Nurse Practitioner Skills Checklist Date:* Name: (First, MI, Last)* Email GENERAL NURSE PRACTITIONERObtain Complete Health History* N/A Inexperienced Limited Experience Experienced Highly Experienced Perform Complete Physical Exam* N/A Inexperienced Limited Experience Experienced Highly Experienced Order / Perform Diagnostic Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Order / Perform Diagnostic Tests* N/A Inexperienced Limited Experience Experienced Highly Experienced Interpret Clinical Findings* N/A Inexperienced Limited Experience Experienced Highly Experienced Develop Differential Diagnoses* N/A Inexperienced Limited Experience Experienced Highly Experienced Develop Health Care Problems Lists* N/A Inexperienced Limited Experience Experienced Highly Experienced Develop / Implement Plan for Client* N/A Inexperienced Limited Experience Experienced Highly Experienced Identify / Use Available Resources* N/A Inexperienced Limited Experienced Experienced Highly Experienced Arrange Referrals / Consults* N/A Inexperienced Limited Experience Experienced Highly Experienced Prescribe Specific Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Prescribe Specific Therapeutic Interventions* N/A Inexperienced Limited Experience Experienced Highly Experienced Authorize / Coordinate Admission* N/A Inexperienced Limited Experience Experienced Highly Experienced Authorize / Coordinate Discharge* N/A Inexperienced Limited Experience Experienced Highly Experienced Coordinates Medical Follow-up* N/A Inexperienced Limited Experience Experienced Highly Experienced Develop / Implement Health Promotion Plan* N/A Inexperienced Limited Experience Experienced Highly Experienced Develop / Implement Illness Prevention Plan* N/A Inexperienced Limited Experience Experienced Highly Experienced Develop / Implement Injury Prevention Plan* N/A Inexperienced Limited Experience Experienced Highly Experienced Provide Patient Education & Counseling* N/A Inexperienced Limited Experience Experinced Highly Experienced Documentation to Established Standards* N/A Inexperienced Limited Experience Experienced Highly Experienced Participate in Quality Assurance Activities* N/A Inexperienced Limited Experience Experienced Highly Experienced Participate in Audit Activitates* N/A Inexperienced Limited Experience Experienced Highly Experienced Participates in Risk Management Activities* N/A Inexperienced Limited Experience Experienced Highly Experienced Participate in Research Activities* N/A Inexperienced Limited Experience Experienced Highly Experienced Policy & Procedure Development* N/A Inexperienced Limited Experience Experienced Highly Experienced Promote Evident Based Practice* N/A Inexperienced Limited Experienced Experienced Highly Experienced GENERAL NURSINGDevelop / Provide Clinical* N/A Inexperienced Limited Experienced Experienced Highly Experienced Education of Health Providers* N/A Inexperienced Limited Experience Experienced Highly Experienced Supervise Unlicensed Personnel* N/A Inexperienced Limited Experience Experienced Highly Experienced Vital Sign Monitoring* N/A Inexperienced Limited Experience Experienced Highly Experienced Pulse Oximetry* N/A Inexperienced Limited Experience Experienced Highly Experienced Assist with Code / Resuscitation* N/A Inexperienced Limited Experience Experienced Highly Experienced Automatic External Defibrillator* N/A Inexperienced Limited Experienced Experienced Highly Experienced Portable EKG Monitor* N/A Inexperienced Limited Experience Experienced Highly Experienced Isolation Techniques* N/A Inexperienced Limited Experience Experienced Highly Experienced Advances Directives* N/A Inexperienced Limited Experience Experienced Highly Experienced Pain Assessment / Management* N/A Inexperienced Limited Experience Experienced Highly Experienced GENERAL SURGERYPreoperative / Preprocedure Assessment* N/A Inexperienced Limited Experience Experienced Highly Experienced Obtain / Document Informed Consent* N/A Inexperienced Limited Experience Experienced Highly Experienced Debridement of Wound* N/A Inexperienced Limited Experience Experienced Highly Experienced Incision and Drainage* N/A Inexperienced Limited Experience Experienced Highly Experienced Set-up / Assist Suturing* N/A Inexperienced Limited Experience Experienced Highly Experienced Suture / Staple Removal* N/A Inexperienced Limited Experience Experienced Highly Experienced Drain Insertion* N/A Inexperienced Limited Experience Experienced Highly Experienced Drain Removal* N/A Inexperienced Limited