Operating Room Skills Checklist

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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.

1 = Never Performed 2 = Limited Experience 3 = Comfortable Performing 4 = Proficient

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GENERAL SURGICAL	1	2	3	4	1	2	3	4
Abdominal Perineal Resection
Adrenalectomy
Anal Fissurectomy
Appendectomy
Breast Biopsy
Central Line Insertion
a. Hickman
b. Groshong
c. Portacath
Cholecystectomy/cholangiogram
Colectomy
Colon Resection
Colostomy/Ileostomy
Gastroplasty
Hemorrhoidectomy
Hepatic Resection
Herniorrhaphy
a. Inguinal
b. Umbilical
Hiatal Herniorrhaphy
a. Transabdominal
b. Transthoracic
Hydrodelectomy
Imperforate Anus Reconstruction
Lumbar Sympathectomy
Omphalocele Repair
Pancreatectomy/Pancreatogram
Pilonidal Cystectomy
Portal Caval Shunt
Pyloric Stenosis
Radical Mastectomy
Saphenous Vein Ligation/Stripping
Splenectomy
Tenchkhoff Catheter Placement
Thyroglossal Duct Cyst Excision
Thyroidectomy
Vagotomy
Whipple (Open)

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CARDIOTHORACIC	1	2	3	4	1	2	3	4
CABG
Chest Tube Insertion
Closed Thoracotomy
Coarctation Resection, Aorta
Open Heart Procedures
a. Patient ductus arteriosus
b. Septal defect repairs
c. Ascending Dissection
d. Descending Dissection
e. Arch Dissection
f. Tetralogy of Fallot
g. Commissurotomy/Valve Repair/Replacement
Pacemaker Implantation
a. Endocardial
b. Myocardial
Pectus Excavatum Correction
Pericardectomy
Pneumonectomy/Lobectomy
Rib Resection
Thoracoplasty
Tracheal Resection
Transthoracic Diaphragmatic Herniorrhaphy
Vein Harvesting
a. Endoscopic
b. Open

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NEUROSURGICAL	1	2	3	4	1	2	3	4
A-V Malformation
Ant. Laparoscopic Spine Procedure
Anterior Lumbar Interbody Fusion
Burr Holes for Subdural Hematoma
Carotid Ligation
Cervical Fusion
a. Anterior
b. Posterior
Cervical Sympathectomy
Cranioplasty/Craniotomy
a. Aneurysm Clipping
b. Tumor Excison
c. Stealth
Craniectomy for Decompression Fx
Crutchfield Tong Insertion
Discectomy
Hypophysectomy
Medication Pump Insertion
Myelomeningocele Repair
Nerve Stimulator Insertion
Pedicle Screw Insertion
Posterior Lumbar Interbody Fusion
Shunt Procedure, VP & VA
Ulnar Nerve Transfer
Ventriculography
Ventriculostomy

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ENDOSCOPIC	1	2	3	4	1	2	3	4
Bronchoscopy
Colonscopy
Cystoscopy
Gastroscopy
Hyteroscopy
Laparoscopy
a. Appendectomy
b. Cholecystectomy
c. Cholangiogram
d. Colon Resection
e. Herniorrhaphy
Laparoscopy (continued)
f. Nissen Fundoplication
g. Pelvic Exoneration
h. Salpingooophorectomy
i. Tubal Ligation
j. Scope Assisted Vaginal Hysterectomy
Laryngoscopy & Microlaryngoscopy
Mediastinoscopy
Sigmoidoscopy
Thoracoscopy
Ureteroscopy

