Operating Room/Recovery Room/PACU INTERNATIONAL HEALTHCARE RECRUITERS
Skills Self Assessment Tool
Name: Date: RN / Tech
Level of Experience: 0= Never Done, 1= Perform Under Supervision, 2= Perform Independently
GENERAL SURGERY / Scrub / Circ. / EQUIPMENT / Scrub / Circ.Hernias / Blood warmer
Breast Biopsies / Cardiac Monitor & Pacemaker
Types:
Perineal Resection / Arthroscopy Cameras
Anal Fissurectomy / Laser
Mastectomy / Water Sterilizer
Radical Mastectomy / Bovie Electrosurgical Kit
Bowel Resection / Aquamatic K Thermia Unit
Colostomy / Ileostomy / Cell Saver
Adreanalectomy / Eye Magnet
Appendectomy / Kiddie Pneumatic Tourniquet
Gastroectomy / Flash autoclave
Clectomy / Disposable Bovie Plates
Hepatic Resection / Fiber Optic Luminators
Whipple / Ultra Sonic Cleaner
Types;
Hydrocelectomy / Vac-Pac Positioner
Laparoscopy – Diagnostic / Steri-Vac Aeration Cabinet
Lap Cole / Fluid Pumps
Lap AP / Ethylene Oxide Sterilzer
Lap Hernia / Nerve Stimulator
Leveen –Peritonela Shunt / Operating Microscope
Pilonidal Cystectomy / Dermatomes
Lumbar Sympathectomy / Drills
Nissesn Fundoplication / Vacuum Curettage
Portal Caval Shunt / Other: (Please List):
Saphenous Vein Ligation and Stripping
Pancreatectomy
Splenectomy
Staging Laporotomy
Thyroglossal Duct Cyst Excision
Pg. 1
Name: Date: RN / Tech
Level of Experience: 0= Never Done, 1= Perform Under Supervision, 2= Perform Independently
EAR, NOSE and THROAT / Scrub / Circ. / GYNECOLOGY / Scrub / Circ.Acoustic Neuroma / D & C (Dilation & Curettage)
Tonsillectomy / Cone Biopsy
Adenoidectomy / Operative Hysterectomy
Laryngectomy / Operative Laparoscopy
Tracheostomy / Diagnostic Hysterectomy
Vocal Cord Stripping / Vaginal Hysterectomy
Ethymoidectomy / Endometrial Ablation
Fenestration Procedure / Pubo Vaginal Sling
Mastoidectomy / LAVH
Myringotomy / Colpotomy
Stapedectomy / Salpingoplast
Tympanoplasty / Vaginal Reconstruction
Nasal polypectomy / Shirodkar Operation
Glossectomy / C-Sections
Frontal Flap Sinus Procedure / Radium Insertion
Pharyngeal Flap Procedure
Parotidectomy / NEUROLOGY
Sinusotomy / Carpal Tunnel
Maxillary Advancement with Hip Graft / Burr Holes
Open Reduction Facial Fractures / Lumbar and Cervical Laminectomy
Open Reduction Tripod Fractures / Cartoid Endarterectomy
Ranulectomy / Cartoid Ligation
PE Tube Insertion / Craniotomy for Subdural Hematoma
Radical Neck Dissection / Craniotomy for Tumor excision
Selective Osteotomy of Maxilla / Mandible / Clipping for Intracranial Aneurysm
Submucous Resection / Meningocele Repair
Other: (Please list): / VA & VP Shunt
Shunts
Transphenoid Hypothypectomy
Pg. 2
Name: Date: RN / Tech
Level of Experience: 0= Never Done, 1= Perform Under Supervision, 2= Perform Independently
NEUROLOGY CON’TD. / Scrub / Circ. / ORTHOPEDICS CONT’D. / Scrub / Circ.Ventricular Procedures / Laminectomy
Vinke Tong Insertion / Capsularrhaphy
Other (Please List): / Anterior Crucidate Ligament Repair
Harrington Rod Insertion
I.M. Rodding
