Skill Checklists

CVOR 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

Scrub General Surgery

AKA/BKA (Amputation)

Radical Mastectomy

Abdominal - Perineal Resection

Cholecystectomy (Open)

Exploratory Laparatomy

Appendectomy

Scrub Cardiac

DaVinci Procedures

Coronary Artery By-Pass

Mitral Valve Repair/Replacement

Aortic Valve Replacement

Multiple Valve Transposition

Septal Defects

Ventricular aneurysm Repair

Bring Back Heart

Pericardial Window

Intra-Aortic Balloon Insertion

Heartport or Similar CABG

Thoraco approach Mid-Cab

Aortic Arch Replacement

Aortic Valve Conduit

Mechanical Heart/LVAD

Pediatric Hearts

Tetrology of Fallot

Chamberlain Procedure

Femoral Artery Cannulation

AICD Insertion

Saphenous Vein Harvest

Endoscopic Vein Harvest

Gastric Artery Harvest

Radial Vein Harvest

Carotid Endarterectomy

Abdominal Aortic Aneurysm

Femoral-Popliteal By-Pass Graft

Thrombectomy

AV Shunt

Pacemaker Insertion

Scrub Pediatric Cases

Inguinal Hernia Repair

Pyloric Stenosis

Circumcision

Exploratory Laparotomy

Scrub Vascular Surgery

Carotid Endarterectomy

Abdominal Aoric Aneurysm

Femoral-Popliteal By-Pass Graft (Insitu)

Femoral-Popliteal By-Pass Graft (Graph)

Portacath, Tesio, Hickman

AV Shunt

Thrombecomy

Pacemaker Insertion

Intra-Operative Angioplasty

Subclavian/Carotid By-Pass

Scrub Orthopedics

Total Hip Replacement

Bipolar Hip

Compression Hip Screw

Total Knee Replacement

Knee Artoscopy

ACL Knee Repair

harrington Rod or Similar

I.M. Rodding

Hand and Foot procedures

Mini Fragment Screws & Plates

External Fixation

Shoulder Repair

Spinal Fusion

Fracture Table Set-Up

Drills, Saws and Reamers

Scrub Gynecology

D&C

Diagnostic Laparascope

Laparoscopic Asst'd Vaginal Hysterectomy

Abdominal Hysterectomy

Vaginal Hysterectomy

Anterior/Posterior Repair

MMK (Marshall Marchetti Krantz)

Tuboplasty

BLT (Bilateral Tubal Ligation)

C-Section

Scrub Urology

Radical Prostatectomy

Radical Lymph Node Dissection

Insertion Penile Prosthesis

Hydrocelectomy

Cystoscopy

Ureteroscopy

TURP/TURBT

Scrub Neurology

Cervical Laminectomy (Anterior)

Cervical Laminectomy (Posterior)

Lumbar Lamincetomy, Discectomy

Percutaneous Micro Discectomy

Craniotomy for Tumor

Craniotomy for Aneurysm

Burr Holes

VP Shunts

Transphenoidal Hypothypectomy

Harrington Rod or Similar

SCRUB PLASTICS

Mammoplasty

Facelifts

Skin Grafts

Rhinoplasty

Cleft Lip Repair

Abdominalplasty

Blepharoplasty

Otoplasty

Muscle Flaps

Trauma

Transplant Surgery

Organ Procurements (Harvest)

Scrub ENT

Middle Ear

T&A

Myringotomy

Tympanoplasty

Radical Neck Dissection

Septoplasty

Sinus Endoscopy

Scrub Thoracic

Thoracoscopy

Thoracotomy

Age Specific Competencies

Infant (Birth - 1 year)

Preschooler (ages 2-5 years)

Childhood (ages 6-12 years)

Adolescents (ages 13-21 years)

Young Adults (ages 22-39 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79 years)

Elderly (ages 80+ years)

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.