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OPERATING ROOM SKILLS CHECKLIST OPERATING ROOM
SKILLS CHECKLIST
To Assignment Americas Healthcare Professionals:
The purpose of the following checklist is to assist in matching your skills and interests with available assignments, thus meeting your
needs and the needs of our clients as much as possible. Your employment is not dependent upon responses given in this checklist.
**
Please make sure this Skills Checklist is signed and dated.
The information I have given is true and accurate to the best of my knowledge. In addition, I hereby authorize Assignment America,
to release this Skills Checklist to client institutions of Assignment America, in relation to my employment with that institution.
Signature
Date
To Assignment Americas Client Institution:
Assignment America has developed unique skills checklists for each nursing specialty. This checklist is not necessarily a valid indicator of clinical
skills and should not be utilized as the sole measure of the ability of an individual to perform the duties of a registered nurse or therapist in your
facility. It is intended to be used only as a guide in your screening procedures and in orientation to procedures within your institution.
Applicants Name:
FIRST
MIDDLE INITIAL
LAST
Date:
OR 1 OF 5 Rev 3/01
A. General Surgery
1. Abdominal Perineal Resection
2. Adrenalectomy
3. Anal Fissurectomy
4. Appendectomy
5. Cholecystectomy/Cholangiogram
6. Colectomy
7. Colon Resection
8. Colostomy/Ileostomy
9. Gastrectomy
10. Hepatic Resection
11. Hernia Repair
12. Hydrocelectomy
13. Leveen-Peritoneal Shunt
14. Lumbar Sympathectomy
15. Minor Case Set-Up (Breast Biopsies, Hernias)
16. Nissen Fundoplication
17. Pancreatectomy/Pancreatogram
18. Pilonidal Cystectomy
Rate 1-4
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19. Portal Caval Shunt
20.Radical Mastectomy
21. Rectal Cases
22.Saphenous Vein Ligation and Stripping
23.Splenectomy
24. Staging Laporotomy
25.Thyroglossal Duct Cyst Excision
26.Thyroidectomy
27. Vagotomy
28.Whipple Procedure
29.Endoscopic Procedures
B. Thoracic/Open Heart
1. Cervical Rib Excision
2. Chamberlain Procedure
3. Closed Thoracotomy
4. Esophagectomy
5. Heller Procedure
Rate 1-4
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Profession:
RN Technician
PLEASE MARK YOUR LEVEL OF EXPERIENCE
No Experience: Observed Only
Moderate Experience: Performs 1-2 Times/Month; May Need Minimal Resource
Limited Experience: Performs < 6 Times Per Year; Needs Review
Highly Experienced: Performs on Daily or Weekly Basis; Proficient
1
2
3
4 Applicants Name
OR 2 OF 5
6. C.A.B.G.
7. Mitral or Aortic Valve Replacement
8. Patent Ductus Arteriosus
9. Tetrology of Fallot
10. VSD (Ventral or Ventricular Septal Defect)
11. ASD (Atrial Septal Defect)
12. Pacemaker Implantation Endocardial
13. Pacemaker Implantation Myocardial
14. Pneumonectomy/Lobectomy
15. Port-A-Cath Insertion
16. Resection Coarctation Aorta
17. First Rib Resection
18. Thoracoplasty
19. Tracheal Resection
20.Transthoracic Diaphragmatic Herniorrhaphy
21. Transplant Experience
C. Vascular
1. A-V Fistula Shunt
2. Aortic Aneurysm
3. Aorto-Illiac/Femoral Graft
4. Brachio Axillary Dacron Fistula
5. Carotid Endarterectomy
6. Femoral-Popliteal Graft
7. Leaking Ruptured Aneurysm
8. Mohin-Uddin Umbrella
9. Resection Carotid Aneurysm with Graft
10. Tenckhoff Catheter Placement
11. Thrombectomy
12. Vena Cava Ligatio
D. Trauma
1. Burns
2. Gunshot Wounds:
a. Chest
b. Abdomen
3. Motor Vehicle Accidents (Multiple Injuries)
4. Traumatic Amputations
Rate 1-4
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E. Neurology
1. Burr Holes (Subdural Hematoma)
2. Cartoid Endarterectomy
3. Cartoid Ligation
4. Cervical Laminectomy
5. Cervical Sympathectomy
6. Clipping of Intracranial Aneurysm
7. Craniectomy for Decompression Fracture
8. Cranioplasty
9. Craniotomy for Tumor Excision
10. Crutchfield Tong Insertion
11. Exterior Cervical Fusion
12. Hypophysectomy
13. Laminectomy
14. Lumbar Laminectomy
15. Meningocele Repair
16. Transphenoid Hypothypectomy
17. Ulna Nerve Transplant
18. VA & VP Shunt
19. Ventricular Procedures
20.Vinke Tong Insertion
F. Orthopedics
1. Achilles Tendon Repair
2. Amputation/Leg, Arm
3. Anterior Crucidate Ligament Repair
4. Application Halo Traction
5. Arthroscopic Surgery
6. Capsularrhaphy
7. Closed Reduction Fracture
8. Cup Arthroplasty/Insertion Prosthesis
9. Dwyer Anterior Fusion
10. Fracture Table Use
11. Hand Surgery with Implants
12. Harrington Rod Insertion
Rate 1-4
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PLEASE MARK YOUR LEVEL OF EXPERIENCE
