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CVOR RN Skills 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 |
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| Rating Stars (Click) | SCRUB GENERAL SURGERY | 1 | 2 | 3 | 4 | ||
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AKA/BKA (Amputation) | ||||||
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Radical Mastectomy | ||||||
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Abdominal - Perineal Resection | ||||||
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Cholecystectomy (Open) | ||||||
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Exploratory Laparatomy | ||||||
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Appendectomy | ||||||
| Rating Stars (Click) | SCRUB CARDIAC | 1 | 2 | 3 | 4 | ||
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DaVinci Procedures | ||||||
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Coronary Artery By-Pass | ||||||
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Mitral Valve Repair/Replacement | ||||||
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Aortic Valve Replacement | ||||||
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Multiple Valve Transposition | ||||||
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Septal Defects | ||||||
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Ventricular aneurysm Repair | ||||||
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Bring Back Heart | ||||||
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Pericardial Window | ||||||
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Intra-Aortic Balloon Insertion | ||||||
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Heartport or Similar CABG | ||||||
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Thoraco approach Mid-Cab | ||||||
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Aortic Arch Replacement | ||||||
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Aortic Valve Conduit | ||||||
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Mechanical Heart/LVAD | ||||||
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Pediatric Hearts | ||||||
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Tetrology of Fallot | ||||||
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Chamberlain Procedure | ||||||
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Femoral Artery Cannulation | ||||||
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AICD Insertion | ||||||
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Saphenous Vein Harvest | ||||||
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Endoscopic Vein Harvest | ||||||
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Gastric Artery Harvest | ||||||
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Radial Vein Harvest | ||||||
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Carotid Endarterectomy | ||||||
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Abdominal Aortic Aneurysm | ||||||
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Femoral-Popliteal By-Pass Graft | ||||||
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Thrombectomy | ||||||
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AV Shunt | ||||||
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Pacemaker Insertion | ||||||
| Rating Stars (Click) | SCRUB LAPARASCOPIC PROCEDURES | 1 | 2 | 3 | 4 | ||
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Cholecystectomy (Open) | ||||||
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Appendectomy | ||||||
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Hernia | ||||||
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Nissan | ||||||
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Colectomy | ||||||
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Gastrectomy | ||||||
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Inguinal/Ventral hernia Repair | ||||||
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Splenectomy | ||||||
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Bowel Rescetion/Colostomy | ||||||
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Thyroidectomy | ||||||
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Rectal Procedures | ||||||
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Esophagascopy/Gastrocopy | ||||||
| Rating Stars (Click) | SCRUB PEDIATRIC CASES | 1 | 2 | 3 | 4 | ||
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Inguinal Hernia Repair | ||||||
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Pyloric Stenosis | ||||||
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Circumcision | ||||||
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Exploratory Laparotomy | ||||||
| Rating Stars (Click) | SCRUB VASCULAR SURGERY | 1 | 2 | 3 | 4 | ||
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Carotid Endarterectomy | ||||||
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Abdominal Aoric Aneurysm | ||||||
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Femoral-Popliteal By-Pass Graft (Insitu) | ||||||
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Femoral-Popliteal By-Pass Graft (Graph) | ||||||
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Portacath, Tesio, Hickman | ||||||
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AV Shunt | ||||||
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Thrombecomy | ||||||
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Pacemaker Insertion | ||||||
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Arterial Stenting | ||||||
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Intra-Operative Angioplasty | ||||||
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Subclavian/Carotid By-Pass | ||||||
| Rating Stars (Click) | SCRUB ORTHOPEDICS | 1 | 2 | 3 | 4 | ||
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Total Hip Replacement | ||||||
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Bipolar Hip | ||||||
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Compression Hip Screw | ||||||
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Total Knee Replacement | ||||||
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Knee Artoscopy | ||||||
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ACL Knee Repair | ||||||
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harrington Rod or Similar | ||||||
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I.M. Rodding | ||||||
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Hand and Foot procedures | ||||||
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Mini Fragment Screws & Plates | ||||||
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External Fixation | ||||||
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Shoulder Repair | ||||||
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Shoulder Arthoscopy | ||||||
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Spinal Fusion | ||||||
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Fracture Table Set-Up | ||||||
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Drills, Saws and Reamers | ||||||
| Rating Stars (Click) | SCRUB GYNECOLOGY | 1 | 2 | 3 | 4 | ||
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D&C | ||||||
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Diagnostic Laparascope | ||||||
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Laparoscopic Asst'd Vaginal Hysterectomy | ||||||
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Abdominal Hysterectomy | ||||||
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Vaginal Hysterectomy | ||||||
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Anterior/Posterior Repair | ||||||
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MMK (Marshall Marchetti Krantz) | ||||||
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Tuboplasty | ||||||
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BLT (Bilateral Tubal Ligation) | ||||||
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C-Section | ||||||
| Rating Stars (Click) | SCRUB UROLOGY | 1 | 2 | 3 | 4 | ||
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Radical Prostatectomy | ||||||
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Radical Lymph Node Dissection | ||||||
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Insertion Penile Prosthesis | ||||||
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Hydrocelectomy | ||||||
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Cystoscopy | ||||||
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Ureteroscopy | ||||||
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TURP/TURBT | ||||||
| Rating Stars (Click) | SCRUB NEUROLOGY | 1 | 2 | 3 | 4 | ||
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Cervical Laminectomy (Anterior) | ||||||
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Cervical Laminectomy (Posterior) | ||||||
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Lumbar Lamincetomy, Discectomy | ||||||
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Percutaneous Micro Discectomy | ||||||
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Craniotomy for Tumor | ||||||
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Craniotomy for Aneurysm | ||||||
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Burr Holes | ||||||
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VP Shunts | ||||||
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Transphenoidal Hypothypectomy | ||||||
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Harrington Rod or Similar | ||||||
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SCRUB PLASTICS | ||||||
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Mammoplasty | ||||||
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Facelifts | ||||||
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Skin Grafts | ||||||
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Rhinoplasty | ||||||
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Cleft Lip Repair | ||||||
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Abdominalplasty | ||||||
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Blepharoplasty | ||||||
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Otoplasty | ||||||
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Muscle Flaps | ||||||
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Trauma | ||||||
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Transplant Surgery | ||||||
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Organ Procurements (Harvest) | ||||||
| Rating Stars (Click) | SCRUB ENT | 1 | 2 | 3 | 4 | ||
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Middle Ear | ||||||
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T&A | ||||||
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Myringotomy | ||||||
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Tympanoplasty | ||||||
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Radical Neck Dissection | ||||||
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Septoplasty | ||||||
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Sinus Endoscopy | ||||||
| Rating Stars (Click) | SCRUB THORACIC | 1 | 2 | 3 | 4 | ||
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Thoracotomy | ||||||
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Thoracoscopy | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Elderly (ages 80+ years) | ||||||