Peri-Operative RN Skill Checklist

Fill Out and Submit your Skills Checklist
Skills Checklist
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:
1No Experience
2Need Training
3Able to perform with supervisione
4Able to perform independently
IV Therapy
Start peripheral IV - angio cath
0
IV Therapy - Assist with:
Insertion of A-lines
0
Insertion of CVP - jugular
0
Insertion of CVP - sublavian
0
Insertion of Swan-Ganz
0
Drawing blood from central line
0
Drawing venous blood
0
Administration of blood and products
Packed red blood cells
0
Plasma/Albumin
0
Whole blood
0
General Surgery
Abdominal perineal resection
0
Adrenalectomy
0
Anal fissurectomy
0
Appendectomy
0
Bowel resection
0
Breast biopsy
0
Cholecystectomy (open)
0
Colectomy
0
Colostomy/ileostomy
0
Esophogeal resection
0
Exploratory laparotomy
0
Gastrectomy
0
Gastroplasty
0
Hemorrhoidectomy
0
Hemicolectomy
0
Hepatic resection
0
Herniorrhaphy - femora
0
Herniorrhaphy - inguina
0
Herniorrhaphy - umbilical
0
Herniorrhaphyhiatal transabdominal/transthoracic
0
Hiatal hernia repair
0
Hepatic resection
0
Insertion - Hickman
0
Insertion - Groshong
0
Insertion - Portacath
0
Hydroceletomy
0
Imperforate anus reconstruction
0
Lumbar sympathectomy
0
Omphalocele repair
0
Pancreatectomy / pancreatogram
0
Pilonidal cystectomy
0
Portal caval shunt
0
Pyloric stenosis
0
Radical mastectomy
0
Saphenous vein ligation and stripping
0
Sentinel node biopsy
0
Splenectomy
0
Tenchknoff duct cyst excision
0
Thyroglossal duct cyst excision
0
Thryoidectomy
0
Vagotomy
0
Thoracic and Open Heart
Cervical rib excision
0
Chamberlain procedure
0
Closed thoracotomy
0
Correction pectus excavatum
0
Esophagectomy
0
Heller procedure
0
Mitral commissurotomy
0
Mitral or aortic valve replacement
0
IAPB insertion
0
CABG
0
Cardiac valve replacement
0
Patent ductus arteriosus repair
0
Septal defect repairs
0
Pacemaker implanation - endocardial
0
Pacemaker implanation - myocardia
0
Pacemaker - temporary
0
Pericardiectomy
0
Pericardial window
0
Resection coarctation aorta
0
Portocaval shunt
0
Tetrology of fallot
0
Thoracoplasty
0
Tracheal resection
0
Transthoracic diaphragmatic heniorrhaphy
0
Vascular
A-V access graft
0
Aortic aneurysm with graft replacement
0
Endarterectomy/carotid - femoral
0
Fem-pop bypass
0
Peripheral vascular bypass procedures
0
Resection carotid aneurysm with graft
0
Thrombectomy/embolectomy
0
Vena cava filter/umbrella
0
Vena cava ligation
0
Neurology
A-V malformation
0
Anterior cervical fusion
0
Anterior laparoscopic spine procedures
0
Anterior lumbar interbody fusion (ALIF)
0
Burr holes for subdural hematoma
0
Carotid ligation
0
Cervical sympathectomy
0
Craniectomy for decompression fracture
0
Discetomy
0
Hypophysectomy
0
Insertion nerve stimulators
0
Insertion medication pumps
0
Laminectomy
0
Myelomeningocele repair
0
Pedicle screw insertion
0
Posterior lumbar interbody fusion (PLIF)
0
Shunt procedure/VP, VA/LP
0
Spine fusion
0
Ulnar nerve transfer
0
Ventriculography / ventriculoscopy
0
Ventriculostomy
0
Neurology - Cranioplasty/craniotomy
Clipping of aneurysm
0
Tumor excision
0
Stealth crainiotomy
0
Urology
Adult circumcision
0
Cystectomy
0
Cystoscopy/ureteroscopy
0
Hypospadias repair
0
Ileal loop
0
Implants - penile and testicular
0
Lithotripsy
0
Nephrectomy
0
Nephrolithotomy
0
Orchiopexy
0
Prostatectomy - perineal
0
Prostatectomy - supra-pubic
0
Pyleoplasty
0
Radical node dissection
0
Scott incontinence device
0
TURP
0
Ureterolithotomy
0
Vasectomy
0
Vasovasostomy
0
Waterhouse procedure
0
Gynecology
Cesarean section
0
Colpotomy
0
