Berean Healthcare Staffing - Travel Nursing Perioperative RN Skills Checklist

Perioperative Skills Checklist

This profile is for use by Perioperative nurses with more than one year's experience in their discipline and specialty.

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Please indicate your level of experience

A. Theory, no practice	C. Two plus years experience
B. One - two years experience


A. EAR, NOSE & THROAT		SCRUB	CIRCULATE

	1. Adenoidectomy	A B C	A B C
	2. Caldwell - Luc	A B C	A B C
	3. Cleft lip/palate repair	A B C	A B C
	4. Closed reduction nasal fracture	A B C	A B C
	5. Ethmoidectomy	A B C	A B C
	6. Excision of salivary gland tumor	A B C	A B C
	7. Fenestration procedure	A B C	A B C
	8. Frontal flap sinus procedure	A B C	A B C
	9. Glossectomy	A B C	A B C
	10. Laryngectomy	A B C	A B C
	11. Mandibulectomy	A B C	A B C
	12. Mastoidectomy	A B C	A B C
	13. Maxillary advancement with hip graft	A B C	A B C
	14. Maxillectomy	A B C	A B C
	15. Myringoplasty	A B C	A B C
	16. Myringotomy/with PE tube insertion	A B C	A B C
	17. Nasal polypectomy	A B C	A B C
	18. Open reduction facial fracture	A B C	A B C
	19. Open reduction nasal fracture	A B C	A B C
	20. Parotidectomy	A B C	A B C
	21. Pharyngeal flap procedure	A B C	A B C
	22. Radical neck dissection	A B C	A B C
	23. Ranulectomy	A B C	A B C
	24. Rhinoplasty/septoplasty	A B C	A B C
	25.Selective osteotomy of maxilla/mandible	A B C	A B C
	26. Sinus endoscopy	A B C	A B C
	27. Sinusotomy	A B C	A B C
	28. Stapedectomy	A B C	A B C
	29. Submucous resection	A B C	A B C
	30. Tonsillectomy	A B C	A B C
	31. Tracheostomy	A B C	A B C
	32. Tympanoplasty	A B C	A B C


B. ENDOSCOPIC PROCEDURES			SCRUB	CIRCULATE

	1. Bronchoscopy		A B C	A B C
	2. Colonoscopy		A B C	A B C
	3. Culdoscopy		A B C	A B C
	4. Cystoscopy		A B C	A B C
	5. Esophagoscopy		A B C	A B C
	6. Gastroscopy		A B C	A B C
	7. Hysteroscopy		A B C	A B C
	8. Laparoscopic procedures
		a. Appendectomy	A B C	A B C
		b. Cholecystectomy/cholangiogram	A B C	A B C
		c. Colon resection	A B C	A B C
		d. Hernia repair	A B C	A B C
		e. Nissen fundoplication	A B C	A B C
		f. Salpingo-oophorectomy	A B C	A B C
		g. Tubal ligation	A B C	A B C
		h. Vaginal hysterectomy	A B C	A B C
	9. Laryngoscopy & microlaryngoscopy		A B C	A B C
	10. Mediastinoscopy		A B C	A B C
	11. Pelviscopy		A B C	A B C
	12. Sigmoidoscopy		A B C	A B C
	13. Thoracoscopy		A B C	A B C


C. GENERAL SURGERY		SCRUB	CIRCULATE

	1. Abdominal perineal resection	A B C	A B C
	2. Adrenalectomy	A B C	A B C
	3. Anal fissurectomy	A B C	A B C
	4. Appendectomy	A B C	A B C
	5. Breast biopsy	A B C	A B C
	6. Colectomy	A B C	A B C
	7. Colostomy/ileostomy	A B C	A B C
	8. Gastrectomy	A B C	A B C
	9. Gastroplasty	A B C	A B C
	10. Hemorrhoidectomy	A B C	A B C
	11. Hepatic resection	A B C	A B C
	12. Herniorrhaphy - femoral, inguinal, umbilical	A B C	A B C
	13. Hiatal herniorrhaphy, transabdominal/transthoracic	A B C	A B C
	14. Hickman/Groshong/Portacath insertion	A B C	A B C
	15. Hydrocelectomy	A B C	A B C
	16. Imperforate anus reconstruction	A B C	A B C
	17. Lumbar sympathectomy	A B C	A B C
	18. Omphalocele repair	A B C	A B C
	19. Pancreatectomy/pancreatogram	A B C	A B C
	20. Pilonidal cystectomy	A B C	A B C
	21. Portal caval shunt	A B C	A B C
	22. Pyloric stenosis	A B C	A B C
	23. Radical mastectomy	A B C	A B C
	24. Saphenous vein ligation and stripping	A B C	A B C
	25. Sentinel node biopsy	A B C	A B C
	26. Splenectomy	A B C	A B C
	27. Tenchkhoff catheter placement	A B C	A B C
	28. Thyroglossal duct cyst excision	A B C	A B C
	29. Thyroidectomy	A B C	A B C
	30. Tracheostomy	A B C	A B C
	31. Vagotomy	A B C	A B C


