Skill Checklists

Peri-Operative RN

This checklist was electronically signed on (Today’s date)

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

IV Therapy

Start peripheral IV - angio cath

IV Therapy - Assist with:

Insertion of A-lines

Insertion of CVP - jugular

Insertion of CVP - sublavian

Insertion of Swan-Ganz

Drawing blood from central line

Drawing venous blood

Administration of blood and products

Packed red blood cells

Plasma/Albumin

Whole blood

General Surgery

Abdominal perineal resection

Adrenalectomy

Anal fissurectomy

Appendectomy

Bowel resection

Breast biopsy

Cholecystectomy (open)

Colectomy

Colostomy/ileostomy

Esophogeal resection

Exploratory laparotomy

Gastrectomy

Gastroplasty

Hemorrhoidectomy

Hemicolectomy

Hepatic resection

Herniorrhaphy - femora

Herniorrhaphy - inguina

Herniorrhaphy - umbilical

Herniorrhaphyhiatal transabdominal/transthoracic

Hiatal hernia repair

Hepatic resection

Insertion - Hickman

Insertion - Groshong

Insertion - Portacath

Hydroceletomy

Imperforate anus reconstruction

Lumbar sympathectomy

Omphalocele repair

Pancreatectomy / pancreatogram

Pilonidal cystectomy

Portal caval shunt

Pyloric stenosis

Radical mastectomy

Saphenous vein ligation and stripping

Sentinel node biopsy

Splenectomy

Tenchknoff duct cyst excision

Thyroglossal duct cyst excision

Thryoidectomy

Vagotomy

Thoracic and Open Heart

Cervical rib excision

Chamberlain procedure

Closed thoracotomy

Correction pectus excavatum

Esophagectomy

Heller procedure

Mitral commissurotomy

Mitral or aortic valve replacement

IAPB insertion

CABG

Cardiac valve replacement

Patent ductus arteriosus repair

Septal defect repairs

Pacemaker implanation - endocardial

Pacemaker implanation - myocardia

Pacemaker - temporary

Pericardiectomy

Pericardial window

Resection coarctation aorta

Portocaval shunt

Tetrology of fallot

Thoracoplasty

Tracheal resection

Transthoracic diaphragmatic heniorrhaphy

Vascular

A-V access graft

Aortic aneurysm with graft replacement

Endarterectomy/carotid - femoral

Fem-pop bypass

Peripheral vascular bypass procedures

Resection carotid aneurysm with graft

Thrombectomy/embolectomy

Vena cava filter/umbrella

Neurology

A-V malformation

Anterior cervical fusion

Anterior laparoscopic spine procedures

Anterior lumbar interbody fusion (ALIF)

Burr holes for subdural hematoma

Carotid ligation

Cervical sympathectomy

Craniectomy for decompression fracture

Discetomy

Hypophysectomy

Insertion nerve stimulators

Insertion medication pumps

Laminectomy

Myelomeningocele repair

Pedicle screw insertion

Posterior lumbar interbody fusion (PLIF)

Shunt procedure/VP, VA/LP

Spine fusion

Ulnar nerve transfer

Ventriculography / ventriculoscopy

Ventriculostomy

Neurology - Cranioplasty/craniotomy

Clipping of aneurysm

Tumor excision

Stealth crainiotomy

Urology

Adult circumcision

Cystectomy

Cystoscopy/ureteroscopy

Hypospadias repair

Ileal loop

Implants - penile and testicular

Lithotripsy

Nephrectomy

Nephrolithotomy

Orchiopexy

Prostatectomy - perineal

Prostatectomy - supra-pubic

Pyleoplasty

Radical node dissection

Scott incontinence device

TURP

Ureterolithotomy

Vasectomy

Vasovasostomy

Waterhouse procedure

Gynecology

Cesarean section

Colpotomy

Dilation and curettage (DandC)

Hysterectomy - abdominal

Hysterectomy - vaginal

Marshall - Marchetti

Marsupialization, Bartholin cyst

Ovarian cystectomy

Radium insertion

Salpingo-oophorectomy

Sacral spinus fixation

Shirodkar procedure

Suction curettage

Termination of pregnancy

Tubal ligation

Vaginal recontruction

Vaginectomy/vulvectomy

Orthopedics

Acetabular/pelvic ORIF

Achilles tendon repair

Amputation- leg, arm

Application of external fixators - extremeties

Application of external fixators - pelvis

Application of halo traction

Arthrotomy

Bunionectomy

Calcanel reconstruction

Capsulorrhaphy

Carpal tunnel release

Closed reduction fracture

Hand surgery with implants

Harrington rod instrumentation and / or Dwyer procedure

Heel cord lengthening

Laminectomy

Olecranon bursa, excision of

ORIF, internal fixation with compression set

Patellectomy

PuttiPlatt/Bankart procedure/rotator cuff repair

Reduction with compression sets

Reimplanation of digits

Sacro-iliac (SI) joint screws

Sharrard procedure

Spica cast, application

Spinal fusion

Tendon transplants (hand and foot)

