This checklist was electronically signed on
September 12, 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
PATIENT RIGHTS
COMMUNICATION
GENERAL INFECTION CONTROL MEASURES
TRANSMISSION-BASED PROTOCOL
PERFORMANCE MANAGEMENT
STAFF DEVELOPMENT
RELATIONSHIP MANAGEMENT
STAFF RETENTION
HUMAN RESOURCE MANAGEMENT
PERFORMANCE IMPROVEMENT
CUSTOMER AND PATIENT ENGAGEMENT
PATIENT SAFETY
PROFESSIONAL DEVELOPMENT
CHANGE MANAGEMENT
PROJECT MANAGEMENT
CONTINGENCY PLAN
COMMUNICATION
FINANCIAL MANAGEMENT
AUTOMATED MEDICATION DISPENSING SYSTEMS
ELECTRONIC DOCUMENTATION
AGE-SPECIFIC COMPETENCIES