Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
| SCRUB GENERAL SURGERY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| AKA/BKA (Amputation) |
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| Radical Mastectomy |
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| Abdominal - Perineal Resection |
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| Cholecystectomy (Open) |
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| Exploratory Laparatomy |
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| Appendectomy |
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| SCRUB CARDIAC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| DaVinci Procedures |
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| Coronary Artery By-Pass |
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| Mitral Valve Repair/Replacement |
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| Aortic Valve Replacement |
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| Multiple Valve Transposition |
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| Septal Defects |
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| Ventricular aneurysm Repair |
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| Bring Back Heart |
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| Pericardial Window |
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| Intra-Aortic Balloon Insertion |
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| Heartport or Similar CABG |
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| Thoraco approach Mid-Cab |
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| Aortic Arch Replacement |
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| Aortic Valve Conduit |
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| Mechanical Heart/LVAD |
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| Pediatric Hearts |
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| Tetrology of Fallot |
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| Chamberlain Procedure |
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| Femoral Artery Cannulation |
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| AICD Insertion |
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| Saphenous Vein Harvest |
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| Endoscopic Vein Harvest |
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| Gastric Artery Harvest |
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| Radial Vein Harvest |
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| Carotid Endarterectomy |
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| Abdominal Aortic Aneurysm |
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| Femoral-Popliteal By-Pass Graft |
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| Thrombectomy |
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| AV Shunt |
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| Pacemaker Insertion |
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| SCRUB LAPARASCOPIC PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cholecystectomy (Open) |
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| Appendectomy |
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| Hernia |
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| Nissan |
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| Colectomy |
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| Gastrectomy |
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| Inguinal/Ventral hernia Repair |
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| Splenectomy |
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| Bowel Rescetion/Colostomy |
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| Thyroidectomy |
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| Rectal Procedures |
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| Esophagascopy/Gastrocopy |
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| SCRUB PEDIATRIC CASES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Inguinal Hernia Repair |
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| Pyloric Stenosis |
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| Circumcision |
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| Exploratory Laparotomy |
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| SCRUB VASCULAR SURGERY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Carotid Endarterectomy |
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| Abdominal Aoric Aneurysm |
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| Femoral-Popliteal By-Pass Graft (Insitu) |
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| Femoral-Popliteal By-Pass Graft (Graph) |
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| Portacath, Tesio, Hickman |
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| AV Shunt |
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| Thrombecomy |
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| Pacemaker Insertion |
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| Arterial Stenting |
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| Intra-Operative Angioplasty |
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| Subclavian/Carotid By-Pass |
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| SCRUB ORTHOPEDICS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Total Hip Replacement |
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| Bipolar Hip |
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| Compression Hip Screw |
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| Total Knee Replacement |
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| Knee Artoscopy |
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| ACL Knee Repair |
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| harrington Rod or Similar |
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| I.M. Rodding |
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| Hand and Foot procedures |
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| Mini Fragment Screws & Plates |
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| External Fixation |
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| Shoulder Repair |
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| Shoulder Arthoscopy |
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| Spinal Fusion |
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| Fracture Table Set-Up |
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| Drills, Saws and Reamers |
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| SCRUB GYNECOLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| D&C |
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| Diagnostic Laparascope |
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| Laparoscopic Asst'd Vaginal Hysterectomy |
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| Abdominal Hysterectomy |
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| Vaginal Hysterectomy |
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| Anterior/Posterior Repair |
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| MMK (Marshall Marchetti Krantz) |
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| Tuboplasty |
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| BLT (Bilateral Tubal Ligation) |
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| C-Section |
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| SCRUB UROLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Radical Prostatectomy |
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| Radical Lymph Node Dissection |
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| Insertion Penile Prosthesis |
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| Hydrocelectomy |
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| Cystoscopy |
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| Ureteroscopy |
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| TURP/TURBT |
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| SCRUB NEUROLOGY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cervical Laminectomy (Anterior) |
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| Cervical Laminectomy (Posterior) |
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| Lumbar Lamincetomy, Discectomy |
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| Percutaneous Micro Discectomy |
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| Craniotomy for Tumor |
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| Craniotomy for Aneurysm |
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| Burr Holes |
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| VP Shunts |
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| Transphenoidal Hypothypectomy |
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| Harrington Rod or Similar |
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| SCRUB PLASTICS |
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| Mammoplasty |
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| Facelifts |
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| Skin Grafts |
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| Rhinoplasty |
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| Cleft Lip Repair |
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| Abdominalplasty |
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| Blepharoplasty |
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| Otoplasty |
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| Muscle Flaps |
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| Trauma |
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| Transplant Surgery |
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| Organ Procurements (Harvest) |
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| SCRUB ENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Middle Ear |
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| T&A |
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| Myringotomy |
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| Tympanoplasty |
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| Radical Neck Dissection |
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| Septoplasty |
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| Sinus Endoscopy |
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| SCRUB THORACIC | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Thoracotomy |
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| Thoracoscopy |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 years) |
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| Childhood (ages 6-12 years) |
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| Adolescents (ages 13-21 years) |
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| Young Adults (ages 22-39 years) |
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| Adults (ages 40-64 years) |
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| Older Adults (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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