Experience Experienced Highly Experienced Anoscopy* N/A Inexperienced Limited Experience Experienced Highly Experienced Hemorrhoid Banding* N/A Inexperienced Limited Experience Experienced Highly Experienced Use of Doppler* N/A Inexperienced Limited Experience Experienced Highly Experienced Use of Electrosurgical* N/A Inexperienced Limited Experience Experienced Highly Experienced NEUROSURGERYAssist with Lumbar Puncture* N/A Inexperienced Limited Experience Experienced Highly Experienced Assist with Trigeminal Nerve Block* N/A Inexperienced Limited Experience Experienced Highly Experienced Halo Adjustment* N/A Inexperienced Limited Experience Experienced Highly Experienced Halo Removal* N/A Inexperienced Limited Experience Experienced Highly Experienced Set up Baclofen Pump Computer* N/A Inexperienced Limited Experience Experienced Highly Experienced NEUROLOGYAdministration of Imitrex* N/A Inexperienced Limited Experienced Experienced Highly Experienced Administration of Betaserone* N/A Inexperienced Limited Experienced Experienced Highly Experienced Administration of Copaxone* N/A Inexperienced Limited Experienced Experienced Highly Experienced Administration of Avonex* N/A Inexperienced Limited Experienced Experienced Highly Experienced TENS (Transcutaneous Elec. Nerve Stimulator)* N/A Inexperienced Limited Experienced Experienced Highly Experienced ORTHOPEDICPin Care* N/A Inexperienced Limited Experience Experienced Highly Experienced Remove External Fixators w/ Pin* N/A Inexperienced Limited Experience Experienced Highly Experienced Screw-Hardware Removal* N/A Inexperienced Limited Experience Experienced Highly Experienced Instruct Crutch Walking* N/A Inexperienced Limited Experience Experienced Highly Experienced Cast Care* N/A Inexperienced Limited Experience Experienced Highly Experienced Apply Braces (Wrist, Ankle etc.)* N/A Inexperienced Limited Experience Experienced Highly Experienced RHEUMATOGOLYArthrocentesis (Aspiration)* N/A Inexperienced Limited Experience Experienced Highly Experienced Arthrocentesis (Injection)* N/A Inexperienced Limited Experience Experienced Highly Experienced Solganol (Gold) Injection* N/A Inexperienced Limited Experience Experienced Highly Experienced TRANSPLANTLiver Biopsy* N/A Inexperienced Limited Experienced Experienced Highly Experienced Kidney Biopsy* N/A Inexperienced Limited Experienced Experienced Highly Experienced Paracentesis* N/A Inexperienced Limited Experienced Experienced Highly Experienced GASTROINTESTINALAssess Bowel Sounds* N/A Inexperienced Limited Experience Experienced Highly Experienced Assess GI Distress / Bleeding* N/A Inexperienced Limited Experience Experienced Highly Experienced Insertion / Monitoring NG Tube* N/A Inexperienced Limited Experience Experienced Highly Experienced CARDIACPerform 12-lead EKG* N/A Inexperienced Limited Experience Experienced Highly Experienced Application of Holter Monitor* N/A Inexperienced Limited Experience Experienced Highly Experienced Debridement of Foot Wounds* N/A Inexperienced Limited Experience Experienced Highly Experienced Attach Leads to Pacemaker Monitor* N/A Inexperienced Limited Experience Experienced Highly Experienced Distinguish Type of Pacemaker* N/A Inexperienced Limited Experience Experienced Highly Experienced Collect Data Regarding Pacemaker* N/A Inexperienced Limited Experience Experienced Highly Experienced Pacemaker Telephone Service* N/A Inexperienced Limited Experience Experienced Highly Experienced Preoperative Teaching* N/A Inexperienced Limited Experience Experienced Highly Experienced Coordinate Workup (X-ray, Lab, EKG)* N/A Inexperienced Limited Experience Experienced Highly Experienced Instruct use of Incentive Spirometer* N/A Inexperienced Limited Experience Experienced Highly Experienced UROLOGYStraight / Foley Cath Female* N/A Inexperienced Limited Experience Experienced Highly Experienced Straight / Foley Cath Male* N/A Inexperienced Limited Experience Experienced Highly Experienced Obtain / Instruct Clean Catch Urine* N/A Inexperienced Limited Experience Experienced Highly Experienced Catheterization of Urostomy* N/A Inexperienced Limited Experience Experienced Highly Experienced Suprapubis Tube* N/A Inexperienced Limited Experience Experienced Highly Experienced Nephrostromy Tube* N/A Inexperienced Limited Experience Experienced Highly Experienced Bladder Irrigation and/or Instillation* N/A Inexperienced Limited Experience Experienced Highly Experienced Cystoscopy* N/A Inexperienced Limited Experience Experienced