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
ENT AND MOUTH – CARE OF PATIENT WITH
NEUROLOGY – CARE OF PATIENT WITH
SENSORY DEFICITS – CARE OF PATIENT WITH
CARDIAC – CARE OF PATIENT WITH
RESPIRATORY – CARE OF PATIENT WITH
ENDOCRINE – CARE OF PATIENT WITH
GASTROINTESTINAL – CARE OF PATIENT WITH
RENAL/GENITOURINARY – CARE OF PATIENT WITH
OB-GYN – CARE OF PATIENT WITH
ORTHOPEDIC – CARE OF PATIENT WITH
INTEGUMENTARY/SKIN – CARE OF PATIENT WITH
GENERAL PATIENT CARE
CLINICAL SETTINGS
EQUIPMENTS
SPECIMEN COLLECTION
NURSING PROCEDURES
MEDICATIONS
AUTOMATED MEDICATION DISPENSING SYSTEMS
ELECTRONIC DOCUMENTATION
AGE-SPECIFIC COMPETENCIES