	1	2	3	4
Participate in Quality Assurance Activities	N/A	1	2	3	4
Participate in Audit Activities	N/A	1	2	3	4
Participate in Risk Management Activities	N/A	1	2	3	4
Participate in Research Activities	N/A	1	2	3	4
Policy & Procedure Development	N/A	1	2	3	4
Promote Evidence Based Practice	N/A	1	2	3	4
GENERAL NURSING	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Develop / Provide Clinical Supervision	N/A	1	2	3	4
Education of Health Providers	N/A	1	2	3	4
Supervise Unlicensed Personnel	N/A	1	2	3	4
Vital Sign Monitoring	N/A	1	2	3	4
Pulse Oximetry	N/A	1	2	3	4
Assist with Code / Resuscitation	N/A	1	2	3	4
Automatic External Defibrillator	N/A	1	2	3	4
Portable EKG Monitor	N/A	1	2	3	4
Isolation Techniques	N/A	1	2	3	4
Advance Directives	N/A	1	2	3	4
Pain Assessment / Management	N/A	1	2	3	4
GENERAL SURGERY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Preoperative / Preprocedure Assessment	N/A	1	2	3	4
Obtain/Document Informed Consent	N/A	1	2	3	4
Debridement of Wound	N/A	1	2	3	4
Incision and Drainage	N/A	1	2	3	4
Set-up / Assist Suturing	N/A	1	2	3	4
Suture / Staple Removal	N/A	1	2	3	4
Drain Insertion	N/A	1	2	3	4
Drain Removal	N/A	1	2	3	4
Anoscopy	N/A	1	2	3	4
Hemorrhoid Banding	N/A	1	2	3	4
Use of Doppler	N/A	1	2	3	4
Use of Electrosurgical Cautery	N/A	1	2	3	4
NEUROSURGERY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Assist with Lumbar Puncture	N/A	1	2	3	4
Assist with Trigeminal Nerve Block	N/A	1	2	3	4
Halo Adjustment	N/A	1	2	3	4
Halo Removal	N/A	1	2	3	4
Set up Baclofen Pump Computer	N/A	1	2	3	4
Baclofen Pump Refill & Check	N/A	1	2	3	4
NEUROLOGY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Administration of Imitrex	N/A	1	2	3	4
Administration of Betaserone	N/A	1	2	3	4
Administration of Copaxone	N/A	1	2	3	4
Administration of Avonex	N/A	1	2	3	4
TENS(Transcutaneous Elec. Nerve Stimulator)	N/A	1	2	3	4
ORTHOPEDIC	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Pin Care	N/A	1	2	3	4
Remove External Fixators w/ Pin	N/A	1	2	3	4
Screw-Hardware Removal	N/A	1	2	3	4
Instruct Crutch Walking	N/A	1	2	3	4
Cast Care	N/A	1	2	3	4
Apply Braces (Wrist, Ankle etc.)	N/A	1	2	3	4
RHEUMATOLOGY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Arthrocentesis (Aspiration)	N/A	1	2	3	4
Arthrocentesis (Injection)	N/A	1	2	3	4
Solganol (Gold) Injection	N/A	1	2	3	4
TRANSPLANT	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Liver Biopsy	N/A	1	2	3	4
Kidney Biopsy	N/A	1	2	3	4
Paracentesis	N/A	1	2	3	4
GASTROINTESTINAL	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Assess Bowel Sounds	N/A	1	2	3	4
Assess GI Distress / Bleeding	N/A	1	2	3	4
Insertion / Monitoring NG Tube	N/A	1	2	3	4
CARDIAC	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Perform 12-lead EKG	N/A	1	2	3	4
Application of Holter Monitor	N/A	1	2	3	4
Debridement of Foot Wounds	N/A	1	2	3	4
Attach Leads to Pacemaker Monitor	N/A	1	2	3	4
Distinguish Type of Pacemaker	N/A	1	2	3	4
Collect Data Regarding Pacemaker	N/A	1	2	3	4
Pacemaker Telephone Service	N/A	1	2	3	4
Preoperative Teaching	N/A	1	2	3	4
Coordinate Workup(X-ray, Lab, EKG)	N/A	1	2	3	4
Instruct use of Incentive Spirometer	N/A	1	2	3	4
UROLOGY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Straight / Foley Cath Female	N/A	1	2	3	4
Straight / Foley Cath Male	N/A	1	2	3	4
Obtain / Instruct Clean Catch Urine	N/A	1	2	3	4
Catheterization of Urostomy	N/A	1	2	3	4
Suprapubic Tube	N/A	1	2	3	4
Nephrostomy Tube	N/A	1	2	3	4
Bladder Irrigation and/or Instillation	N/A	1	2	3	4
Cystoscopy	N/A	1	2	3	4
Stent Removal	N/A	1	2	3	4
Bladder Biopsy	N/A	1	2	3	4
Cystometrogram	N/A	1	2	3	4
Prostate Biopsy	N/A	1	2	3	4
Contigen Injection to Bladder Neck	N/A	1	2	3	4
