Nurse Practitioner NP skills checklist - Freedom …

1 Page 1of 4 This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment withFreedom SCALE1. No Experience 2. Need Training 3. Able to perform with supervision 4. Able to perform independentlyProficiencyScale1234 ProficiencyScale1234 Areas Worked:Specialty:Emergency ASHD (arteriosclerotic heart disease)Inpatient careCardiacUrgent careDyslipidemiaPrivate practiceGastroenterologyHMOO steomyelitisMD officePVD (peripheral vascular disease)SchoolsHTN (hypertension)Health departmentPeripheral neuropathyAmbulatory clinicDiabetesRural health clinicOrthopedicPsychiatric facility Emergency departmentCorrectional facilityOther (list):Mobile medical unitCorporate worksiteExperience with.

2 Health departmentOxygen administrationOccupational healthLiquid oxygenNursing home/ Long term care facility Naso-gastric tubesWomen s health clinicIPPB machine use (C-PAP)Government health agencyDiabetesAcute care hospitalCatheter careOther (list): ContracturesIncontinence care-bowel/bladderPatient populationDermal ulcersNeo-natalEnemas/ Suppositories/ Fecal impactionPediatricInjectionsAdolescentSt aph infectionsAdultTracheotomiesGeriatricWou nd careMigrant WorkersBedridden residentsHomelessNurse Practitioner (NP) skills checklist Nurse PractitionerSkills ChecklistPage 2of 4 ProficiencyScale1234 ProficiencyScale1234 Experience with:Collaboration (continued).

3 Pap smearsDrug therapyVisual acuityPrescriptionAudiometryOver the counter (OTC)Tym-panometryKnowledge of pharmacologySplinting of extremitiesKnowledge of pharmacokineticsInterpreting 12 lead EKG sKnowledge of drug interactionsInterpret ABG (blood gases)Knowledge of side effectsLocal infiltrationKnowledge of potential adverse reactionsSingle layer wound closureAllergic reactionsFlouresceinstaining of eyesAnaphylaxis reactionRadiographic interpretation (initial)Dispensing medicationsIncision and drainageMonitoring drug therapyExcisionsManagement of controlled substancesIntubations(DEA)Comprehensive physical assessmentAcute disease conditionNon-pharmacologic interventionsChronic disease conditionsMedical nutrition therapyFamily historyExerciseDifferential diagnosisCessation of substance abuse (alcohol, tobacco)Order, may perform, and interpretscreening and diagnostic testsMental health issues (stress management,depression)Informed consentObesity managementExplanation to patient/ familyOther (list):DocumentationVenipunctureMiscella neous.

4 Urine collectionPublic health and health promotionSputum collectionResearchPregnancy test kitsQuality assuranceHemoglobinmeterLeadership and teaching skillsUltrasoundsLegal and ethical issuesConfidentialityCollaboration:Cultu ral awarenessFamily, support system, community resourcesSelf evaluation to improve patient careConsulting with PhysiciansContinuing educationConsulting with PharmacistsWorking within scope of practiceConsulting with Speech TherapistDischarge planning/ collaborationConsulting with Dietician and Diet AideConsulting with Occupational TherapistReferral to Pastoral servicesOther (list): Nurse PractitionerSkills ChecklistPage 3of 4 ProficiencyScale1234 ProficiencyScale1234 Programs:OSHA (Occupational, Safety and HealthAdministrationCLIA waiver (Clinical Laboratory ImprovementAmendments)JCAHO (Joint commission on Accreditation ofHealthcare Organizations)HEDIS (Health Plan Employer Data andInformation Set)DQIP (Diabetes Quality Improvement Program)HIPAA (Health Insurance Portability andAccountability Act)Other (list): Nurse PractitionerSkills ChecklistPage 4of 4 Age Specific CompetencyAble to ensure a safe and caring environment for the specific age groups indicated below.)

5 Able to communicate and instruct patients from various age groups; able to evaluate age-appropriate behavior and SCALE1234 Newborn (birth-30 days)Infant (30 days-1 yrs)Toddler (1-3 yrs)Preschooler (3-5 yrs)School Age (5-12 yrs)Adolescents (12-18 yrs)Young Adults (18-39 yrs)Middle Adults (39-64 yrs)Older Adults (64 yrs +)The information represented above is true and correct to the best of my knowledge. I also authorize FreedomHealthcare Staffing to share the above skills checklist with its hospital (Printed) _____