Dilation and curettage (DandC)
0
Hysterectomy - abdominal
0
Hysterectomy - vaginal
0
Marshall - Marchetti
0
Marsupialization, Bartholin cyst
0
Ovarian cystectomy
0
Radium insertion
0
Salpingo-oophorectomy
0
Sacral spinus fixation
0
Shirodkar procedure
0
Suction curettage
0
Termination of pregnancy
0
Tubal ligation
0
Vaginal recontruction
0
Vaginectomy/vulvectomy
0
Orthopedics
Acetabular/pelvic ORIF
0
Achilles tendon repair
0
Amputation- leg, arm
0
Anterior cruciate ligament repair
0
Application of external fixators - extremeties
0
Application of external fixators - pelvis
0
Application of halo traction
0
Arthrotomy
0
Bipolar/unipolar hips
0
Bunionectomy
0
Calcanel reconstruction
0
Capsulorrhaphy
0
Carpal tunnel release
0
Closed reduction fracture
0
Hand surgery with implants
0
Harrington rod instrumentation and / or Dwyer procedure
0
Heel cord lengthening
0
Laminectomy
0
Olecranon bursa, excision of
0
ORIF, internal fixation with compression set
0
Patellectomy
0
PuttiPlatt/Bankart procedure/rotator cuff repair
0
Reduction with compression sets
0
Reimplanation of digits
0
Repair hammer toes
0
Sacro-iliac (SI) joint screws
0
Sharrard procedure
0
Spica cast, application
0
Spinal fusion
0
Tendon transplants (hand and foot)
0
Orthopedics - Arthroscopy
Ankle
0
Elbow
0
Knee
0
Shoulder
0
Orthopedics - Hip compression nails and lag screws
Jewett
0
Kuntscher rod
0
Lottes
0
Rush
0
Schneider
0
Zimmer
0
Iliac crest bone graft
0
Insertion Austin Moore hip prosthesis
0
Orthopedics - Intramedullary rods
Extraction
0
Femoral
0
Humeral
0
Insertion
0
Supracondylar
0
Tibal
0
Orthopedics - Total joint replacements/revisions
Hip
0
Knee
0
Shoulder
0
Plastics
Abdominal lipectomy
0
Abdominalplasty
0
Blepharoplasty
0
Cleft lip repair
0
Dermabrasion
0
Face lift
0
Mentoplasty
0
Otoplasty
0
Pedicle grafts
0
Rhytidectomy
0
Scar revisions
0
Split thickness skin grafting
0
Tissue expanders
0
Plastics - Mammoplasty
Augmentation
0
Reduction
0
Tramflaps with reconstructive mammoplasty
0
Ear, Nose and Throat
Adenoidectomy
0
Caldwell - Luc
0
Cleft lip/palate repair
0
Closed reduction nasal fx
0
Ethmoidectomy
0
Excision of salivary gland tumor
0
Fenestration procedure
0
Frontal flap sinus procedure
0
Glossectomy
0
Laryngectomy
0
Mandibulectomy
0
Mastoidectomy
0
Maxillary advancement with graft
0
Maxillectomy
0
Myringoplasty
0
Myringotomy with PE tube insertion
0
Nasal polypectomy
0
Open reducation facial fx
0
Open reducation nasal fx
0
Parotidectomy
0
Pharyngeal flap procedure
0
Radical neck dissection
0
Ranulectomy
0
Rhinoplasty/septoplasty
0
Selective osteotomy of maxilla/mandible
0
Sinus endoscopy
0
Sinusotomy
0
Stapedectomy
0
Submucous resection
0
Tonsillectomy
0
Tracheostomy
0
Tympanoplasty
0
Oral
Closed reducation facial fractures/wiring
0
Excision odontoma
0
Excision of deciduous teeth
0
Extraction of impacted molars
0
Fractured jaws, mandibular and zagomatic
0
Ginivectomy
0
LeFort osteotomies
0
Maxillary procedure with graft
0
Pediatric dentistry
0
Sagittal osteotomy
0
Temporomandibular (TMJ) with arthroplasty
0
TMJ exploration
0
Ophthalmology
Cataract extraction with IOL
0
Corneal transplant
0
Dacryocystectomy
0
Eye enucleation
0
Exicison of chalazion
0
Canthotomy
0
Correction of ectropian/entropian
0
Enucleation
0
Eye transplant
0
Iridectomy
0
Lacrimal duct probing
0
Lid and muscle procedures
0
Orbital implant
0
Phaco emulsification
0
Ptergium repair
0
Recession resection
0
Refractive keratoplasty
0
Repair orbital blowout fracture
0
Repair of retinal detachment
0
Scleral buckle
0
Vitrectomy
0
Endoscopic Procedures
