Peri-Operative RN Skill Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
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.  
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

 
       
Rating Stars (Click) IV Therapy 1 2 3 4  
Start peripheral IV - angio cath  
Rating Stars (Click) IV Therapy - Assist with: 1 2 3 4  
Insertion of A-lines  
Insertion of CVP - jugular  
Insertion of CVP - sublavian  
Insertion of Swan-Ganz  
Drawing blood from central line  
Drawing venous blood  
Rating Stars (Click) Administration of blood and products 1 2 3 4  
Packed red blood cells  
Plasma/Albumin  
Whole blood  
Rating Stars (Click) General Surgery 1 2 3 4  
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  
Rating Stars (Click) Thoracic and Open Heart 1 2 3 4  
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  
Rating Stars (Click) Vascular 1 2 3 4  
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  
Vena cava ligation  
Rating Stars (Click) Neurology 1 2 3 4  
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  
Rating Stars (Click) Neurology - Cranioplasty/craniotomy 1 2 3 4  
Clipping of aneurysm  
Tumor excision  
Stealth crainiotomy  
Rating Stars (Click) Urology 1 2 3 4  
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  
Rating Stars (Click) Gynecology 1 2 3 4  
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  
Rating Stars (Click) Orthopedics 1 2 3 4  
Acetabular/pelvic ORIF  
Achilles tendon repair  
Amputation- leg, arm  
Anterior cruciate ligament repair  
Application of external fixators - extremeties  
Application of external fixators - pelvis  
Application of halo traction  
Arthrotomy  
Bipolar/unipolar hips  
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  
Repair hammer toes  
Sacro-iliac (SI) joint screws  
Sharrard procedure  
Spica cast, application  
Spinal fusion  
Tendon transplants (hand and foot)  
Rating Stars (Click) Orthopedics - Arthroscopy 1 2 3 4  
Ankle  
Elbow  
Knee  
Shoulder  
Rating Stars (Click) Orthopedics - Hip compression nails and lag screws 1 2 3 4  
Jewett  
Kuntscher rod  
Lottes  
Rush  
Schneider  
Zimmer  
Iliac crest bone graft  
Insertion Austin Moore hip prosthesis  
Rating Stars (Click) Orthopedics - Intramedullary rods 1 2 3 4  
Extraction  
Femoral  
Humeral  
Insertion  
Supracondylar  
Tibal  
Rating Stars (Click) Orthopedics - Total joint replacements/revisions 1 2 3 4  
Hip  
Knee  
Shoulder  
Rating Stars (Click) Plastics 1 2 3 4  
Abdominal lipectomy  
Abdominalplasty  
Blepharoplasty  
Cleft lip repair  
Dermabrasion  
Face lift  
Mentoplasty  
Otoplasty  
Pedicle grafts  
Rhytidectomy  
Scar revisions  
Split thickness skin grafting  
Tissue expanders  
Rating Stars (Click) Plastics - Mammoplasty 1 2 3 4  
Augmentation  
Reduction  
Tramflaps with reconstructive mammoplasty  
Rating Stars (Click) Ear, Nose and Throat 1 2 3 4  
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  
Sinusotomy  
Stapedectomy  
Submucous resection  
Tonsillectomy  
Tracheostomy  
Tympanoplasty  
Rating Stars (Click) Oral 1 2 3 4  
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  
Rating Stars (Click) Ophthalmology 1 2 3 4  
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  
Phaco emulsification  
Ptergium repair  
Recession resection  
Refractive keratoplasty  
Repair orbital blowout fracture  
Repair of retinal detachment  
Scleral buckle  
Vitrectomy  
Rating Stars (Click) Endoscopic Procedures 1 2 3 4  
Bronchoscopy  
Colonscopy  
Culdoscopy  
Esophagoscopy  
Gastroscopy  
Hysteroscopy  
Rating Stars (Click) Laparoscopic procedures 1 2 3 4  
Appendectomy  
Cholecystectomy / cholangiogram  
Colon resection  
Diagnostic  
Hernia repair  
Nissen fundoplication  
Salpingo-oophorectomy  
Tubal ligation  
Vaginal hysterectomy  
Larynoscpy and microlaryngoscopy  
Mediastinoscopy  
Pelviscopy  
Sigmoidoscopy  
Thoracoscopy  
Rating Stars (Click) Transplant 1 2 3 4  
Bone  
Bone marrow  
Corneal transplant  
Harvesting  
Heart  
Kidney  
Liver  
Lung  
Multi-organ  
Pancreas  
Skin  
Rating Stars (Click) Trauma 1 2 3 4  
Burns  
Motor vehile accidents (multiple injuries)  
Traumatic amputations  
Rating Stars (Click) Trauma - Gunshot/stab wounds 1 2 3 4  
Abdomen  
Chest  
Head  
Rating Stars (Click) Equipment 1 2 3 4  
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  
Rating Stars (Click) Equipment - Fracture tables 1 2 3 4  
Chick/Marquet tables  
Jackson table  
Rush/Skytron tables  
Rating Stars (Click) Equipment - Intestinal stapling devices 1 2 3 4  
EEA  
GIA  
LDS  
TA  
Rating Stars (Click) Equipment - Laser 1 2 3 4  
CO2  
Eye magnet  
Yag  
Other  
Rating Stars (Click) Camera/video systems 1 2 3 4  
Camera controller  
Light source  
Printers  
VCRs  
Rating Stars (Click) Dermatome 1 2 3 4  
Brown  
Padgett  
Zimmer  
Disposable grounding pads  
Rating Stars (Click) Drills 1 2 3 4  
3-M maxi driver  
Codman craniotome  
Hall air-driver  
Hall dental  
Hall neurotome  
Midax Rex/Anspach  
Minidriver  
Stryker drills - large battery  
Stryker drills - small battery  
Surgairtome  
Synthes A-O drill  
Electrosurgical unit  
Rating Stars (Click) Miscellaneous 1 2 3 4  
Assist with intubation  
Conscious sediation administration  
Conscious sediation monitoring  
Management of malignant hypertensive crisis  
Rating Stars (Click) Able to assure a safe environment for the specific needs of various age groups 1 2 3 4  
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+)  
Rating Stars (Click) Able to communicate and/or instruct patients according to their age, maturity, comprehension 1 2 3 4  
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+)  
Rating Stars (Click) Evaluate age-appropriate behavior, motor skills and physiological norms 1 2 3 4  
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+)