Highly Experienced Stent Removal* N/A Inexperienced Limited Experience Experienced Highly Experienced Bladder Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Cystometrogram* N/A Inexperienced Limited Experience Experienced Highly Experienced Prostate Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Contigen Injection to Bladder Neck* N/A Inexperienced Limited Experience Experienced Highly Experienced Testosterone Implant* N/A Inexperienced Limited Experience Experienced Highly Experienced Lupron Therapy for Prostate Cancer* N/A Inexperienced Limited Experience Experienced Highly Experienced PAP Smears* N/A Inexperienced Limited Experience Experienced Highly Experienced PULMONARYApply Oxygen* N/A Inexperienced Limited Experience Experienced Highly Experienced Obtain Arterial Blood Gases (ABGs)* N/A Inexperienced Limited Experience Experienced Highly Experienced Interpret ABGs* N/A Inexperienced Limited Experience Experienced Highly Experienced Thoracentesis* N/A Inexperienced Limited Experience Experienced Highly Experienced Trach Care / Suctioning* N/A Inexperienced Limited Experience Experienced Highly Experienced Home Oxygen Use* N/A Inexperienced Limited Experience Experienced Highly Experienced Metered Dose Inhaler* N/A Inexperienced Limited Experience Experienced Highly Experienced Aerochamber* N/A Inexperienced Limited Experience Experienced Highly Experienced Peak Flow Meter* N/A Inexperienced Limited Experience Experienced Highly Experienced DERM & DERM SURGERYShave Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Punch Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Excisional Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Scissor Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Electrodesiccation & Curettage (ED&C)* N/A Inexperienced Limited Experience Experienced Highly Experienced Excision* N/A Inexperienced Limited Experience Experienced Highly Experienced Unna Boot* N/A Inexperienced Limited Experience Experienced Highly Experienced Patch Test* N/A Inexperienced Limited Experience Experienced Highly Experienced Phototherapy* N/A Inexperienced Limited Experience Experienced Highly Experienced Dermabrasion / Microdermabraion* N/A Inexperienced Limited Experience Experienced Highly Experienced Nail Surgery* N/A Inexperienced Limited Experience Experienced Highly Experienced IM Methotrexate Injection* N/A Inexperienced Limited Experience Experienced Highly Experienced IM Steroid Injection* N/A Inexperienced Limited Experience Experienced Highly Experienced Moh's Surgery / Chemo* N/A Inexperienced Limited Experience Experienced Highly Experienced Moh's Surgery Closure* N/A Inexperienced Limited Experience Experienced Highly Experienced Evacuation of Hermtoma / Seroma* N/A Inexperienced Limited Experience Experienced Highly Experienced Excision of Lesions and Masses* N/A Inexperienced Limited Experience Experienced Highly Experienced Application of Dressings* N/A Inexperienced Limited Experience Experienced Highly Experienced Application of Burn Dressings* N/A Inexperienced Limited Experience Experienced Highly Experienced Total Body UVB Unit (Narrow Band)* N/A Inexperienced Limited Experience Experienced Highly Experienced Total Body UVB Unit (Broad Band)* N/A Inexperienced Limited Experience Experienced Highly Experienced Portable UVB Unit* N/A Inexperienced Limited Experience Experienced Highly Experienced Total Body UVA Unit* N/A Inexperienced Limited Experience Experienced Highly Experienced Portable UVA Unit* N/A Inexperienced Limited Experience Experienced Highly Experienced Pulsed Dye Laser* N/A Inexperienced Limited Experience Experienced Highly Experienced Argon Laser* N/A Inexperienced Limited Experience Experienced Highly Experienced CO2 Laser* N/A Inexperienced Limited Experience Experienced Highly Experienced Versa Pulse Laser* N/A Inexperienced Limited Experience Experienced Highly Experienced PAIN MANAGEMENTTrigger Point Injections* N/A Inexperienced Limited Experience Experienced Highly Experienced Cervical Epidural* N/A Inexperienced Limited Experience Experienced Highly Experienced Lumbar Epidural* N/A Inexperienced Limited Experience Experienced Highly Experienced Stellate Ganglian Block* N/A Inexperienced Limited Experience Experienced Highly Experienced Bier Block* N/A Inexperienced Limited Experience Experienced Highly Experienced Axillary Block* N/A Inexperienced Limited Experience Experienced Highly Experienced Thoracic Epidural* N/A Inexperienced Limited Experience Experienced Highly Experienced Lidocaine