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ORTHOPEDIC	1	2	3	4	1	2	3	4
Acetabular/Pelvic ORIF
Achilles Tendon Repair
Anterior Cruciate Ligament Repair
Arthroscopy
a. Ankle
b. Elbow
c. Hip
d. Knee
e. Shoulder
Arthrotomy
Bipolar/Unipolar Hips
Bunionectomy
Calcaneal Reconstruction
Capsulorrhaphy
Carpel Tunnel Release
Closed Reduction Fracture
External Fixator Application
a. Extremities
b. Pelvis
Extremity Amputation
Halo Traction Application
Hammer Toe Repair
Hand Surgery
Harrington Rod Insertion
Heel Cord Lengthening
Hip Compression & Lag Screws
a. Rush
b. Schneider
Hip Compression & Lag Screws (continued)
c. Smith & Richards
d. Zimmer
e. Other
Hip Prothesis Insertion
Iliac Crest Bone Graft
Intramedullary Rods Insertion
a. Femoral
b. Humeral
c. Supracondylar
d. Tibial
Laminectomy
Olecranon Bursa Excision
Reduction with Compression
Remiplanation of Digits
Rotator Cuff Repair
a. Putti Platt
b. Bankart
Sacro-iliac Joint Screws
Spica Cast Application
Spinal Fusion
a. Anterior
b. Posterior
Tendon Transplants
Total Joint Replacement
a. Hip
b. Knee
c. Shoulder

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GYNECOLOGIC	1	2	3	4	1	2	3	4
Cesarean Section
Colpotomy
D & C
Ectopic Pregnancy
Hysterectomy
a. Abdominal
b. Vaginal
Marshall-Marchetti
Marsupialization-Bartholin Cyst
Ovarian Cystectomy
Radium Insertion
Sacral Spinus Fixation
Salpingoplasty
Shirodkar Procedure
Suction Curettage
Vaginal Reconstruction
Vaginectomy
Vulvectomy

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VASCULAR	1	2	3	4	1	2	3	4
A-V Access Graft
Aortic aneurysm w/ graft replacement
Aortograms
Carotid aneurysm resection & graft
Endarterectomy
a. Carotid
b. Femoral
Endoscopic Aortic Aneurysm Repair
Peripheral Vascular Bypasses
Stent Placements
a. Aorta
b. Brachial
c. Carotid
d. Femoral
Thrombectomy/Embolectomy
Vena Cava Filter
Vena Cava Ligation

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UROLOGIC	1	2	3	4	1	2	3	4
Adult Circumcision
Bladder Suspension
Cystectomy
Hypospadias Repair
Implants
Lithotripsy
Nephrectomy
Nephrolithotomy
Orchiopexy
Prostatectomy
a. Perineal
b. Suprapubic
Pyeloplasty
Radical Node Resection
Radium Seed Implants
Scott Incontinence Device
TURP/TURBP
Utereolithotomy
Vasectomy
Vasotomy

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ORAL	1	2	3	4	1	2	3	4
Closed Reduction Facial Fractures
Excision Odontoma
Fractured Jaws
LeFort Osteotomy
Maxillary Graft
Pediatric Dentistry
Sagittal Osteotomy
Teeth Extraction
TMJ with Arthroplasty
TMJ Exploration

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OTORHINOLARYNGOLOGIC	1	2	3	4	1	2	3	4
Adenoidectomy
Caldwell-Luc
Cleft Lip/Palate Repair
Closed Reduction Nasal Fracture
Ethymoidectomy
Excision Salivary Gland Tumor
Fenestration
Frontal Flap Sinus
Glossectomy
Laryngectomy
Mandibulectomy
Mastoidectomy
Maxillary Advancement/Hip Graft
Maxillectomy
Myringoplasty w/ PE Tube Insertion
Nasal Polypectomy
Open Reduction
a. Facial Fractures
b. Nasal Fractures
Parotidectomy
Pharyngeal Flap
Radical Neck Dissection
Ranulectomy
Rhinoplasty/Septoplasty
Selective Osteotomy
a. Maxilla
b. Mandible
Sinus Endoscopy
Sinusotomy
Stapedectomy
Submucous Resection
Tonsillectomy
Tracheostomy
Tympanoplasty

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OPHTHALMOLOGIC	1	2	3	4	1	2	3	4
Cataract Extraction
Corneal Transplant
Dacryocystectomy
Dacryocystorhinostomy
Enucleation
Iridectomy
Lid & Muscle Procedures
Orbital Implant
Phaco Emulsificatin
Pterygium Repair
Recession Resection
Repair Orbital Blowout Fracture
Scleral Buckle
Vitrectomy

