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1 NURSE PRACTITIONER SKILLS CHECKLIST Name: Date: 1. No experience for the stated task 2. Familiar with the state task 3. Experience in the stated task 4. Expert in the state task General Nurse Practitioner Obtain complete health history Perform complete physical exam Order/perform diagnostic procedures Order/perform diagnostic test Interpret clinical findings Develop differential diagnosis Develop health care problems list Develop/implement plan for client Arrange referrals/consults Prescribe specific medications Prescribe therapeutic interventions Authorize/coordinate admissions Authorize/coordinate discharge Provide patient education/counseling Participate in risk management Policy and procedure development Promot evidence based practice Speciality Areas ASHA (arteriosclerotic heart disease) Dyslipidemia Osteomyelititis PVD (periopheral vascular disease) HTN (hypertension) Peripheral Neuropathy Diabetes Orthopedics Emergency department Neuro Surgery Assist with lumbar puncture Assist with trigeminal nerve block Halo adjust 1 P a g e
2 Halo removal Baclofen Pump refill & check Set up Baclofen Pump computer Transplant Liver Biopsy Kidney Biopsy Paracentesis General Surgery Perioperative/preprocedure assessment Obtain/document informed consent Debridement of wound Incision and drainedge Set up/assist suturing Suture/staple removal Drain insertion Drain removal Minor surgery Anoscopy Hemorrhoid banding Use of Doppler Use of electrosurgical cautery Orthopedic Pin Care Remove External Fixators w/pin Screw Hardware Removal Instruct Crutch Walking Cast Care Apply Braces (Wrist, Ankle, etc) Apply Imobilizers (Clavicle, Knee, etc) Rheumatology Arthrocentesis (Aspiration) Arthrocentesis (Injection) Solganol (Gold) Injection Gastrointestinal Assess Bowel Sounds Assess GI Distress/Bleeding Insertion/Monitoring NG Tube 2 P a g e
3 Cardiac Perform 12-lead EKG Application of Halter Monitor Debridement of Foot Wounds Pacemaker Testing Equipment Attach leads to pacemaker monitor Distinguish type of pacemaker Collect data regarding pacemaker Pacemaker telephone service Vascular Preop Prep & Teaching Preoperative Teaching Coordinate Workup (Xray, lab, EKG, etc) Instruct use of Incentive Spirometer Pulmonary Apply Oxygen Obtain Arterial Blood Gases (ABGs) Interpret ABGs Thoracentesis Trach Care/Suctioning Instruct Patient/Family Regarding: Home oxygen use Metered dose inhaler Aerochamber Peak flow meter Thera positive expir. Pressure therapy Pain Management Trigger point injections Cervical epidural Lumbar epidural Stellate ganglian block Bier block Axillary block Thoracic Epidural Lidocaine infusion test Implantable narcotic pump refill Cadual Selective nerve root blocks Facet joint blocks Celiac plexus blocks Use of pneumatic tourniquet Cryo-analgesia machine 3 P a g e
4 Meds/IV Therapy Administer PO medications Administer IM & SQ meds Peripheral IV insertion Discontinue peripheral IVs Administer IV medications Needle-less systems Access/care of central lines Access/care of ports Removal of central lines Access/care of PICC line Removal of PICC line Draw blood for lab studies Administer/monitor conscious sedation Assess allergies/latex allergies Urology Straight/Foley Cath Female Straight/Foley Cath Male Obtain/Instruct Clean Catch Urine Catheterization of Urostomy Suprapubic Tube Nephrostomy Tube Bladder Irrigation and/or Instillation Cystocopy Stent Removal Bladder Biopsy Cystometrogram Prostate Biopsy Urethral Dilation Contigen Injection to Bladder Neck Testosterone Implant Lupron Therapy for Prostate Cancer PAP Smears Derm & Derm Surgery Shave biopsy Punch biopsy Excisional biopsy Scissor biopsy Electrodesiccation & Curettage (ED&C() Excision Unna Boot Patch Test 4 P a g e
5 Phototherapy Dermabrasion/Microdermabrasion Nail Surgery IM Methotrexate Injection IM Steroid Injection Moh s Surgery/Chemo Moh s Surgery Closure Evacuation of Hematoma/Seroma Excision of Lesions and Masses Application of Dressings Application of Burn Dressings Use of Equipment per instructions: Total Body UVB Unit ( Narrow Band) Total Body UVB Unit ( Broad Band) Portable UVB Unit Total Body UVB Unit Pulsed Dye Laser Argon Laser CO2 Laser Versa Pulse Laser Plastics Liposuction Blepharoplasty/Rhytidectomy Excision of Lesions & Masses Laser Procedures Nipple Reconstruction Tissue Expansion Endocrinology Specialized Endocrine Tests Thyroid Aspirate/Biopsy Insulin Provacative Test (Triple Test) TK Skin Testing Use of Accucheck Monitor Diabetic Teaching Maxillofacial Maxillofacial Prosthetics Prosthodontics-Restorative Dentistry Preventative Care Sterlization & Infection Control Patient Teaching Follow Up Care 5 P a g e
6 ENT Sinus Irrigation Ear Biopsy Ear Irrigation w/hi Pressure Syringe Nose Biopsy Mouth Biopsy Myringotomy with Tubes Myringotomy without Tubes Closed Reduction of Nasal Fracture Fiberoptic Laryngoscopy Facial Nerve Monitor Stimulation Maloney Esophageal Dilation Drug Therapy OTC drugs Herbal drugs Pharmacology Pharmacokeninetics Drug interactions/side effects Allergic/Anaphaylaxis Reactions Age-Appropriate Care: Ability to adapt care to incorporate normal growth and development, adapt method and terminology of client instructions as it relates to the age and comprehension level of the client, and to ensure a safe environment reflecting specific needs of the client and various age groups. Age Newborn (birth-30 days) Infant (30 days 1 year) Toddler (1-3 ears) Preschooler (3-5 years) School Age (5-12 years) Adolescents (12-18 years) Young Adults (18-39 years) Middle Adults (39-64 years) Older Adults (64+ years) The information I have given is true and accurate to the best of my knowledge, and I hereby authorize the Agency to release this Skills Checklist to staffing clients of Agency as requested. Submit this skills self-evaluation with your initial application. To be updated annually. Signature Date Print Name & Title Agency Representative Signature 6 P a g e
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* The following grid only identifies items that require preapproval from. Breast Pumps Notes: No preapproval required for 1st month rental; beyond one month rental requires preapproval Genetic Testing