Infusion Test* N/A Inexperienced Limited Experience Experienced Highly Experienced Implantablw Narcotic Pump Refill* N/A Inexperienced Limited Experience Experienced Highly Experienced Caudal* N/A Inexperienced Limited Experience Experienced Highly Experienced Selective Nerve Root Blocks* N/A Inexperienced Limited Experience Experienced Highly Experienced Facet Joint Blocks* N/A Inexperienced Limited Experience Experienced Highly Experienced Celiac Plexus Blocks* N/A Inexperienced Limited Experience Experienced Highly Experienced Use of Pneumatic Tourniquet* N/A Inexperienced Limited Experience Experienced Highly Experienced Cryo-Analgesia Machine* N/A Inexperienced Limited Experience Experienced Highly Experienced MEDS / IV THERAPYAdminister PO Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Administer IM & SQ Meds* N/A Inexperienced Limited Experience Experienced Highly Experienced Peripheral IV Insertion* N/A Inexperienced Limited Experience Experienced Highly Experienced Discontinue Peripheral IVs* N/A Inexperienced Limited Experience Experienced Highly Experienced Administer IV Medications* N/A Inexperienced Limited Experience Experienced Highly Experienced Needle-less Systems* N/A Inexperienced Limited Experience Experienced Highly Experienced Access / Care of Central Lines* N/A Inexperienced Limited Experience Experienced Highly Experienced Access / Care of Ports* N/A Inexperienced Limited Experience Experienced Highly Experienced Removal of Central Lines* N/A Inexperienced Limited Experience Experienced Highly Experienced Access / Care of PICC Line* N/A Inexperienced Limited Experience Experienced Highly Experienced Removal of PICC Line* N/A Inexperienced Limited Experience Experienced Highly Experienced Draw Blood for Lab Studies* N/A Inexperienced Limited Experience Experienced Highly Experienced Administer / Monitor Conscious Sedation* N/A Inexperienced Limited Experience Experienced Highly Experienced PLASTICSLiposuction* N/A Inexperienced Limited Experience Experienced Highly Experienced Blepharoplasty / Rhytidectomy* N/A Inexperienced Limited Experience Experienced Highly Experienced Excision of Lesions & Masses* N/A Inexperienced Limited Experience Experienced Highly Experienced Laser Procedures* N/A Inexperienced Limited Experience Experienced Highly Experienced Nipple Reconstruction* N/A Inexperienced Limited Experience Experienced Highly Experienced Tissue Expansion* N/A Inexperienced Limited Experience Experienced Highly Experienced Assess Allergies / Latex Allergies* N/A Inexperienced Limited Experience Experienced Highly Experienced ENDOCRINOLOGYSpecialized Endocrine Tests* N/A Inexperienced Limited Experience Experienced Highly Experienced Thyroid Aspirate / Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Insulin Provacative Test (Triple Test)* N/A Inexperienced Limited Experience Experienced Highly Experienced TB Skin Testing* N/A Inexperienced Limited Experience Experienced Highly Experienced Use of Accucheck Monitor* N/A Inexperienced Limited Experience Experienced Highly Experienced Diabetic Teaching* N/A Inexperienced Limited Experience Experienced Highly Experienced ENTSinus Irrigation* N/A Inexperienced Limited Experience Experienced Highly Experienced Ear Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Ear Irrigation w/ Hi Pressure Syringe* N/A Inexperienced Limited Experience Experienced Highly Experienced Nose Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Mouth Biopsy* N/A Inexperienced Limited Experience Experienced Highly Experienced Myringotomy with Tubes* N/A Inexperienced Limited Experience Experienced Highly Experienced Closed Reduction of Nasal Fraction* N/A Inexperienced Limited Experience Experienced Highly Experienced Myringotomy without Tubes* N/A Inexperienced Limited Experience Experienced Highly Experienced Fiberoptic Laryngoscopy* N/A Inexperienced Limited Experience Experienced Highly Experienced Facial Nerve Monitor Stimulation* N/A Inexperienced Limited Experience Experienced Highly Experienced Maloney Esophageal Dilatation* N/A Inexperienced Limited Experience Experienced Highly Experienced BLS MM slash DD slash YYYY ACLS MM slash DD slash YYYY Telemetry Certificate MM slash DD slash YYYY ONS Chemo/Biotherapy Certification MM slash DD slash YYYY Other Chemo Certification MM slash DD slash YYYY Areas of Expertise:Consent* By submitting this form, I agree to all terms and conditions and agree to authorize consent NameThis field is for validation purposes and should be left unchanged.