D. GYNECOLOGY		SCRUB	CIRCULATE

	1. Cesarean section	A B C	A B C
	2. Colpotomy	A B C	A B C
	3. Dilation and curettage (D & C)	A B C	A B C
	4. Hysterectomy, abdominal	A B C	A B C
	5. Hysterectomy, vaginal	A B C	A B C
	6. Marshall - Marchetti	A B C	A B C
	7. Marsupialization, Bartholin cyst	A B C	A B C
	8. Ovarian cystectomy	A B C	A B C
	9. Radium insertion	A B C	A B C
	10. Sacral spinus fixation	A B C	A B C
	11. Shirodkar procedure	A B C	A B C
	12. Suction curettage	A B C	A B C
	13. Vaginal reconstruction	A B C	A B C
	14. Vaginectomy/vulvectomy	A B C	A B C


E. NEUROLOGY			SCRUB	CIRCULATE

	1. A-V malformation		A B C	A B C
	2. Anterior cervical fusion		A B C	A B C
	3. Anterior laparoscopic spine procedures		A B C	A B C
	4. Anterior lumbar interbody fusion (ALIF)		A B C	A B C
	5. Burr holes for subdural hematoma		A B C	A B C
	6. Carotid ligation		A B C	A B C
	7. Cervical sympathectomy		A B C	A B C
	8. Craniectomy for decompression fracture		A B C	A B C
	9. Cranioplasty/craniotomy
		a. Clipping of aneurysm	A B C	A B C
		b. Tumor excision	A B C	A B C
		c. Using stealth equipment (stealth craniotomy)	A B C	A B C
	10. Discectomy		A B C	A B C
	11. Hypophysectomy		A B C	A B C
	12. Insertion nerve stimulators/medication pumps		A B C	A B C
	13. Laminectomy		A B C	A B C
	14. Myelomeningocele repair		A B C	A B C
	15. Pedicle screw insertion		A B C	A B C
	16. Posterior lumbar interbody fusion (PLIF)		A B C	A B C
	17. Shunt procedure/VP, VA/LP		A B C	A B C
	18. Spine fusion - list systems you have used
	19. Ulnar nerve transfer		A B C	A B C
	20. Ventriculography procedure/ventriculoscopy		A B C	A B C
	21. Ventriculostomy		A B C	A B C


F. OPTHALMOLOGY		SCRUB	CIRCULATE

	1. Cataract extraction with IOL	A B C	A B C
	2. Corneal transplant	A B C	A B C
	3. Dacryocystectomy	A B C	A B C
	4. Dacryocystorhinostomy	A B C	A B C
	5. Iridectomy	A B C	A B C
	6. Lid and muscle procedures	A B C	A B C
	7. Orbital implant	A B C	A B C
	8. Phaco emulsification	A B C	A B C
	9. Pterygium repair	A B C	A B C
	10. Recession resection	A B C	A B C
	11. Repair orbital blowout fracture	A B C	A B C
	12. Scleral buckle	A B C	A B C
	13. Vitrectomy	A B C	A B C


G. ORAL		SCRUB	CIRCULATE

	1. Closed reduction facial fractures/wiring	A B C	A B C
	2. Excision odontoma	A B C	A B C
	3. Extraction of deciduous teeth	A B C	A B C
	4. Extraction of impacted molars	A B C	A B C
	5. Fractured jaws, mandibular and zagomatic	A B C	A B C
	6. LeFort osteotomies	A B C	A B C
	7. Maxillary procedure with graft	A B C	A B C
	8. Pediatric dentistry	A B C	A B C
	9. Sagittal osteotomy	A B C	A B C
	10. Temporomandibular joint (TMJ) with arthroplasty	A B C	A B C
	11. TMJ exploration	A B C	A B C


