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OPERATING ROOM KNOWLEDGE & SKILLS

CHECKLIST
NAME:       DIRECTIONS: Please indicate your level of
ID #:       experience by placing a check (√) in the
DATE:       box. Experience level:
1 NO EXPERIENCE
2 MINIMAL EXPERIENCE-requires
This Skills Checklist is for use by nurses supervision/assistance
with more than one year experience in 3 MODERATELY EXPERIENCED-requires
their discipline and specialty. Please be initial review, then performs
accurate with your assessment. independently
4 VERY EXPERIENCED- proficient
DESCRIPTION 1 2 3 4
NEUROLOGY DESCRIPTION 1 2 3 4
1. Acoustic Neuromas 5. Sinus Endoscopy
2. Aneurysm Repair 6. Stapedectomy
3. Cervical Laminectomy 7. T & A Myringotomies
4. Craniotomy 8. Tracheostomy
5. Endarterectomy 9. Tympanoplasty
6. Hematoma Evacuation 10. Vocal Cord Stripping
7. Lumbar Laminectomy GENERAL
8. Neuro Trauma 1. Abdominal Resection
9. Shunts 2. Appendectomy
EYE 3. Cholecystectomy
1. Blepharoplasty 4. Colon Resection
2. Cataract with IOL 5. Colostomy
3. Chalazion 6. Gastrectomy
4. Corneal Transplant 7. Hernia Repair
5. Dacryocystorhinoplasty 8. Lap Chole
6. Enucleation 9. Laparotomy
7. Iridectomy 10. Mastectomy
8. Muscle Repair 11. Thyroidectomy
9. Removal Foreign Body THORACIC/OPEN HEART
10. Retinal Detachment Repair 1. Atrial Septal Defect
11. Trabeculectomy 2. Bronchoscopy
ORAL 3. CABG
1. Grafts 4. Internal Defibrillator
2. Letorte Osteotomies 5. Mediastinoscopy
3. Mandibular Procedures 6. Pacemaker Insertion
4. Maxillary Procedures 7. Pneumonectomy
5. TMJ Arthroplasty 8. Thoracotomy
EAR, NOSE, THROAT 9. Valve Replacement
1. Laryngectomy 10. Ventricular Septic Defect
2. Mastoidectomy VASCULAR
3. Radical Neck 1. Aortic Aneurysm
4. Septoplasty 2. Embolectomy
3. Fem-Fem Bypass
4. Fem-Pop Bypass
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OPERATING ROOM KNOWLEDGE & SKILLS
CHECKLIST
5. Fem-Tib Bypass
ID #:      
Name:       DESCRIPTION 1 2 3 4
DESCRIPTION 1 2 3 4 2. MVA
6. Vein Ligation 3. Traumatic Amputations
7. Carotid Endarterectomy TRANSPLANTS
UROLOGY 1. Harvest Organs
1. Archiotomy 2. Heart
2. Cystoscopy 3. Kidney
3. Nephrectomy 4. Liver
4. Penile Prosthesis 5. Lung
5. Radical Prostate Resection PEDIATRICS
6. TURP 1. Abdominal Procedures
7. Ureterolithotomy 2. Neonatal Procedures
8. Urinary Diversion 3. Open Heart
ORTHOPEDICS 4. Orthopedic Procedures
1. Amputation 5. Plastics
2. Arthroscopy 6. Thoracotomy
3. Bunionectomy EQUIPMENT
4. Carpal Tunnel Release 1. Ceiling Mount Microscope
5. Closed Reduction 2. Doppler
6. Hip pinning 3. Electrosurgery Unit
7. ORIF 4. Endoscopy Scopes
8. Spinal Rodding/Fixation 5. Fracture Table
9. Total Joint Replacement 6. High Flow Insuflator
10. Hip Replacement 7. Intra Aortic Balloon Pump
11. Knee Replacement 8. Laser
12. Shoulder Replacement 9. Nerve Stimulators
13. Hand Surgery 10. Pacemakers
GYNECOLOGY 11. Portable Microscope
1. A&P Repair 12. Ventilators
2. Laparoscopy 13. Anesthesia Equipment
3. Vaginal Hysterectomy 14. Cardiac Monitors
4. Abdominal Hysterectomy 15. Infusion Pumps
5. C-Section 16. Drills/Saws
6. Marshall Marchetti 17. Tourniquet
7. Tubal Ligation 18. Midas Rex
PLASTICS COMPUTERIZED CHARTING
1. Abdominoplasty 1. Cerner
2. Breast Reconstruction 2. Eclipsys
3. Cleft Lip/Palate 3. Epic
4. Flap Grafts 4. McKesson
5. Mammoplasty 5. Meditech
6. Rhinoplasty 6. Other:
TRAUMA
1. Gunshot Wounds

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OPERATING ROOM KNOWLEDGE & SKILLS
CHECKLIST

Name:      

Please check the boxes below for each ID #:      


age group for which you have expertise in
providing age-appropriate nursing care. I HAVE CURRENT CERTIFICATIONS FOR:

A. Newborn/Neonatal (birth – 30 days) TYPE COURSE


B. Infant (30 days – 1 year) DATE (MM/DD/YY)
C. Toddler (1 – 3 years) ARRHYTHMIA      
D. Preschool (3 – 5 years) CRITICAL CARE      
E. School Age Children (5 – 12 years) ACLS      
F. Adolescent (12 – 18 years) BCLS      
G. Young Adults (18 – 39 years) TNCC      
H. Middles Adults (40 – 64 years) NRP      
I. Older Adults (64 + years) PALS      
NALS      
EXPERIENCE WITH AGE GROUPS: BTLS      
1. Able to assess age appropriate CCRN      
behavior, motor skills and physiological Other            
norms. Other            

A B C D E F G H I
The information I have provided in this
knowledge and skills checklist it true and
2. Able to adapt care according to normal accurate to the best of my knowledge.
growth and development.
           
A B C D E F G H I Signature Date
(Written/Electronic)
ID #:      
3. Able to communicate and instruct
patient according to their age, maturity This skills checklist has been reviewed
and comprehension ability. and approved by Nicole Bloxham, RN.

A B C D E F G H I            
Signature Date
(Written/Electronic)
4. Able to provide a safe environment ID #:      
according to the specific needs of various
age groups.
Please return to: Northwest Nurse Staffing
Company, PA
A B C D E F G H I
ATTN: Records Dept.
Fax: (866) 352-4338

Email: records@nns-ic.com

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