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PLASTIC	1	2	3	4	1	2	3	4
Abdominal Lipectomy
Blepharoplasty
Face Lift
Free Flaps
Mammoplasty
a. Augmentation
b. Reduction
c. TRAM Flap
Mentoplasty
Otoplasty
Pedicle Grafts
Scar Revisions
Split Thickness Skin Grafting
Tissue Expanders

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TRANSPLANT	1	2	3	4	1	2	3	4
Bone
Bone Marrow
Corneal
Heart
Kidney
Liver
Lung
Multi-organ
Pancreas
Skin
Harvesting

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TRAUMA	1	2	3	4	1	2	3	4
Burns
Gunshot/Stab Wounds
a. Abdomen
b. Chest
c. Head
Multiple Injury Accidents

SKILLS/PROCEDURES	1	2	3	4
Blood/Blood Product Infusion
a. Packed RBCs
b. Whole Blood
Blood Gas Interpretation
Chest Tube & Drainage System
Foley Catheter Insertion & Care
a. Female
b. Male
Gastric Suction
Phlebotomy
a. Venous Blood Draw
b. Central Line Blood Draw
Restraints
Intubation
Extubation
Hemodynamic Monitoring Noninvasive
a. Ausculation
b. Electronic
Intravenous Therapy
a. Angiocath Insertion
b. A-Line Insertion (assist)
c. CVP Insertion (assist)
d. Swan-Ganz Insertion (assist)
Malignant Hyperthermia Crisis
a. Assessment
b. Management
Oxygen Therapy Administration
a. Face Mask
b. Nasal Cannula
c. Trach Collar
Suctioning
a. Nasopharyngeal
b. Oropharyngeal
c. Tracheostomy
Temperature
a. Axillary
b. Oral
c. Rectal
d. Tympanic
Wound Care
a. Incisional Dressing Assessment
b. Surgical Wounds with Drains
Knowledge of Medications
Knowledge of Emergency Meds
Patient Teaching

EQUIPMENT & SUPPLIES	1	2	3	4
Argon Beam Coagulator
Autoclave
Bair Hugger
Blood/Fluid Warmer
Camera/Video Systems
a. Camera controller
b. Light source
c. Printers
d. VCR's
CD Players
Computer Skills/Abilities
Cardiac Monitor
Cell Saver
Cryo Unit for Cardiac Surgery
Cry-ophthalmic Unit
Defibrillator
Dermatome
a. Padgett
b. Zimmer
Drills
a. 3-M maxi driver
b. Codman craniotome
c. Hall air driver
d. Hall dental
e. Hall neurotome
f. Midax Rex/Anspach
g. Minidriver
h. Stryker
i. Surgairtome
j. Synthes A-O Drill
Emerson Thoracic Pump
ESU Cautery
Fiber Optic Luminator
Flash Autoclave
Fracture Tables
a. Chick/Marquet
b. Jackson
c. Skytron/Rush
Infusion Delivery Devices (specify)
-
-
-
-
Internal Stapling Devices
Kreiselman Resuscitator
Laser
a. CO2
b. Holmium
c. Yag
d. Other:
Mesh graft
Microscopes
Nitrous Oxide Bank
Continuous SVO2 & CO Monitor
Pleurevac Chest Drainage System
Pneumatic Tourniquet
Pulse Oximeter
Steris Unit
Suction Units
Teletherometer
Vac-Pac Positioner
Computer Charting Systems

PAIN MANAGEMENT	1	2	3	4
Pain Level Assessment
Care of Patient with:
a. Epidural Anesthesia
b. IV Conscious Sedation
c. PCA
d. Narcotic Agents

PRIMARY OR EXPERIENCE	# of years
Endoscopy
Cardiothoracic
General Surgery
Gynecologic
Neurosurgical
Ophthalmologic
Oral
Orthopedic
Otorhinolaryngologic
Plastic
Transplant
Trauma
Urologic
Vascular

Do you speak any languages other than English?	Yes	No

If yes, which language(s)?

I hereby certify that ALL information I have provided to Emerald, 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.