No Experience: Observed Only
Limited Experience: Performs < 6 Times Per Year; Needs Review
Moderate Experience: Performs 1-2 Times/Month; May Need Minimal Resource
Highly Experienced: Performs on Daily or Weekly Basis; Proficient
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2
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4 OR 3 OF 5
Applicants Name
13. Heel Cord Lengthening
14. I.M. Rodding
15. Insertion Tibial Plateau Prosthesis
16. Nailing Procedures
17. Excision of Olecranon Bursa
18. Open Reduction Fracture
19. Patellectomy
20.Putti Platt/Bankart Procedure
21. Reduction with Compression Sets
22.Sharrard Procedure
23.Application of Spica Cast
24. Spinal Fusion
25.Insertion of Swanson Finger Prosthesis
26.Tendon Implants
27. Total Joint Replacement
28.Zimmer Hip Compression
G. Urology
1. Circumcision
2. Cystectomy
3. Hypospadius Repair
4. Nephrectomy
5. Orchiopexy
6. Perineal Prostatectomy
7. Suprapubic Prostatectomy
8. Pyelolithotomy
9. Pyeloplasty
10. Radical Node Dissection
11. Scott Incontinence Device
12. Scott Penile Prosthesis
13. T.U.R.
14. Ureterolithotomy
15. Vasectomy
16. Vasovasostomy
Rate 1-4
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H. Gynecology
1. Abdominal Hysterectomy
2. C-Sections
3. Colpotomy
4. Dilation and Curettage
5. Laporoscopy
6. Marshall Marchetti
7. Marsupialization Bartholin Cyst
8. Pelvic:
a. Anterior
b. Posterior
c. Total
9. Radical Hysterectomy
10. Radium Insertion
11. Salpingoplasty
12. Shirodkar Operation
13. Suction Curettage
14. Tubal Ligation
15. Tuboplasty/Microscope
16. Vaginal Hysterectomy
17. Vaginal Reconstruction
18. Vaginectomy
19. Vulvectomy
I.
Pediatrics
1. Bronchoscopy
2. Inguinal Hernia
3. Lap
4. Pyloric Stenosis
5. Cleft Lip/Palate Repair
J
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Plastics
1. Abdominal Lipectomy
2. Augmentation Mammoplasty
3. Blepheroplasty
4. Dermabrasion
Rate 1-4
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PLEASE MARK YOUR LEVEL OF EXPERIENCE
No Experience: Observed Only
Limited Experience: Performs < 6 Times Per Year; Needs Review
Moderate Experience: Performs 1-2 Times/Month; May Need Minimal Resource
Highly Experienced: Performs on Daily or Weekly Basis; Proficient
1
2
3
4 Applicants Name
5. Mentoplasty
6. Myelomeningocele Repair
7. Otoplasty
8. Pedicle Grafts
9. Reduction Mammoplasty
10. Rhinoplasty
11. Scar Revisions
12. Skin Grafts/Split Thickness
K. Ears, Nose & Throat
1. Acoustic Neuroma
2. Caldwell-Luc
3. Closed Reduction Nasal Fracture
4. Commando Procedure
5. Ear Cases:
a. Mastoidectomy
b. Myringotomy
c. Stapedectomy
d. Tympanoplasty
6. Ethymoidectomy
7. Excision Salivary Gland Tumor
8. Fenestration Procedure
9. Frontal Flap Sinus Procedure
10. Glossectomy
11. Laryngectomy
12. Maxillary Advancement with Hip Graft
13. Nasal Polypectomy
14. Open Reduction Facial Fractures
15. Open Reduction Tripod Fractures
16. Parotidectomy
17. PE Tube Insertion
18. Pharyngeal Flap Procedure
19. Radical Neck Dissection
20.Ranulectomy
21. Selective Osteotomy of Maxilla/Mandible
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Rate 1-4
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22.Sinusotomy
23.Submucous Resection
24. Tonsillectomy
25.Tracheostomy
26.Vocal Cord Stripping
L. Equipment
1. Aquamatic K Thermia Unit
2. Arthroscopy Cameras
3. Blood Warmer
4. Bovie Electrosurgical Unit
5. Cardiac Monitor & Pacemaker:
a. Electrodyn
6. Cavitran - Coopervision
7. Cell Saver
8. Set Synthes Compression
9. Cry-Opthalmic Unit
10. Dermatomes
11. Disposable Bovie Plates
12. Drills
13. Emerson Thoracic Pump
14. Eye Magnet
15. Ethylene Oxide Sterilizer
16. Flash Autoclave
17. Fiber Optic Luminators
18. Fluid Pumps
19. Kiddie Pneumatic Tourniquet
20.Kreiselman Resuscitator
21. Laser
22.Nerve Stimulator
23.Nitrous Oxide Bank
24. Operating Microscope
25.Suction Units
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Rate 1-4
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OR 4 OF 5
PLEASE MARK YOUR LEVEL OF EXPERIENCE
No Experience: Observed Only
Limited Experience: Performs < 6 Times Per Year; Needs Review
Moderate Experience: Performs 1-2 Times/Month; May Need Minimal Resource
Highly Experienced: Performs on Daily or Weekly Basis; Proficient
1
2
3
4 Applicants Name
27.