Bronchoscopy
0
Colonscopy
0
Culdoscopy
0
Esophagoscopy
0
Gastroscopy
0
Hysteroscopy
0
Laparoscopic procedures
Appendectomy
0
Cholecystectomy / cholangiogram
0
Colon resection
0
Diagnostic
0
Hernia repair
0
Nissen fundoplication
0
Salpingo-oophorectomy
0
Tubal ligation
0
Vaginal hysterectomy
0
Larynoscpy and microlaryngoscopy
0
Mediastinoscopy
0
Pelviscopy
0
Sigmoidoscopy
0
Thoracoscopy
0
Transplant
Bone
0
Bone marrow
0
Corneal transplant
0
Harvesting
0
Heart
0
Kidney
0
Liver
0
Lung
0
Multi-organ
0
Pancreas
0
Skin
0
Trauma
Burns
0
Motor vehile accidents (multiple injuries)
0
Traumatic amputations
0
Trauma - Gunshot/stab wounds
Abdomen
0
Chest
0
Head
0
Equipment
Argon beam coagulator
0
Bair hugger
0
Blood/fluid warmer
0
Cardiac monitor and pacemaker
0
Cell saver
0
Cidex soak
0
Cry-opthalmic unit
0
Defibrillator/pacer
0
Electrosurgical unit
0
Emerson thoracic pump
0
ETO sterilizer
0
Eye magnet
0
Fiber optic luminator
0
Flash autoclave
0
Hypo/hyperthemia units
0
Kreiselman resuscitor
0
Mesh graft
0
MicroscopesNerve stimulatorNitrous oxide bank
0
Nitrous oxide bank
0
Ohio suction units
0
Orthopedic arm board with drain
0
Pleurevac disp. chest drainage
0
Pneumatic tourniquet
0
Sterad machine
0
Steri-vac aeratopm cabinet
0
Steris unit
0
Tele therometer
0
Ultrasonic cleaner
0
Vac-pac positioner
0
Vacuum curettage
0
Washer sanitizer
0
Washer sterilizer
0
Equipment - Fracture tables
Chick/Marquet tables
0
Jackson table
0
Rush/Skytron tables
0
Equipment - Intestinal stapling devices
EEA
0
GIA
0
LDS
0
TA
0
Equipment - Laser
CO2
0
Eye magnet
0
Yag
0
Other
0
Camera/video systems
Camera controller
0
Light source
0
Printers
0
VCRs
0
Dermatome
Brown
0
Padgett
0
Zimmer
0
Disposable grounding pads
0
Drills
3-M maxi driver
0
Codman craniotome
0
Hall air-driver
0
Hall dental
0
Hall neurotome
0
Midax Rex/Anspach
0
Minidriver
0
Stryker drills - large battery
0
Stryker drills - small battery
0
Surgairtome
0
Synthes A-O drill
0
Electrosurgical unit
0
Miscellaneous
Assist with intubation
0
Conscious sediation administration
0
Conscious sediation monitoring
0
Management of malignant hypertensive crisis
0
Able to assure a safe environment for the specific needs of various age groups
A.Newborn/Neonate (birth - 30 days)
0
B.Infant (30 days - 1 year)
0
C.Toddler (1 - 3 years)
0
D.Preschooler (3 - 5 years)
0
E.School age children (5 - 12 years)
0
F.Adolescents (12 - 18 years)
0
G.Young adults (18 - 39 years)
0
H.Middle adults (39 - 64 years)
0
I.Older adults (64+)
0
Able to communicate and/or instruct patients according to their age, maturity, comprehension
A.Newborn/Neonate (birth - 30 days)
0
B.Infant (30 days - 1 year)
0
C.Toddler (1 - 3 years)
0
D.Preschooler (3 - 5 years)
0
E.School age children (5 - 12 years)
0
F.Adolescents (12 - 18 years)
0
G.Young adults (18 - 39 years)
0
H.Middle adults (39 - 64 years)
0
I.Older adults (64+)
0
Evaluate age-appropriate behavior, motor skills and physiological norms
A.Newborn/Neonate (birth - 30 days)
0
B.Infant (30 days - 1 year)
0
C.Toddler (1 - 3 years)
0
D.Preschooler (3 - 5 years)
0
E.School age children (5 - 12 years)
0
F.Adolescents (12 - 18 years)
0
G.Young adults (18 - 39 years)
0
H.Middle adults (39 - 64 years)
0
I.Older adults (64+)
0

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Reach us
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  • care@selectsourceintl.com
  • Phone: +1-952-546-3300
  • Fax: +1-952-546-3500
  • 13911 Ridgedale Drive, Suite 230
    Minnetonka, Minnesota 55305, United States

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