Open Reduction Fracture
OPHTHALMOLOGY / Closed Reduction Fracture
Chelazion / Fracture Table Use
Cataract / Dwyer Anterior Fusion
Lacrimal Probing / Hand Surgery with Implants
IOL Glaucoma Filtering Procedures / Insertion of Swanson Finger Prosthesis
Retinal Surgery / Tendon Implants
Corneal Transplant / Heel Cord Lengthening
Other (Please List): / Insertion of Tibial Plateau Prostheses
Patellectomy
ACL / PCL
Instrumented Spines
ORTHOPEDICS / Zimmer Hip Compression
Dupuytrens / Nailing Procedures
I & D / Excision of Olecranon Bursa
Amputation Arm / Leg / Other (Please List):
Arthroscopy
Achilles Tendon Repair
Application of Halo Traction
ORIF with Plates and Screws / OPEN HEART / THORACIC
Anterior Crucidtae ligament repair / CABG
Hemiarthropsy / Cervical Rib Excision
Cup Arthroplasty / Closed Thoracotomy
Total Joint Replacement / Esopagectomy
Pg. 3
Name: Date: RN / Tech
Level of Experience: 0= Never Done, 1= Perform Under Supervision, 2= Perform Independently
OPEN HEART / THORACIC CONT’D. / Scrub / Circ. / VASCULAR / Scrub / Circ.Chamberlain Procedure / Insertion of Vascular Access Devices
Heller Procedure / A-V Fistula Shunt
Valve replacement / Pacemaker Insertion
Pacemaker Implantation Myocardial / Arterial Bypass Grafts
Pacemaker Implantation Endocardial / Aortic Aneurysm
Port – A – Cath Insertion / AAA
Patent Ductus Arteiosus / Mohin-Uddin Umbrella
ASD (Atrial Septal defect) / Resection of Carotid Aneurysm with Graft
VSD ( Ventricular / Ventral Septal defect) / Tenkhoff Catheter Placement
Pneumonectomy (Lobectomy) / Embolectomy / Thrombectomy
Tracheal Resection / Leaking Ruptured Aneurysm
Resection of Coarctation Aorta / Vena Cava Ligatio
First Rib Resection / Other (Please List):
Other (Please List):
PLASTICS
TRANSPLANT / Skin Grafts
Kidney / Abdominal Lipectomy
Heart / Liposuction
Liver / Breast Augmentation
Lung / Breast Reduction
TRAUMA / Scar Revisions
Gun Shot Wounds: Chest / Myelomeningocele Repair
Abdomen / Mentoplasty
Burns / Blepheroplasty
Automobile Accidents / Rhinoplasty
Traumatic Amputations / Otoplasty
Pg. 4
Name: Date: RN / Tech
Level of Experience: 0= Never Done, 1= Perform Under Supervision, 2= Perform Independently
UROLOGY / Scrub / Circ. / Ages of Patients Cared For / Scrub / Circ.Circumcision / Infants and Toddlers (to age 3)
Diagnostic Cystoscopy / Children (aged 4 – 12 years )
Hydrocele / Variocele / Adolescents (aged 13- 20 years )
Cystectomy / Young Adults (aged 21 – 39 years )
Nephrectomy / Older Adults (aged 41 – 64 years )
Perineal Prostatectomy / Seniors ( over 64 years)
Suprapubic prostatectomy
Pyleoplasty
Pyelolithotomy
Penile Prosthesis
Radical Node Dissection
Ureteroscopy
TUR
Prostate Brachytherapy
Holmium Laser Lithotripsy
Indigo Laser Lithotripsy
Vasectomy
Vasovasotomy
Ileo conduit
Other (Please List):
I hereby certify the above to be true and accurate.
Signature: Date:
1133 S. University Drive * Suite 211 * Plantation, Florida 33324
(954) 382-0000 * Fax: (954) 916-6615