Orthopedics - Arthroscopy

Orthopedics - Arthroscopy

Ankle

Elbow

Knee

Shoulder

Orthopedics - Hip compression nails and lag screws

Jewett

Kuntscher rod

Lottes

Rush

Schneider

Zimmer

Iliac crest bone graft

Insertion Austin Moore hip prosthesis

Orthopedics - Intramedullary rods

Extraction

Femoral

Humeral

Insertion

Supracondylar

Tibal

Orthopedics - Total joint replacements/revisions

Hip

Knee

Shoulder

Plastics

Abdominal lipectomy

Abdominalplasty

Blepharoplasty

Cleft lip repair

Dermabrasion

Face lift

Mentoplasty

Otoplasty

Pedicle grafts

Rhytidectomy

Scar revisions

Split thickness skin grafting

Tissue expanders

Plastics - Mammoplasty

Augmentation

Reduction

Tramflaps with reconstructive mammoplasty

Ear, Nose and Throat

Adenoidectomy

Caldwell - Luc

Cleft lip/palate repair

Closed reduction nasal fx

Ethmoidectomy

Excision of salivary gland tumor

Fenestration procedure

Frontal flap sinus procedure

Glossectomy

Laryngectomy

Mandibulectomy

Mastoidectomy

Maxillary advancement with graft

Maxillectomy

Myringoplasty

Myringotomy with PE tube insertion

Nasal polypectomy

Open reducation facial fx

Open reducation nasal fx

Parotidectomy

Pharyngeal flap procedure

Radical neck dissection

Ranulectomy

Rhinoplasty/septoplasty

Selective osteotomy of maxilla/mandible

Sinus endoscopy

Sinus endoscopy

Sinusotomy

Stapedectomy

Submucous resection

Tonsillectomy

Tracheostomy

Tympanoplasty

Oral

Closed reducation facial fractures/wiring

Excision odontoma

Excision of deciduous teeth

Extraction of impacted molars

Fractured jaws, mandibular and zagomatic

Ginivectomy

LeFort osteotomies

Maxillary procedure with graft

Pediatric dentistry

Sagittal osteotomy

Temporomandibular (TMJ) with arthroplasty

TMJ exploration

Ophthalmology

Cataract extraction with IOL

Corneal transplant

Dacryocystectomy

Eye enucleation

Exicison of chalazion

Canthotomy

Correction of ectropian/entropian

Enucleation

Eye transplant

Iridectomy

Lacrimal duct probing

Lid and muscle procedures

Orbital implant

Ptergium repair

Recession resection

Refractive keratoplasty

Repair orbital blowout fracture

Repair of retinal detachment

Scleral buckle

Vitrectomy

Endoscopic Procedures

Bronchoscopy

Colonscopy

Culdoscopy

Esophagoscopy

Gastroscopy

Hysteroscopy

Transplants

Bone marrow

Bone

Corneal transplant

Harvesting

Heart

Kidney

Liver

Lung

Multi-organ

Pancreas

Skin

Trauma

Burns

Motor vehile accidents (multiple injuries)

Traumatic amputations

Trauma - Gunshot/stab wounds

Abdomen

Chest

Head

Equipment

Argon beam coagulator

Bair hugger

Blood/fluid warmer

Cardiac monitor and pacemaker

Cell saver

Cidex soak

Cry-opthalmic unit

Defibrillator/pacer

Electrosurgical unit

Emerson thoracic pump

ETO sterilizer

Eye magnet

Fiber optic luminator

Flash autoclave

Hypo/hyperthemia units

Kreiselman resuscitor

Mesh graft

MicroscopesNerve stimulatorNitrous oxide bank

Nitrous oxide bank

Ohio suction units

Orthopedic arm board with drain

Pleurevac disp. chest drainage

Pneumatic tourniquet

Sterad machine

Steri-vac aeratopm cabinet

Steris unit

Tele therometer

Ultrasonic cleaner

Vac-pac positioner

Vacuum curettage

Washer sanitizer

Washer sterilizer

Equipment - Fracture tables

Chick/Marquet tables

Jackson table

Rush/Skytron tables

Equipment - Intestinal stapling devices

GIA

EEA

LDS

TA

Equipment - Laser

Eye magnet

CO2

Yag

Other

Camera/video systems

Camera controller

Light source

Printers

VCRs

Dermatome

Brown

Padgett

Disposable grounding pads

Drills

3-M maxi driver

Codman craniotome

Hall air-driver

Hall dental

Midax Rex/Anspach

Stryker drills - large battery

Stryker drills - small battery

Surgairtome

Synthes A-O drill

Electrosurgical unit

Miscellaneous

Assist with intubation

Miscellaneous

Assist with intubation

Conscious sediation administration

Conscious sediation monitoring

Able to assure a safe environment for the specific needs of various age groups

A.Newborn/Neonate (birth - 30 days)

B.Infant (30 days - 1 year)

C.Toddler (1 - 3 years)

D.Preschooler (3 - 5 years)

E.School age children (5 - 12 years)

F.Adolescents (12 - 18 years)

G.Young adults (18 - 39 years)

G.Young adults (18 - 39 years)

H.Middle adults (39 - 64 years)

I.Older adults (64+)

Evaluate age-appropriate behavior, motor skills and physiological norms

A.Newborn/Neonate (birth - 30 days)

B.Infant (30 days - 1 year)

C.Toddler (1 - 3 years)

D.Preschooler (3 - 5 years)

E.School age children (5 - 12 years)

F.Adolescents (12 - 18 years)

G.Young adults (18 - 39 years)

H.Middle adults (39 - 64 years

I.Older adults (64+)

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.