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
SET UP AND INITIATE DIALYSIS TREATMENT
ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS
CARE OF PATIENTS WITH
WATER TREATMENT PROCEDURES
MACHINE ALARM TROUBLESHOOTING PROCEDURES
EXPERIENCE
EMERGENCIES
MISCELLANEOUS
ELECTRONIC DOCUMENTATION
AGE SPECIFIC COMPETENCIES