Perioperative Skills Checklist Back to   This checklist will be used to assess your suitability for placement.   Experience Guide 1 - Not Applicable - minimal or no exposure to clinical aspect or care. 2 - Beginner - sufficient knowledge to understand the contextual nature of the function, able to perform routine functions independently, requires assistance when setting priorities in complex situations, needs to gain speed and flexibility to be competent. 3 - Competent - perceives situations and functions as a whole, has knowledge of the typical events to expect in a given situation and the appropriate responses, flexible in decision making. 4 - Proficient - considerable background and experience, can grasp situations intuitively, mastery in performance, incorporates elements of innovation and creativity in clinical experience.    Clinical Practice  General   Experience   1    2    3    4   Circulate        Inpatient        Outpatient        Pediatrics        Scrub         General  General   Experience   1    2    3    4   Abdominal Resection        Adrenalectomy        Bowel Resection        Cholecystectomy        Gastrectomy        Hemicolectomy        Hepatic Resection        Herniorrhaphy Femoral/Inguinal        Hiatal Herniorrhaphy Transabdominal        Internal Defibrillator        Organ Procurement        Pancreatectomy        Radical Mastectomy        Saphenous Vein Ligation and Stripping        Splenectomy        Thyroidectomy        Tracheostomy        Whipple Procedure         Cardiovascular  General   Experience   1    2    3    4   Access Lines        Aneurysms        Aorta Femoral Bypass/Graft Insertion        Aortic Aneurysm        AV Shunts        Carotid Ligation        Cartoid Endarterectomy        Coronary Artery Bypass Graft        External Temporary Pacemaker        Fem-fem Bypass        Fem-pop Bypass        Heart Transplant Surgery        Intra Aortic Baloon Pump        Pacemaker Insertion        Patient Duct Repair        Pericardial Windows        Peripheral Grafts        Porta Systemic Shunt        Repair of Septal Defects        Thrombectomy        Valve Replacement        Vein Ligation        Vena Cava Ligation         Neurosurgery  General   Experience   1    2    3    4   Anterior Cervical Fusion        Burr Holes for Subdural Hematoma        Craniotomy        Discectomy        ICP        Lumbar Laminectomy        Meningocele Repair        Shunts        Spinal Fusion        Steroctatic Brain Biopsy         Thoracic  General   Experience   1    2    3    4   Hiatal Hernia        Lung/Wedge Resection        Pneumonectomy        Sternal Splitting        Thoracotomy         Laparoscopic  General   Experience   1    2    3    4   Appendectomy        Cholecystectomy        Colon Resection        Hernia Repair        LAVH/Hysteroscopy        Spine Procedures         Orthopedics  General   Experience   1    2    3    4   Amputation        Application of Halo Traction        Arthroscopy        Closed Pinning and Reduction        External Compression Devices        Hand Surgery        Insertion of Finger Prosthesis        ORIF        Patellectomy        Repair of Dislocation        Spica Cast Application        Spinal Fusion / Harrington Rods        Tendon Implants and Reanastomosis        Total Joint Replacement        Trauma         Gynecology  General   Experience   1    2    3    4   Abdominal Hysterectomy        C-section        Dilation and Curettage        Laser Surgery        Mastiodectomy        Pelvic Clearance        Radium Insertion        Salpingo Oopherectomy        Shirodkar Procedure        Termination of Pregnancy        Tubal Ligation        Tympanoplasty        Vaginal Hysterectomy        Vaginal Reconstruction        Vaginectomy         Urology  General   Experience   1    2    3    4   Circumcision        Cystectomy        Cystoscopy        Hypospadias Repair        Ileal Loop        Kidney Repair        Lithotripsy        Nephrectomy        Orchiectomy        Penile Implant        Prostatectomy        Pylolithotomy        Renal Transplant        TURP/TURB        Ureterolithotomy        Vasectomy         Hepatobiliary  General   Experience   1    2    3    4   Liver Transplants         Plastics  General   Experience   1    2    3    4   Abdominoplasty Abdominal Lipectomy        Augmentation Mammoplasty        Burns        Cleft Lip/Palate Repair        Dermabrasion        Digital Flexor Tendon Repair        Liposuction        Myelomeningocele Repair        Otoplasty        Reduction of Facial Fracture        Rhinoplasty        Scar & Graft Revision        Skin Meshing        Split Thickness Skin Grafting         Opthalmic  General   Experience   1    2    3    4   Corneal Transplant        ECCE + IOL: Cataracts        EUA of Eye        Eye Trauma Surgery        PHACO Cataracts        Removal Foreign Body        Retinal Detachment Repair         Oral  General   Experience   1    2    3    4   Craniofacial Surgery        Dental Restoration        Mandibular Procedures        Maxillary Procedures        Tmj Arthroplasty         Ears, Nose & Throat  General   Experience   1    2    3    4   FESS        Laryngectomy        Mandiblectomy        Mastoidectomy        Oncological: Head & NeckDissection        Rhinoplasty        Sinusostomy        T&a Myringotomies        Tracheostomy        Tympanoplasty         Medication Administration  General   Experience   1    2    3    4   Cardiac Medications        Endotracheal Medications        Insulin        Intramuscular        Narcotics        Oral        Psychotropics        Rectal Enemas        Rectal Medication        Subcutaneous         Intravenous   Experience   1    2    3    4   Central Lines        Infusions        IV Push        IV Sedation        Peripheral Line Insertion        Piggyback        Age Specific Practice Criteria Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care.   A. New Born/Neonate (Birth - 30 days) B. Infant (30 days - 1 Year) C. Toddler (1 - 3 Years) D. Preschooler (3 - 5 Years) E. School age children (5 - 12 Years)   F. Adolescents (12 - 18 Years) G. Young Adults (18 - 39 Years) H. Middle Adults (39 - 64 Years) I. Older Adults ( +64 Years)    Experience With Age Groups   Able to adapt care to incorporate normal growth and development A  B  C  D  E  F  G  H  I&n