Clinical Skills and Procedures Self-Assessment Form specific to your NP track

Procedure	Confidence Level	Strengths	Opportunities for Improvement
Arterial blood gas (ABG)	Confident (can complete independently)	I am comfortable with the steps involved in obtaining an ABG and interpreting the results. I am also familiar with the different types of ABGs and the indications for each.	I could improve my speed and efficiency in obtaining an ABG. I could also learn more about the different types of ABG machines and how to troubleshoot them.
Chest tube insertion	Mostly confident (can complete with supervision)	I have performed a chest tube insertion under supervision in the clinical setting. I am comfortable with the steps involved and the potential complications.	I could improve my technique in inserting a chest tube. I could also learn more about the different types of chest tubes and how to manage them.
Central line insertion	Beginning (have performed with supervision or need supervision to feel confident)	I have performed a central line insertion under supervision in the clinical setting. I am familiar with the steps involved and the potential complications.	I need more practice in inserting a central line. I could also learn more about the different types of central lines and how to manage them.
IV catheter insertion	Confident (can complete independently)	I am comfortable with the steps involved in inserting an IV catheter. I am also familiar with the different types of IV catheters and the indications for each.	I could improve my speed and efficiency in inserting an IV catheter. I could also learn more about the different types of IV fluids and medications that can be administered through an IV.
Lumbar puncture	Beginning (have performed with supervision or need supervision to feel confident)	I have assisted with a lumbar puncture in the clinical setting. I am familiar with the steps involved and the potential complications.	I need more practice in performing a lumbar puncture. I could also learn more about the different indications for a lumbar puncture.
Nephrostomy tube insertion	New (have never performed or does not apply)	I have never performed a nephrostomy tube insertion.	I would need to learn the steps involved in inserting a nephrostomy tube and the potential complications.

drive_spreadsheetExport to Sheets Summary of Strengths

• I am confident in my ability to perform the majority of the procedures listed on the Clinical Skills and Procedures Self-Assessment Form.
• I am familiar with the theory behind each procedure and the potential complications.
• I am comfortable working with patients and providing them with clear and concise instructions.

Opportunities for Improvement

• I could improve my speed and efficiency in performing some of the procedures.
• I could learn more about the different types of equipment and supplies that are used for each procedure.
• I could gain more experience in performing procedures on real patients.

Goals and Objectives for This Practicum Experience

• To improve my speed and efficiency in performing the procedures listed on the Clinical Skills and Procedures Self-Assessment Form.
• To learn more about the different types of equipment and supplies that are used for each procedure.
• To gain more experience in performing procedures on real patients.

Specifically, I would like to:

• Perform an ABG independently and interpret the results accurately.
• Insert a chest tube independently without complications.
• Insert a central line independently with minimal supervision.
• Insert an IV catheter independently and administer IV fluids and medications safely.
• Perform a lumbar puncture independently with minimal supervision.

I believe that these goals and objectives are specific, measurable, achievable, relevant, and time-bound (SMART). I am confident that I can achieve these goals with the support of my preceptor and the other healthcare professionals in the practicum setting. I am excited to start my practicum experience and to gain the skills and knowledge that I need to be a successful AGPCNP. I am confident that I will be able to achieve my goals and objectives and that I will be a valuable member of the healthcare team.  

Sample Solution