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
APPROPRIATE PPE FOR THE FOLLOWING SCENARIOS
REGULATORY AGENCIES/STANDARDS OF CARE AGENCIES
PROFESSIONAL PRACTICE
VITAL SIGNS/ INTAKE and OUTPUT MONITORING
INTERDISCIPLINARY COMMUNICATION
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Communicate with patients and their companions in a courteous manner using age and cultural appropriate methods. |
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Understand the chain of communication, who to contact, and when. |
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Listen actively to patient concerns and address them appropriately. |
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Perform and maintain accurate patient records and documentation related to nursing interventions, plan of care, nursing diagnoses. |
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Maintain patient confidentiality according to HIPAA guidelines i.e.: status updates to family members. |
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Implement effective solutions for communication with patients when barriers exist i.e.: physiological, cultural, language. |
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Anticipate needs of patient, doctors, and other members of the team i.e.: equipment, supplies, instruments, etc. |
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SAFETY/ENVIRONMENT OF CARE
EMERGENCY MANAGEMENT/ANESTHESIA
INFECTION CONTROL
NUTRITION/HYDRATION
OBSERVATIONS/REPORTING/DOCUMENTATION
OXYGEN THERAPY
PERSONAL CARE
PROVISION OF CARE
TECHNOLOGY
SAFETY DEVICES
USE OF ANCILLARY EQUIPMENTS
ELECTRONIC DOCUMENTATION
AGE-SPECIFIC COMPETENCIES