PERIOPERATIVE NURSES, INC.

COMPETENCY SKILLS CHECKLIST


Name Date Years Experience


Instructions: Please Place A 1,2 or 3 By Each Procedure According to Key
C = Circulate     S= Scrub


KEY:
1. No experience-Or have done less than 5 times.
2. Moderate-Comfortable with resource person available.
3. Extensive-Done frequently fell comfortable without assistance.

C
S
General
C
S
Orthopedics
C
S
Neurology


Cholecystectomy
w/CDE


Anterior cervical/
discectomy/ fusion


Crani
(hematoma/ tumor)


Ventral/Inguinal
hernias


Post. Lumbar/
Cervical Lami/ disc


VP Shunts


Gastric Resections


Post Lumbar
Fusion w/Hardware


Aneurysm Cliping


Bowel-colon
Resections


Ant. Lumbar Interbody
fusion w/implant


Transphenoidal


Thyroidectomy


ALIF/Post.
Fusion/360


Percutaneous
Rhizotomy


Radical Neck


Open Reduction
Internal Fixation





Breast biopsy
/mastectomy


Hand/nerve
/tendon repair


ORAL


Mastectomy
w/reconstruction


Podiatry/Bunions
/Neuromas/Osteotomy


Arch bars
/extractions


Lap Cholecystectomy


Arthroscopy/Knee


Le Fort I, II, III


Lap Hernia repairs


ACL reconstruction


ORIF Mandible





Arthroscopy/shoulder





GYN/OB


Total joint/Hip


Urology


D&C (suction)


Total joint/Knee


Cysto(stone basket)


Total Abd.
Hysterectomy


Total joint/Shoulder


TURP/TURB


Total Vag.
Hysterectomy


Hip compression
Screws/Plates


Kidney Transplant


Laproscopy
Dx./BTL





Nephrectomy
/Ureterostomy


A/P Repair


OPTHALMOLOGY


Penile Prosthesis





Cataract w/
IOL/Vitrectomy


Bladder Suspension


ENT


Corneal Transplant


Radical Prostatectomy


Tonsillectomy
/Adenoidectomy


Strabismas repair





Myringotomy
w/tubes


Retinal Procedures


CARDIO


Tympano-


Enucleation
/Eviseroneurotomy


Abdominal
Aortic Aneurysm


Laryngectomy





A/V Fistula


Tracheotomy


PLASTICS


CABG/Valve


Septoplasty
/Turbinates


Abdominoplasty


Fem-pop Bypass


Endoscopic Sinus Procedures


Blepharoplasty


Heart/Lung
Transplant


Laryngoscopy (direct/indirect)


Facelift


Cartoid
Endarterectomy





Flaps (myocutaneous
/free)


Thoracotomy
/Thoracoscopy


ENDOSCOPY


Breast Augmentation





Brochoscopy


Breast Reduction
/Reconstruction





Sigmoidoscopy


Skin Grafts
(ftsg /stsg)





Gastoscopy/EGD


Cranio-facial
Reconstruction





PEG


Rhinoplasty





PEDIATRICS


TRAUMA





General


General





Orthopedic


Orthopedic





ENT


Thoracic /Vascular





Thoracic/Vascular


Urology





Opthalmology