OR Surgical Checklist


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.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  GENERAL SURGERY         Rating Stars (Click) 1 2 3 4
  Anal Fistulectomy/Anoplasty  
  Appendectomy/Cholecystectomy  
  Biopsy (Mass  
  Muscle  
  Lymph Node)  
  Bronchoscopy  
  Colostomy  
  Esophagogastroduodenoscopy w/ Biopsy  
  Esophagoscopy  
  Exploratory Laparotomy  
  Flexible Sigmoidoscopy  
  Fundoplication  
  Gastrostomy  
  Herniorrhaphy  
  Insertion of Port-a-Cath  
  Hickman  
  Broviac  
  Laparascopic General Surgery Procedures  
  Liver Biopsy  
  Percutaneous Endoscopic Gastrostomy  
  Thoracoscopy/Nuss Procedure  
  CARDIOVASCULAR         Rating Stars (Click) 1 2 3 4
  Aorta Repair  
  Aorto-Bifemoral/Femoral-Pop Bypass Graft  
  Cardiac Bypass Surgery  
  Carotid Endarterectomy  
  Endoscopic Vascular Procedures  
  Femoral Popliteal Bypass Graft  
  Laparascopic Cardiac Surgery  
  Robotic Assisted Cardiac Surgery  
  Valve Replacement/Repair  
  Ventricular Assist Device  
  THORACIC         Rating Stars (Click) 1 2 3 4
  Endoscopic Thoracic Procedures  
  Esophagogastrectomy  
  Mediastinotomy/Sternotomy  
  Thoracoscopy/Nuss Procedure  
  Thoracotomy  
  ORTHOPEDIC         Rating Stars (Click) 1 2 3 4
  Total Joint Replacement  
  Closed Reduction of Fracture  
  External Fixator  
  Cannulated Hip Screws  
  Bankhart Procedure  
  Birmingham Procedure  
  Carpal Tunnel Release  
  Arthroscopy  
  Anterior Cruciate Ligament Reconstruction  
  NEUROLOGICAL         Rating Stars (Click) 1 2 3 4
  Craniotomy  
  Steriotactic Guided Brain Biopsy  
  Laminectomy  
  Laparoscopic Anterior Laminectomy  
  Insertion of Vagal Nerve Stimulator  
  Insertion of VP Shunt  
  Spinal Fusion  
  Anterior Cervical Discectomy with Fusion  
  Posterior Cervical Laminectomy  
  GENITOURINARY         Rating Stars (Click) 1 2 3 4
  Circumcision  
  Cystoscopy/Cystogram/Pyelogram  
  Hydrocelectomy  
  Nephrectomy  
  Orchidectomy/Orchidopexy  
  Repair of Hypospadias  
  Retrograde Pyelogram  
  Ureterostomy  
  GYNECOLOGICAL         Rating Stars (Click) 1 2 3 4
  Abdominal Hysterectomy  
  Anterior Posterior Repair  
  C-Section  
  D & C  
  Laparoscopic Assisted Hysterectomy  
  Laparotomy with Microtuboplasty  
  Robotic Assisted GYN Procedures  
  Vaginal Delivery  
  Vaginal Hysterectomy  
  EAR/NOSE/THROAT         Rating Stars (Click) 1 2 3 4
  Cochlear Implant  
  Laryngotracheoplasty  
  Myringotomy with Tubes  
  Septoplasty.Suspension Microlaryngoscopy  
  Tonsillectomy & Adenoidectomy  
  Tracheostomy  
  Turbinate Reduction  
  Tympanoplasty/Typanomastoidectomy  
   
  CRANIOFACIAL/ORAL/PLASTICS         Rating Stars (Click) 1 2 3 4
  Craniectomy  
  Craniofacial Reconstruction  
  Dental Surgery  
  Leforte 1 Maxillary/Sagittal Osteotomy  
  Mandibular Osteotomy  
  ORIF Mandibular Fracture  
  Otoplasty  
  Reconstruction of Ear  
  Repair of Cleft Lip  
  Nose  
  Palate  
  Rhinoplasty  
  Skin Graft  
  PLASTIC         Rating Stars (Click) 1 2 3 4
  Blephoroplasty  
  Breast Reconstruction with Implant  
  Breast Reduction Mammoplasty  
  Face Lift  
  Mastectomy with Tram Flap Reconstruction  
  Split Thickness Skin Graft  
  Suction Lipectomy  
  TRANSPLANTS         Rating Stars (Click) 1 2 3 4
  Heart  
  Lung  
  Liver  
  Pancreas  
  Eye  
  Organ Donation  
  OPHTHAMOLOGY         Rating Stars (Click) 1 2 3 4
  Corneal Transplant  
  Dacrocystorhinostomy  
  Excision of Chalazion  
  Eye Muscle Surgery  
  Levator Resection  
  Orbitotomy of Eye  
  Repair of Ptosis  
  NEURO         Rating Stars (Click) 1 2 3 4
  Craniotomy  
  Insertion of Vagal Nerve Stimulator  
  Insertion of VP Shunt  
  Laminectomy  
  CARDIAC/VASCULAR         Rating Stars (Click) 1 2 3 4
  Arterial Switch  
  ASD/VSD Repair  
  Atrial Septectomy Bidirectional Glenn  
  BT Shunt  
  ECMO Insertion/Decannulation  
  Fontan Procedure  
  Norwood Procedure  
  Pacemaker  
  PDA Ligation  
  Repair of Coarctation of Aorta  
  Ross Procedure  
  Tetralogy of Fallot Repair  
  Valve Repair/Replacement  
  Ventricular Assist Device  
  TRANSPLANT         Rating Stars (Click) 1 2 3 4
  Heart  
  Kidney  
  Liver/Pancreas  
  Lung  
  Organ Donation  
  ORTHOPEDICS         Rating Stars (Click) 1 2 3 4
  Acetabuloplasty/Triple Innominate  
  Arthroscopy of Knee-Wrist-Shoulder  
  Closed Reduction-Percutaneous Pin  
  External Fixator (Ilizarov/Orthofix)  
  ORIF Shoulder-Humerus-Tibia -Femur  
  Osteotomy/VDRD/Calcaneal/Metatarsal  
  Spinal Fusion/Spinal with Instrumentation  
  Tendoachilles Lengthening  
  OR EQUIPMENT         Rating Stars (Click) 1 2 3 4
  Electrocautery (ESU)  
  Laparoscopy Systems  
  Neuro  
  OR Fracture Tables (List types below)  
  List Types  
  Orthopedic Total Joint Systems  
  Power Equipment  
  Robotics Systems (List types below)  
  List Types  
  Spinal Fusion Instrumentation  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  Malignant Hyperthermia Protocol  
  Infection Prevention  
  Isolation Precautions  
  National Patient Safety Goals/Core Measures  
  Universal Protocol  
  EMR         Rating Stars (Click) 1 2 3 4
  Epic  
  Picis  
  Cerner  
  Eclipsys  
  McKesson  
  Meditech  
  Other Computerized System  
  Computerized Physician Order Entry  
  EMR Conversion  
  EMR Conversion  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Infant (Birth - 1 year)  
  Preschooler (ages 2-5 years)  
  Childhood (ages 6-12 years)  
  Adolescents (ages 13-21 years)  
  Young Adults (ages 22-39 years)  
  Adults (ages 40-64 years)  
  Older Adults (ages 65-79 years)  
  Elderly (ages 80+ years)