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
TRANSMISSION-BASED PROTOCOL
NEUROLOGICAL ASSESSMENT
NEUROLOGICAL EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH NEUROLOGICAL DISEASE
PULMONARY ASSESSMENT
PULMONARY EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH PULMONARY DISEASE
CARDIOVASCULAR ASSESSMENT
CARDIOVASCULAR EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH CARDIOVASCULAR DISEASE
ORTHOPEDICS EQUIPMENT AND PROCEDURES
GASTROINTESTINAL ASSESSMENT
GASTROINTESTINAL EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH GASTROINTESTINAL DISEASE
RENAL/GENITOURINARY ASSESSMENT
RENAL/GENITOURINARY EQUIPMENT & PROCEDURES
CARE OF PATIENT WITH RENAL/GENITOURINARY DISEASE
ENDOCRINE/METABOLIC ASSESSMENT
ENDOCRINE/METABOLIC EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH ENDOCRINE/METABOLIC DISEASE
WOUND ASSESSMENT
WOUND EQUIPMENT AND PROCEDURES
CARE OF PATIENT WITH PAIN
ELECTRONIC DOCUMENTATION
ORTHOPEDICS ASSESSMENT
CARE OF PATIENT WITH WOUND
MEDICATIONS
ATOMATED MEDICATION DISPENSING SYSTEMS
AGE-SPECIFIC COMPETENCIES