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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