OR SCRUB TECH SKILLS CHECKLIST

NAME:
ID #:
DATE:

This Skills Checklist is for use by nurses with more than one year experience in their discipline and specialty. Please be accurate with your assessment.

DIRECTIONS: Please indicate your level of experience by placing a check (√) in the box. Experience level:

1 / NO EXPERIENCE
2 / MINIMAL EXPERIENCE-requires supervision/assistance
3 / MODERATELY EXPERIENCED-requires initial review, then performs independently
4 / VERY EXPERIENCED- proficient
DESCRIPTION / 1 / 2 / 3 / 4
GENERAL SURGERY:
1. Abdominal Resection
2. Adrenal Biopsy
3. Anal Fissurectomy
4. Appendectomy
5. Breast Biopsy
6. Colectomy
7. Cholecystectomy
8. Colon Resection
9. Colostomy
10. Femoral Herniorrhaphy
11. Gastrectomy
12. Hemorrhoidectomy
13. Hernia Repair
14. Hepatic Resection
15. Hiatal Herniorrhaphy
16. Hydrocelectomy
17. Inguinal Herniorrhaphy
18. Lap Chole
19. Laparotomy
20. Lumbar Sympathectomy
21. Mastectomy
22. Pancreatectomy
23. Pilonidal Cystectomy
24. Portal Caval Shunt
25. Pyloric Stenosis
26. Radical Mastectomy
27. Saphenous Vein Ligation
DESCRIPTION / 1 / 2 / 3 / 4
28. Splenectomy
29. Thyroidectomy
30. Tracheostomy
31. Vagotomy
GYNECOLOGY:
1. Abdominal Hysterectomy
2. A&P Repair
3. Cesarean Section
4. Colposcopy
5. Colpotomy
6. Dilation & Curettage
7. Laparoscopy
8. Marshall Marchetti
9. Radium Insertion
10. Sacral Spinus Fixation
11. Salpingoplasty
12. Shirodkar Operation
13. Suction Curettage
14. Tuboplasty
15. Tubal Ligation
16. Vaginal Hysterectomy
17. Vaginal Reconstruction
ENDOSCOPIC:
1. Bronchoscopy
2. Colonoscopy
3. Cystoscopy
4. Culdoscopy
5. Esophagoscopy
6. Gastroscopy
7. Laryngoscopy
8. Pelviscopy
9. Sigmoidoscopy
10. Thoracoscope
ENT:
1. Adenoidectomy
2. Caldwell_LUC Operation
3. Closed Reduction Nasal
4. Fenestration Procedure
5. Glossectomy
6. Laryngectomy
7. Mandibulectomy
8. Mastoidectomy
9. Myringotomy
NAME:
ID #:
DATE:
ENT (CONT):
DESCRIPTION / 1 / 2 / 3 / 4
10. Parotidectomy
11. Pharyngeal Flap Procedure
12. Radical Neck Dissection
13. Rhinoplasty/Septoplasty
14. Sinusotomy
15. Stapendectomy
16. Submucous Resection
17. Tonsillectomy
18. Tracheostomy
19. Tympanoplasty
NEURO:
1. A-V Malfunction
2. Anterior Cervical Fusion
3. Carotid Ligation
4. Cervical Sympathectomy
5. Clipping of Aneurysm
6. Cranioplasty/Craniotomy
7. Decompressive Craniectomy
8. Discectomy
9. Hypophysectomy
10. Laminectomy
11. Myelomeningocele Rep.
12. Pedicle Screw Insertion
13. Shunt Procedure
14. Spinal Fusion
15. Tumor Excision
16. Ulnar Nerve Transfer
17. Ventriculography
18. Ventriculostomy
ORAL:
1. Closed Reduction Facial Fractures
2. Excision Odontoma
3. Extraction of Deciduous Teeth
4. Extraction of Impacted Molars
5. Fractured Jaw
6. LeFort Osteotomies
7. Mandiblectomy
DESCRIPTION / 1 / 2 / 3 / 4
8. Maxillary Procedures
9. Pediatric Dentistry
10. Sagittal Osteotomy
11. TMJ exploration
12. TMJ w/Arthroplasty
OPTHALMOLOGY:
1. Cataract Extraction
2. Corneal transplant
3. Dacryocystectomy
4. Iridectomy
5. Orbital Implant
6. Pterygium Repair
7. Recession Resection
8. Scleral Buckle
ORTHOPEDIC:
1. Acetabular/Pelvic ORIF
2. Achilles Tendon Repair