Testosterone Implant	N/A	1	2	3	4
Lupron Therapy for Prostate Cancer	N/A	1	2	3	4
PAP Smears	N/A	1	2	3	4
PULMONARY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Apply Oxygen	N/A	1	2	3	4
Obtain Arterial Blood Gases (ABGs)	N/A	1	2	3	4
Interpret ABGs	N/A	1	2	3	4
Thoracentesis	N/A	1	2	3	4
Trach Care / Suctioning	N/A	1	2	3	4
Home Oxygen Use	N/A	1	2	3	4
Metered Dose Inhaler	N/A	1	2	3	4
Aerochamber	N/A	1	2	3	4
Peak Flow Meter	N/A	1	2	3	4
DERM & DERM SURGERY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Shave Biopsy	N/A	1	2	3	4
Punch Biopsy	N/A	1	2	3	4
Excisional Biopsy	N/A	1	2	3	4
Scissor Biopsy	N/A	1	2	3	4
Electrodesiccation & Curettage (ED&C)	N/A	1	2	3	4
Excision	N/A	1	2	3	4
Unna Boot	N/A	1	2	3	4
Patch Test	N/A	1	2	3	4
Phototherapy	N/A	1	2	3	4
Dermabrasion / Microdermabrasion	N/A	1	2	3	4
Nail Surgery	N/A	1	2	3	4
IM Methotrexate Injection	N/A	1	2	3	4
IM Steroid Injection	N/A	1	2	3	4
Moh's Surgery / Chemo	N/A	1	2	3	4
Moh's Surgery Closure	N/A	1	2	3	4
Evacuation of Hematoma / Seroma	N/A	1	2	3	4
Excision of Lesions and Masses	N/A	1	2	3	4
Application of Dressings	N/A	1	2	3	4
Application of Burn Dressings	N/A	1	2	3	4
Total Body UVB Unit (Narrow Band)	N/A	1	2	3	4
Total Body UVB Unit (Broad Band)	N/A	1	2	3	4
Portable UVB Unit	N/A	1	2	3	4
Total Body UVA Unit	N/A	1	2	3	4
Portable UVA Unit	N/A	1	2	3	4
Pulsed Dye Laser	N/A	1	2	3	4
Argon Laser	N/A	1	2	3	4
CO2 Laser	N/A	1	2	3	4
Versa Pulse Laser	N/A	1	2	3	4
PAIN MANAGEMENT	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Trigger Point Injections	N/A	1	2	3	4
Cervical Epidural	N/A	1	2	3	4
Lumbar Epidural	N/A	1	2	3	4
Stellate Ganglian Block	N/A	1	2	3	4
Bier Block	N/A	1	2	3	4
Axillary Block	N/A	1	2	3	4
Thoracic Epidural	N/A	1	2	3	4
Lidocaine Infusion Test	N/A	1	2	3	4
Implantable Narcotic Pump Refill	N/A	1	2	3	4
Caudal	N/A	1	2	3	4
Selective Nerve Root Blocks	N/A	1	2	3	4
Facet Joint Blocks	N/A	1	2	3	4
Celiac Plexus Blocks	N/A	1	2	3	4
Use of Pneumatic Tourniquet	N/A	1	2	3	4
Cryo-Analgesia Machine	N/A	1	2	3	4
MEDS / IV THERAPY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Administer PO Medications	N/A	1	2	3	4
Administer IM & SQ Meds	N/A	1	2	3	4
Peripheral IV Insertion	N/A	1	2	3	4
Discontinue Peripheral IVs	N/A	1	2	3	4
Administer IV Medications	N/A	1	2	3	4
Needle-less Systems	N/A	1	2	3	4
Access / Care of Central Lines	N/A	1	2	3	4
Access / Care of Ports	N/A	1	2	3	4
Removal of Central Lines	N/A	1	2	3	4
Access / Care of PICC Line	N/A	1	2	3	4
Removal of PICC Line	N/A	1	2	3	4
Draw Blood for Lab Studies	N/A	1	2	3	4
Administer / Monitor Conscious Sedation	N/A	1	2	3	4
PLASTICS	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Liposuction	N/A	1	2	3	4
Blepharoplasty / Rhytidectomy	N/A	1	2	3	4
Excision of Lesions & Masses	N/A	1	2	3	4
Laser Procedures	N/A	1	2	3	4
Nipple Reconstruction	N/A	1	2	3	4
Tissue Expansion	N/A	1	2	3	4
Assess Allergies / Latex Allergies	N/A	1	2	3	4
ENDOCRINOLOGY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Specialized Endocrine Tests	N/A	1	2	3	4
Thyroid Aspirate / Biopsy	N/A	1	2	3	4
Insulin Provacative Test (Triple Test)	N/A	1	2	3	4
TB Skin Testing	N/A	1	2	3	4
Use of Accucheck Monitor	N/A	1	2	3	4
Diabetic Teaching	N/A	1	2	3	4
ENT	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Sinus Irrigation	N/A	1	2	3	4
Ear Biopsy	N/A	1	2	3	4
Ear Irrigation w/ Hi Pressure Syringe	N/A	1	2	3	4
Nose Biopsy	N/A	1	2	3	4
Mouth Biopsy	N/A	1	2	3	4
Myringotomy with Tubes	N/A	1	2	3	4
Myringotomy without Tubes	N/A	1	2	3	4
Closed Reduction of Nasal Fracture	N/A	1	2	3	4
Fiberoptic Laryngoscopy	N/A	1	2	3	4
Facial Nerve Monitor Stimulation	N/A	1	2	3	4
Maloney Esophageal Dilatation	N/A	1	2	3	4