OPERATING ROOM

KNOWLEDGE & SKILLS

CHECKLIST NAME:       ID #:       DATE:       This Skills Checklist is for use by nurses with more than one year experience in their discipline and specialty. Please be accurate with your assessment.

DIRECTIONS: Please indicate your level of experience by placing a check (√) in the box. Experience level: 1 NO EXPERIENCE 2 MINIMAL EXPERIENCE-requires supervision/assistance

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DESCRIPTION 1. 2. 3. 4. 5. 6. 7. 8. 9. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1. 2. 3. 4. 5. 1. 2. 3. 4.

NEUROLOGY Acoustic Neuromas Aneurysm Repair Cervical Laminectomy Craniotomy Endarterectomy Hematoma Evacuation Lumbar Laminectomy Neuro Trauma Shunts EYE Blepharoplasty Cataract with IOL Chalazion Corneal Transplant Dacryocystorhinoplasty Enucleation Iridectomy Muscle Repair Removal Foreign Body Retinal Detachment Repair Trabeculectomy ORAL Grafts Letorte Osteotomies Mandibular Procedures Maxillary Procedures TMJ Arthroplasty EAR, NOSE, THROAT Laryngectomy Mastoidectomy Radical Neck Septoplasty

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MODERATELY EXPERIENCED-requires initial review, then performs independently VERY EXPERIENCED- proficient

DESCRIPTION 1 2 3 4 5. Sinus Endoscopy 6. Stapedectomy 7. T & A Myringotomies 8. Tracheostomy 9. Tympanoplasty 10. Vocal Cord Stripping GENERAL 1. Abdominal Resection 2. Appendectomy 3. Cholecystectomy 4. Colon Resection 5. Colostomy 6. Gastrectomy 7. Hernia Repair 8. Lap Chole 9. Laparotomy 10. Mastectomy 11. Thyroidectomy THORACIC/OPEN HEART 1. Atrial Septal Defect 2. Bronchoscopy 3. CABG 4. Internal Defibrillator 5. Mediastinoscopy 6. Pacemaker Insertion 7. Pneumonectomy 8. Thoracotomy 9. Valve Replacement 10. Ventricular Septic Defect VASCULAR 1. Aortic Aneurysm 2. Embolectomy 3. Fem-Fem By 4. Fem-Pop By

OPERATING ROOM

KNOWLEDGE & SKILLS

CHECKLIST 5. Fem-Tib By Name:       DESCRIPTION 6. Vein Ligation 7. Carotid Endarterectomy UROLOGY 1. Archiotomy 2. Cystoscopy 3. Nephrectomy 4. Penile Prosthesis 5. Radical Prostate Resection 6. TURP 7. Ureterolithotomy 8. Urinary Diversion ORTHOPEDICS 1. Amputation 2. Arthroscopy 3. Bunionectomy 4. Carpal Tunnel Release 5. Closed Reduction 6. Hip pinning 7. ORIF 8. Spinal Rodding/Fixation 9. Total t Replacement 10. Hip Replacement 11. Knee Replacement 12. Shoulder Replacement 13. Hand Surgery GYNECOLOGY 1. A&P Repair 2. Laparoscopy 3. Vaginal Hysterectomy 4. Abdominal Hysterectomy 5. C-Section 6. Marshall Marchetti 7. Tubal Ligation PLASTICS 1. Abdominoplasty 2. Breast Reconstruction 3. Cleft Lip/Palate 4. Flap Grafts 5. Mammoplasty 6. Rhinoplasty TRAUMA 1. Gunshot Wounds 2 | Page

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ID #:       DESCRIPTION 1 2 3 4 2. MVA 3. Traumatic Amputations TRANSPLANTS 1. Harvest Organs 2. Heart 3. Kidney 4. Liver 5. Lung PEDIATRICS 1. Abdominal Procedures 2. Neonatal Procedures 3. Open Heart 4. Orthopedic Procedures 5. Plastics 6. Thoracotomy EQUIPMENT 1. Ceiling Mount Microscope 2. Doppler 3. Electrosurgery Unit 4. Endoscopy Scopes 5. Fracture Table 6. High Flow Insuflator 7. Intra Aortic Balloon Pump 8. Laser 9. Nerve Stimulators 10. Pacemakers 11. Portable Microscope 12. Ventilators 13. Anesthesia Equipment 14. Cardiac Monitors 15. Infusion Pumps 16. Drills/Saws 17. Tourniquet 18. Midas Rex COMPUTERIZED CHARTING 1. Cerner 2. Eclipsys 3. Epic 4. McKesson 5. Meditech 6. Other:

OPERATING ROOM

KNOWLEDGE & SKILLS

CHECKLIST Name:       Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care.

ID #:      

A. Newborn/Neonatal (birth – 30 days) B. Infant (30 days – 1 year) C. Toddler (1 – 3 years) D. Preschool (3 – 5 years) E. School Age Children (5 – 12 years) F. Adolescent (12 – 18 years) G. Young Adults (18 – 39 years) H. Middles Adults (40 – 64 years) I. Older Adults (64 + years)

TYPE DATE (MM/DD/YY) ARRHYTHMIA CRITICAL CARE ACLS BCLS TNCC NRP PALS NALS BTLS CCRN Other       Other      

EXPERIENCE WITH AGE GROUPS: 1. Able to assess age appropriate behavior, motor skills and physiological norms. A

B

C

D

E

F

G

H

B

C

D

E

F

G

H

COURSE                                                                        

I

2. Able to adapt care according to normal growth and development. A

I HAVE CURRENT CERTIFICATIONS FOR:

I

The information I have provided in this knowledge and skills checklist it true and accurate to the best of my knowledge.       Signature

      Date

(Written/Electronic)

ID #:       3. Able to communicate and instruct patient according to their age, maturity and comprehension ability. A

B

C

D

E

F

G

H

I

This skills checklist has been reviewed and approved by Nicole Bloxham, RN.       Signature

      Date

(Written/Electronic)

4. Able to provide a safe environment according to the specific needs of various age groups. A

B

C

D

E

F

G

H

I

ID #:      

Please return to: Northwest Nurse Company, PA ATTN: Records Dept. Fax: (866) 352-4338

Staffing

Email: [email protected]

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