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
APPROPRIATE PPE FOR THE FOLLOWING SCENARIOS
NEUROLOGICAL ASSESSMENT
NEUROLOGICAL EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH NEUROLOGICAL DISEASE
PULMONARY ASSESSMENT
INTERPRETATION OF PULMONARY LABORATORY RESULT
PULMONARY EQUIPMENT AND PROCEDURES
IDENTIFICATION / INTERVENTION FOR RESPIRATORY COMPLICATIONS
CARE OF PATIENT WITH PULMONARY DISEASE
CARDIOVASCULAR ASSESSMENT
INTERPRETATION OF CARDIOVASCULAR LABORATORY RESULTS
CARDIOVASCULAR EQUIPMENT AND PROCEDURES
HEMODYNAMIC MONITORING
CARDIOVASCULAR MONITORING
CARE OF PATIENT WITH CARDIOVASCULAR DISEASE
GASTROINTESTINAL ASSESSMENT
INTERPRETATION OF GASTROINTESTINAL LABORATORY RESULTS
GASTROINTESTINAL EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH GASTROINTESTINAL DISEASE
RENAL/GENITOURINARY ASSESSMENT
INTERPRETATION OF RENAL/GENITOURINARY LABORATORY RESULTS
RENAL/GENITOURINARY EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH RENAL/GENITOURINARY DISEASE
INTERPRETATION OF ENDOCRINE/METABOLIC LABORATORY RESULTS
ENDOCRINE/METABOLIC EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH ENDOCRINE/METABOLIC DISEASE
WOUND ASSESSMENT
WOUND/TRAUMA/BURN MANAGEMENT EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH WOUND/TRAUMA/BURNS
PAIN MANAGEMENT
CARE OF PATIENT WITH PAIN
MISCELLANEOUS
PHLEBOTOMY/IV THERAPY EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH IV LINES
MEDICATION
AUTOMATED MEDICATION DISPENSING SYSTEMS
ELECTRONIC DOCUMENTATION
AGE-SPECIFIC COMPETENCIES