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.
Skill Level | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
AKA/BKA (amputation) |
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Abdominal-Perineal Resection |
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Cholecystectomy (Open) |
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Exploratory Laparotomy |
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Appendectomy |
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Laparoscopic Procedure | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cholecystectomy |
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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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Spienectomy |
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Bowel Resection / Colostomy |
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Thyroidectomy |
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Rectal Procedures |
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Esophagascopy / Gastroscopy |
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Pediatric Case | 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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E.N.T | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Middle Ear Cases |
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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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Cardiac / Thoracic / Vascular | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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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Chamberlin Procedure |
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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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Insertion Vena Cava Filter |
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Thoracotomy |
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Thoracoscopy |
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Insertion Chest Tube |
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Esophageal Repair |
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Pneurnonectomy / Lobectomy |
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Mediastinodcopy |
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Desendind Aortic Repair |
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Arterial Stenting |
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Intra-Operative Angioplasty |
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Vascular Surgery | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Carotid Endarterectomy |
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Abdominal Aortic Aneurysm |
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Femoral | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Popliteal By-pass Graft (Insitu) |
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Popliteal By-pass Graft (Graph) |
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Portacath, Tesio, Hickman Placement |
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AV Shunt |
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Thrombectomy |
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Pacemaker Insertion |
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Arterial Stenting |
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Intra-Operative Angioplasty |
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Subclavin / Carotid By-pass |
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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 Arthroscopy |
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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 Procedures |
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Foot Procedures |
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Mini, Standard, Large Fragment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Screws & Plates |
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External Fixation |
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Shoulder Repair |
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Shoulder Arthroscopy |
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Spinal Fusion |
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Cast Application |
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Fracture Table Set-up |
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Drills, Saws and Reamers |
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Urology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Radical Prostatectomy |
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Radical Lymph Node Dissection |
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Ureteroscopy |
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TURP / TURST |
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Ultrasonic Lithotripsy |
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Hydrocelectomy |
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Cystoscopy |
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Insertion Penile Prosthesis |
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Gynecology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
D & C |
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Diagnostic Laparascope |
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Laparoscopic Vaginal Hysterectomy |
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Abdominal Hysterectomy |
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Vaginal Hysterectomy |
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Anterior Repair |
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Posterior Repair |
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MMK (Marshall Marchetti Krantz) |
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Tuboplasty |
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BTL (Bilateral Tubal Ligation) |
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C-Sections |
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Neurology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cervical Laminectomy (Anterior) |
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Cervical Laminectomy (Posterior) |
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Lumbar Laminectomy 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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Carpal Tunnel Repair |
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Harrington Rod or Similar |
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Trauma Surgery | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Transplant Surgery |
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Organ Procurement (Harvest) |
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Plastics | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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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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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