This checklist was electronically signed on
July 25, 2026
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
Work Settings
SET UP/INITIATE DIALYSIS TREATMENT
ASSESSMENT DURING DIALYSIS
PATIENT MANAGEMENT
DIALYSIS EQUIPMENT
PROFESSIONAL KNOWLEDGE AND SKILLS
AGE SPECIFIC COMPETENCIES