3. ACL Repair
4. Amputation
5. Arthrotomy
6. Bone Graft
7. Bunionectomy
8. Calcaneal Reconstruction
9. Capsulorrhaphy
10. Carpal Tunnel Release
11. Cup Arthroplasty
12. Hand Surgery
13. Heel Cord Lengthening
14. Hip Prosthesis
15. Laminectomy
16. Patellectomy
17. Reimplantation of Digits
18. Repair Hammer Toes
19. Rotator Cuff Repair
20. Sacro-Illiac Joint Screws
21. Sharrard Procedure
22. Spinal Fusion
23. Tendon Transplant
24. Total Joint Replacement
PEDIATRIC:
1. Broviac
2. ECMO Cannulation
3. Gastrosclesis
4. Myelomeningocele Repair
NAME:
ID #:
DATE:
PEDIATRIC (CONT):
DESCRIPTION / 1 / 2 / 3 / 4
5. Omphalocele
6. Open Heart
7. Pyloric Stenosis Repair
8. Repair of TEF
PLASTICS
1. Abdominal Lipectomy
2. Augumentation
3. Blepharoplasty
4. Cleft Lip
5. Dermabrasion
6. Face Lift
7. Mammoplasty
8. Mentoplasty
9. Otoplasty
10. Pedicle Grafts
11. Reconstructive
12. Reduction
13. Rhinoplasty
14. Scar Revisions
15. Skin Grafting
16. Tissue Expanders
THORACIC/OPEN HEART
1. Aortic Valve Replacement
2. Cervical Rib Excision
3. Chamberlain Procedures
4. Closed Thoracotomy
5. Esophagectomy
6. Heller Procedure
7.Mitral Commissurotomy
8. Mitral Valve Replacement
9. Open Heart
10. Pacemaker Implant
11. Patent Ductus Arteriosus
12. Pericardiectomy
13. Rib Resection
14. Septal Defect Repairs
15. Tetralogy of Fallot
16. Thoracoplasty
DESCRIPTION / 1 / 2 / 3 / 4
17. Tracheal Resection
UROLOGY:
1. Circumcision
2. Cystectomy
3. Lithotripsy
4. Nephrectomy
5. Orchiopexy
6. Penile Implants
7. Prostatectomy
8. Pyeloplasty
9. Radical Node Dissection
10. Scott Incontinence Device
11. TURP
12. Ureterolithotomy
13. Vasectomy
14. Vasovasostomy
15. Waterhouse Procedure
VASCULAR:
1. Aortic Aneurysm w/Graft
2. A-V Access Graft
3. Carotid Aneurysm
4. Endarterectomy Peripheral
5. Thrombectomy Resection
6. Vascular Bypass Resection
7. Vena Cava Filter
8. Vena Cava Ligation
EQUIPMENT:
1. Anesthesia Equipment
2. Arthroscopy Cameras
3. Blood Warmer
4. Cardiac Monitors
5. Doppler Drills/Saws Cell Saver
6. Electrosurgery Unit
7. Endoscopy Scopes
8. Fluid Pumps Eye Magnet
9. Fracture Table
10. Intra Aortic Balloon Pump
11. Infusion Pumps
12. Microscope Pacemakers
13. Midas Rex Laser
14. Nerve Stimulators
15. Nitrous Oxide Bank
16. Tourniquet Portable
NAME:
ID #:
DATE:
EQUIPMENT (CONT):
DESCRIPTION / 1 / 2 / 3 / 4
17. Ultrasonic Cleaners
18. Ventilators
COMPUTERIZED CHARTING
1. Cerner
2. Eclipsys
3. Epic
4. McKesson
5. Meditech
6. Other:

I HAVE CURRENT CERTIFICATIONS FOR:

TYPE EXPIRATION DATE (MM/DD/YY)

ARRHYTHMIA
CRITICAL CARE
ACLS
BLS
TNCC
NRP
PALS
NALS
CCRN
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The information I have provided in this knowledge and skills checklist it true and accurate to the best of my knowledge.

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This skills checklist has been reviewed and approved by Nicole Bloxham, RN.

Signature (Written/Electronic) / Date
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Please return to: Northwest Nurse Staffing Company, PA

ATTN: Records Dept.

Fax: (888) 936-8383

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