Administrative Registered Nurse Skills Checklist

Certified Surgical First Assist Skills Checklist

Fill Out and Submit your Skills Checklist

(Certified Surgical First Assist Skills Checklist)

Your name

Your Email

Last 4 Of SSN

Date

E-Signature

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

Age of Patients Cared For

Newborn/Neonate (birth to 30 days):

★★★★

Infant (1 month to 1 year):

★★★★

Toddler (1 year to 3 years):

★★★★

Preschooler (3 years to 5 years):

★★★★

School Age Child (5 years to 12 years):

★★★★

Adolescents (12 years to 18 years):

★★★★

Young Adults (18 years to 39 years):

★★★★

Middle Adults (39 years to 64 years):

★★★★

Older Adults (64 years to 79 years):

★★★★

Elderly Adults (over 79+ years):

★★★★

MISCELLANEOUS

Adult Respiratory/Cardiac Arrest:

★★★★

Autoclave:

★★★★

Automated Med Dispensing Systems:

★★★★

List Type:

Care of Scopes & Fiberoptic Equipment:

★★★★

Cidex Soap:

★★★★

Crash Cart:

★★★★

Defibrillator:

★★★★

Electronic Documentation:

★★★★

List Types:

Hand-off Communication:

★★★★

Isolation Precautions:

★★★★

Patient Identification:

★★★★

Pediatric Respiratory/Cardiac Arrest:

★★★★

Standard Precautions:

★★★★

Universal Protocol:

★★★★

GENERAL SURGERY

Abdominal Perineal Resection:

★★★★

Adrenalectomy:

★★★★

Bowel Resection:

★★★★

Cholecystectomy:

★★★★

Colostomy/Ileostomy:

★★★★

Gastrectomy:

★★★★

Hemicolectomy:

★★★★

Hepatic Resection:

★★★★

Herniorrhaphy-Femoral/Inguinal:

★★★★

Hiatal Herniorrhaphy-Transabdominal:

★★★★

Pancreatectomy:

★★★★

Organ Procurement:

★★★★

Radical Mastectomy:

★★★★

Saphenous Vein Ligation and Stripping:

★★★★

Splenectomy:

★★★★

Thyroidectomy:

★★★★

Tracheostomy:

★★★★

Whipple Procedure:

★★★★

LAPAROSCOPIC PROCEDURES

Hysterectomy:

★★★★

Cholecystectomy:

★★★★

Appendectomy:

★★★★

Hernia Repair:

★★★★

Colon Resection:

★★★★

GYNECOLOGY

Caesarean Section:

★★★★

Dilation & Curettage:

★★★★

Hysterectomy-Vaginal:

★★★★

Hysterectomy-Abdominal:

★★★★

Laser Surgery:

★★★★

Radium Insertion:

★★★★

Salpingo-Oopherectomy:

★★★★

Shirodkar Procedure:

★★★★

Termination of Pregnancy:

★★★★

Tubal Ligation:

★★★★

Vaginectomy:

★★★★

Vaginal Reconstruction:

★★★★

G.U. AND CYSTO

Circumcision:

★★★★

Cystoscopy/Cystostomy:

★★★★

Cystectomy:

★★★★

Hypospadias Repair:

★★★★

Ileal Loop:

★★★★

Lithotripsy:

★★★★

Nephrectomy:

★★★★

Orchiectomy:

★★★★

Penile Implant:

★★★★

Prostatectomy:

★★★★

Ureterolithotomy:

★★★★

Ureteroscopy:

★★★★

T.U.R.P./T.U.R.B:

★★★★

Vasectomy:

★★★★

ORTHOPEDIC

Amputation-Leg/Arm:

★★★★

Application of Halo Traction:

★★★★

Arthroscopy/Arthrotomy:

★★★★

Closed Pinning & Reduction of Extremities:

★★★★

External Compression Devices:

★★★★

Insertion of Finger Prosthesis:

★★★★

Total Joint Replacement (Knee, Hip, Shoulder):

★★★★

Spinal Fusion-Harrington Rods:

★★★★

Spica Cast Application:

★★★★

O.R.I.F. (Shoulder, Hip, Humerus, etc.):

★★★★

Repair of Dislocation:

★★★★

Patellectomy:

★★★★

Tendon Implants & Reanastomosis:

★★★★

NEUROSURGERY

Anterior Cervical Fusion:

★★★★

AV Malformation:

★★★★

Burrholes for Subdural Hematoma:

★★★★

Craniotomy:

★★★★

Discectomy/Laminectomy:

★★★★

Laminectomy:

★★★★

Meningocele Repair:

★★★★

Nerve Stimulators:

★★★★

Shunt Procedures (VP/VA):

★★★★

Spinal Procedures/Fusions:

★★★★

PLASTICS

Abdominoplasty/Abdominal Lipectomy:

★★★★

Augmentation Mammoplasty:

★★★★

Breast Reduction/Reconstruction:

★★★★

Cleft Lip/Palate Repair:

★★★★

Dermabrasion:

★★★★

Digital Flexor Tendon Repair:

★★★★

Face Lift:

★★★★

Liposuction:

★★★★

Otoplasty:

★★★★

Rhinoplasty:

★★★★

Reduction of Facial Fracture:

★★★★

Scar Revisions:

★★★★

Skin Grafting:

★★★★

EYE

Excision of Chalazion:

★★★★

Canthotomy:

★★★★

Correction of Ectropion/Entropion:

★★★★

Corneal Transplant:

★★★★

Enucleation:

★★★★

I.O.I. Implants:

★★★★

Lacrimal Duct Probing:

★★★★

Refractive Keratoplasty:

★★★★

Repair of Retinal Detachment:

★★★★

Vitrectomy:

★★★★

EAR, NOSE & THROAT

Caldwell-Luc:

★★★★

Ethmoidectomy:

★★★★

Frontal Flap Sinus Procedure:

★★★★

Laryngectomy:

★★★★

Radical Neck:

★★★★

Septoplasty:

★★★★

Sinusotomy:

★★★★

Tonsillectomy & Adenoidectomy:

★★★★

Tracheostomy:

★★★★

Myringotomy:

★★★★

Mastoidectomy:

★★★★

Tympanoplasty:

★★★★

Stapedectomy:

★★★★

Nasal Polypectomy:

★★★★

Laryngoscopy:

★★★★

ENDOSCOPY

Bronchoscopy:

★★★★

CARDIOTHORACIC

Chest Tube Set-Up:

★★★★

Pneumonectomy/Lobectomy:

★★★★

Septal Defect Repair:

★★★★

Sternal Splitting:

★★★★

Thoracotomy:

★★★★

Bronchoscopy:

★★★★

Lung/Wedge Resection:

★★★★

Vein Harvesting:

★★★★

A-V Shunts:

★★★★

Aortic Aneurysm, Abdominal:

★★★★

Aortofemoral Bypass:

★★★★

Graft Insertion:

★★★★

Cardiac Valve Replacement:

★★★★

Coronary Artery Bypass Graft (on Pump):

★★★★

Endarterectomy (Carotid/Femoral):

★★★★

Femoral-Popliteal Bypass:

★★★★

External Temporary Pacemaker:

★★★★

Internal Pacemaker Insertion:

★★★★

Intra-Aortic Balloon Pump Catheter:

★★★★

Patent Ductus Repair:

★★★★

Pericardial Windows:

★★★★

Portasystemic Shunt:

★★★★

Repair of Septal Defects:

★★★★

Thrombectomy:

★★★★

Vena Cava Ligation:

★★★★

TRANSPLANTS

Bone Marrow:

★★★★

Pancreas:

★★★★

Heart:

★★★★

Lung:

★★★★

Liver:

★★★★

Multiorgan:

★★★★

Kidney:

★★★★

Eye:

★★★★

TRAUMA

Burns:

★★★★

MVA:

★★★★

Gun Shot Wounds:

★★★★

Stab Wounds:

★★★★

EQUIPMENT & SURGICAL TECHNIQUES

Robotics:

★★★★

List Type:

Fracture Tables:

★★★★

List Type:

Video Systems:

★★★★

List Type:

CUSA:

★★★★

Cell Saver:

★★★★

PACS Diagnostics:

★★★★

Electrocautery:

★★★★

Drills:

★★★★

List Type:

Saws:

★★★★

List Type:

Stapling Devices:

★★★★

List Type:

Cardiac Monitors:

★★★★

List Type:

Surgical Techniques & Responsibilities

Position Patient Per Surgeon's Order:

★★★★

Pressure Point Padding:

★★★★

Apply Tourniquet as Ordered:

★★★★

Protect From Nerve Damage:

★★★★

Thermoregulation:

★★★★

Use of Fracture Table:

★★★★

Use of Head Stabilizer:

★★★★

Use of Body Stabilizer:

★★★★

Use of C-Arm Extensions:

★★★★

Skin Assessment:

★★★★

Use of Retractors:

★★★★

Packing with Sponges:

★★★★

Digital Manipulation of Tissue:

★★★★

Suctioning, Irrigation, Sponging:

★★★★

Manipulation of Surgical Materials:

★★★★

Clamping/Cauterizing Vessels:

★★★★

Tying/Ligating Clamped Vessels:

★★★★

Apply Hemostatic Clips:

★★★★

Place Local Hemostatic Agents:

★★★★

Direct Digital Pressure:

★★★★

Assist in Volume Replacement:

★★★★

Assist in Autotransfusion:

★★★★

Suturing: All Wound Layers:

★★★★

Wound Dressing (Liquid/Spray):

★★★★

Absorbent Immobilizing Dressing:

★★★★

Assist to Secure Drainage System:

★★★★

Insert/Remove Foley:

★★★★

Drape Patient:

★★★★

Electrocautery Monopolar:

★★★★

Electrocautery Bipolar:

★★★★

Cut Tissue:

★★★★

Harvest Saphenous Vein:

★★★★

Dissect Common Femoral Artery:

★★★★

Insert Drainage Tubes:

★★★★

Certified Surgical First Assist Skills Checklist

Fill Out and Submit your Skills Checklist

(Certified Surgical First Assist Skills Checklist)

Proficiency Scale:

Clinical Skills Checklists

Therapist Skills Checklists

Other Skills Checklists