4/8/24, 10:39 PM CVOR RN Skills Checklist

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

Rating Stars (Click) SCRUB GENERAL SURGERY 1 2 3 4

AKA/BKA (Amputation)

Radical Mastectomy

Abdominal - Perineal Resection

Cholecystectomy (Open)

Exploratory Laparatomy

Appendectomy

Rating Stars (Click) SCRUB CARDIAC 1 2 3 4

DaVinci Procedures

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Coronary Artery By-Pass

Mitral Valve Repair/Replacement

Aortic Valve Replacement

Multiple Valve Transposition

Septal Defects

Ventricular aneurysm Repair

Bring Back Heart

Pericardial Window

Intra-Aortic Balloon Insertion

Heartport or Similar CABG

Thoraco approach Mid-Cab

Aortic Arch Replacement

Aortic Valve Conduit

Mechanical Heart/LVAD

Pediatric Hearts

Tetrology of Fallot

Chamberlain Procedure

Femoral Artery Cannulation

AICD Insertion

Saphenous Vein Harvest

Endoscopic Vein Harvest

Gastric Artery Harvest

Radial Vein Harvest

Carotid Endarterectomy

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Abdominal Aortic Aneurysm

Femoral-Popliteal By-Pass Graft

Thrombectomy

AV Shunt

Pacemaker Insertion

Rating Stars (Click) SCRUB LAPARASCOPIC PROCEDURES 1 2 3 4

Cholecystectomy (Open)

Appendectomy

Hernia

Nissan

Colectomy

Gastrectomy

Inguinal/Ventral hernia Repair

Splenectomy

Bowel Rescetion/Colostomy

Thyroidectomy

Rectal Procedures

Esophagascopy/Gastrocopy

Rating Stars (Click) SCRUB PEDIATRIC CASES 1 2 3 4

Inguinal Hernia Repair

Pyloric Stenosis

Circumcision

Exploratory Laparotomy

Rating Stars (Click) SCRUB VASCULAR SURGERY 1 2 3 4

Carotid Endarterectomy

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Abdominal Aoric Aneurysm

Femoral-Popliteal By-Pass Graft (Insitu)

Femoral-Popliteal By-Pass Graft (Graph)

Portacath, Tesio, Hickman

AV Shunt

Thrombecomy

Pacemaker Insertion

Arterial Stenting

Intra-Operative Angioplasty

Subclavian/Carotid By-Pass

Rating Stars (Click) SCRUB ORTHOPEDICS 1 2 3 4

Total Hip Replacement

Bipolar Hip

Compression Hip Screw

Total Knee Replacement

Knee Artoscopy

ACL Knee Repair

harrington Rod or Similar

I.M. Rodding

Hand and Foot procedures

Mini Fragment Screws & Plates

External Fixation

Shoulder Repair

Shoulder Arthoscopy

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Spinal Fusion

Fracture Table Set-Up

Drills, Saws and Reamers

Rating Stars (Click) SCRUB GYNECOLOGY 1 2 3 4

D&C

Diagnostic Laparascope

Laparoscopic Asst'd Vaginal Hysterectomy

Abdominal Hysterectomy

Vaginal Hysterectomy

Anterior/Posterior Repair

MMK (Marshall Marchetti Krantz)

Tuboplasty

BLT (Bilateral Tubal Ligation)

C-Section

Rating Stars (Click) SCRUB UROLOGY 1 2 3 4

Radical Prostatectomy

Radical Lymph Node Dissection

Insertion Penile Prosthesis

Hydrocelectomy

Cystoscopy

Ureteroscopy

TURP/TURBT

Rating Stars (Click) SCRUB NEUROLOGY 1 2 3 4

Cervical Laminectomy (Anterior)

Cervical Laminectomy (Posterior)

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Lumbar Lamincetomy, Discectomy

Percutaneous Micro Discectomy

Craniotomy for Tumor

Craniotomy for Aneurysm

Burr Holes

VP Shunts

Transphenoidal Hypothypectomy

Harrington Rod or Similar

SCRUB PLASTICS

Mammoplasty

Facelifts

Skin Grafts

Rhinoplasty

Cleft Lip Repair

Abdominalplasty

Blepharoplasty

Otoplasty

Muscle Flaps

Trauma

Transplant Surgery

Organ Procurements (Harvest)

Rating Stars (Click) SCRUB ENT 1 2 3 4

Middle Ear

T&A

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Myringotomy

Tympanoplasty

Radical Neck Dissection

Septoplasty

Sinus Endoscopy

Rating Stars (Click) SCRUB THORACIC 1 2 3 4

Thoracotomy

Thoracoscopy

Rating Stars (Click) Age Specific Competencies 1 2 3 4

Infant (Birth - 1 year)

Preschooler (ages 2-5 years)

Childhood (ages 6-12 years)

Adolescents (ages 13-21 years)

Young Adults (ages 22-39 years)

Adults (ages 40-64 years)

Older Adults (ages 65-79 years)

Elderly (ages 80+ years)

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