Peri-Operative RN Skill Checklist

Fill Out and Submit your Skills Checklist

    (Peri-Operative RN)

    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

    IV Therapy

    0

    IV Therapy - Assist with

    0

    0

    0

    0

    0

    0

    Administration of blood and products

    0

    0

    0

    General Surgery

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Thoracic and Open Heart

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Vascular

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Neurology

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Neurology - Cranioplasty/craniotomy

    0

    0

    0

    Urology

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Gynecology

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Orthopedics

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Orthopedics - Arthroscopy

    0

    0

    0

    0

    Orthopedics - Hip compression nails and lag screws

    0

    0

    0

    0

    0

    0

    0

    0

    Orthopedics - Intramedullary rods

    0

    0

    0

    0

    0

    0

    Orthopedics - Total joint replacements/revisions

    0

    0

    0

    Plastics

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Plastics - Mammoplasty

    0

    0

    0

    Ear, Nose and Throat

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Oral

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Ophthalmology

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Endoscopic Procedures

    0

    0

    0

    0

    0

    0

    Laparoscopic procedures

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Transplant

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Trauma

    0

    0

    0

    Trauma - Gunshot/stab wounds

    0

    0

    0

    Equipment

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Equipment - Fracture tables

    0

    0

    0

    Equipment - Intestinal stapling devices

    0

    0

    0

    0

    Equipment - Laser

    0

    0

    0

    0

    Camera/video systems

    0

    0

    0

    0

    Dermatome

    0

    0

    0

    0

    Drills

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Miscellaneous

    0

    0

    0

    0

    Able to assure a safe environment for the specific needs of various age groups

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Able to communicate and/or instruct patients according to their age, maturity, comprehension

    0

    0

    0

    0

    0

    0

    0

    0

    0

    Evaluate age-appropriate behavior, motor skills and physiological norms

    0

    0

    0

    0

    0

    0

    0

    0

    0