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Nursing Skills Checklist Form Template

Streamline your evaluation of nursing competencies effectively

When you need to ensure your nursing staff meets essential competencies, a comprehensive checklist is crucial. This Nursing Skills Checklist Form Template is designed for healthcare professionals and managers to assess and document the skills of nurses effectively. By using this template, you can easily track nursing competencies, enhance staff training, and ensure compliance with standards, while also simplifying documentation processes and improving patient care outcomes. Explore the live template to support your team's success.

Full name
Email address
Phone number
Current role/credential
Registered Nurse (RN)
Licensed Practical/Vocational Nurse (LPN/LVN)
Certified Nursing Assistant (CNA)
Nurse Practitioner (NP)
Nursing Student
Other
Please Specify:
Years of nursing experience
0-1 years
2-3 years
4-6 years
7-10 years
11+ years
Primary practice settings worked in the past 2 years (select all that apply)
Please Specify:
Do you have an active, unencumbered nursing license?
Yes
No
State(s) of licensure
Current certifications (select all that apply)
Please Specify:
Are you eligible to work in the country of practice?
Yes
No
Shift availability (select all that apply)
Willing to float within competency
Yes
No
Preferred care settings (select all that apply)
Please Specify:
Patient assessment and vital signs
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Documentation and EMR charting
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Medication administration (oral, IM, subcutaneous)
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
IV therapy: insertion, maintenance, and infusion pumps
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Central line care and dressing changes
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Phlebotomy and specimen collection
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Wound care and dressing changes
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Urinary catheter insertion and care
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Enteral feeding tubes (NG/PEG) care and management
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Tracheostomy care and suctioning
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Oxygen therapy and airway management
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Cardiac monitoring/telemetry
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
EKG acquisition and basic interpretation
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Blood glucose monitoring and insulin administration
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Blood transfusion administration and monitoring
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Isolation precautions and PPE
No experience
Training needed
Competent with supervision
Competent independently
Can precept/teach
Not applicable
Specialty areas with experience (select all that apply)
Please Specify:
Are there any restrictions or accommodations we should be aware of?
No
Yes - will describe below
Prefer not to say
Additional comments
Typed signature (enter your full name)
Date signed
I confirm the information provided is accurate to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration featuring a nursing skills checklist template for FormCreatorAI article

When to use this form

Use this checklist when you onboard nurses, assign float staff, or verify travel nurse competencies. It also helps during annual reviews to spot gaps, plan training, and document who can work independently in high-risk areas like ICU or wound care. Home health teams can pair it with the Home health assessment form to align skills to patient needs, and use the Nursing visit report form to support ongoing performance data. HR and clinical educators get consistent records for credentialing, while managers can match nurses to safe assignments faster. The result is safer staffing, fewer escalations, and a focused upskilling plan.

Must Ask Nursing Skills Checklist Questions

  1. Which patient populations and care settings have you practiced independently in within the past 24 months?

    Recency matters for safe assignments and orientation planning. This helps you place nurses where they can perform confidently with minimal ramp-up.

  2. For each listed skill, what is your proficiency level: observe, perform with supervision, perform independently, or teach/precept?

    Clear levels guide staffing, supervision, and preceptor matches. It also shows where a brief check-off or refresher will close a gap.

  3. Which high-risk procedures have you performed in the last year, and about how many times?

    Frequency and recency indicate currency and safety for tasks like central line care, trach care, or insulin titration. You can prioritize simulations or return demos where volume is low.

  4. Which licenses and certifications do you hold, with numbers and expiration dates (e.g., BLS, ACLS, PALS, TNCC)?

    Up-to-date credentials reduce scheduling risk and survey findings. Tracking expirations supports proactive renewals and uninterrupted coverage.

  5. Are you trained and authorized to review, clarify, and implement physician orders in your practice area?

    Confirming scope and process reduces errors and delays in care. For home care, you will document and carry out orders using the Home health physician order form.

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