H. ORTHOPEDICS			SCRUB	CIRCULATE

	1. Acetabular/pelvic ORIF		A B C	A B C
	2. Achilles tendon repair		A B C	A B C
	3. Amputation - leg, arm		A B C	A B C
	4. Anterior cruciate ligament repair		A B C	A B C
	5. Application of external fixators
		a. Extremities	A B C	A B C
		b. Pelvis	A B C	A B C
	6. Application of halo traction		A B C	A B C
	7. Arthroscopy
		a. Ankle	A B C	A B C
		b. Elbow	A B C	A B C
		c. Knee	A B C	A B C
		d. Shoulder	A B C	A B C
	8. Arthrotomy		A B C	A B C
	9. Bipolar/unipolar hips		A B C	A B C
	10. Bunionectomy		A B C	A B C
	11. Calcaneal reconstruction		A B C	A B C
	12. Capsulorrhaphy		A B C	A B C
	13. Carpal tunnel release		A B C	A B C
	14. Closed reduction fracture		A B C	A B C
	15. Hand surgery with implants		A B C	A B C
	16. Harrington rod instrumentation and/or Dwyer procedure		A B C	A B C
	17. Heel cord lenghtening		A B C	A B C
	18. Hip compression nails & lag screws
		a. Jewett	A B C	A B C
		b. Kuntscher rod	A B C	A B C
		c. Lottes	A B C	A B C
		d. Rush	A B C	A B C
		e. Schneider	A B C	A B C
		f. Zimmer	A B C	A B C
		g. Others - list (Hip)
	19. Iliac crest bone graft		A B C	A B C
	20. Insertion Austin Moor hip prosthesis		A B C	A B C
	21. Intramedullary rods
		a. Extraction	A B C	A B C
		b. Femoral	A B C	A B C
		c. Humeral	A B C	A B C
		d. Insertion	A B C	A B C
		e. Supracondylar	A B C	A B C
		f. Tibial	A B C	A B C
	22. Laminectomy		A B C	A B C
	23. Olecranon bursa, excision of		A B C	A B C
	24. Open reduction of fracture, internal fixation with compression set		A B C	A B C
	25. Patellectomy		A B C	A B C
	26. Putti Platt/Bankart procedure/rotator cuff repair		A B C	A B C
	27. Reduction with compression sets		A B C	A B C
	28. Reimplantation of digits		A B C	A B C
	29. Repair hammer toes		A B C	A B C
	30. Sacro-iliac (SI) joint screws		A B C	A B C
	31. Sharrard procedure		A B C	A B C
	32. Spica cast, application of		A B C	A B C
	33. Spinal fusion		A B C	A B C
	34. Tendon transplants (hand and foot)		A B C	A B C
	35. Total joint replacements/revisions
		a. Total hip	A B C	A B C
		b. Total knee	A B C	A B C
		c. Total shoulder	A B C	A B C


I. PLASTICS			SCRUB	CIRCULATE

	1. Abdominal lipectomy		A B C	A B C
	2. Blepharoplasty		A B C	A B C
	3. Face lift		A B C	A B C
	4. Mammoplasty
		a. Augmentation	A B C	A B C
		b. Reduction	A B C	A B C
		c. Tramflaps with reconstructive mammoplasty	A B C	A B C
	5. Mentoplasty		A B C	A B C
	6. Otoplasty		A B C	A B C
	7. Pedicle grafts		A B C	A B C
	8. Scar revisions		A B C	A B C
	9. Split thickness skin grafting		A B C	A B C
	10. Tissue expanders		A B C	A B C


J. THORACIC & OPEN HEART			SCRUB	CIRCULATE

	1. Cervical rib excision		A B C	A B C
	2. Chamberlain procedure		A B C	A B C
	3. Closed thoracotomy		A B C	A B C
	4. Correction pectus excavatum		A B C	A B C
	5. Esophagectomy		A B C	A B C
	6. Heller procedure		A B C	A B C
	7. Mitral commissurotomy		A B C	A B C
	8. Open heart procedures
		a. Mitral or aortic valve replacement	A B C	A B C
		b. Patent ductus arteriosus	A B C	A B C
		c. Septal defect repairs	A B C	A B C
		d. Tetrology of Fallot	A B C	A B C
	9. Pacemaker implantation-endocardial		A B C	A B C
	10. Pacemaker implantation-myocardial		A B C	A B C
	11. Pericardiectomy		A B C	A B C
	12. Resection coarctation aorta		A B C	A B C
	13. Rib resection		A B C	A B C
	14. Thoracoplasty		A B C	A B C
	15. Tracheal resection		A B C	A B C
	16. Transthoracic diaphragmatic herniorrhaphy		A B C	A B C


K. TRANSPLANT		SCRUB	CIRCULATE

	1. Bone	A B C	A B C
	2. Bone marrow	A B C	A B C
	3. Corneal	A B C	A B C
	4. Harvesting	A B C	A B C
	5. Heart	A B C	A B C
	6. Kidney	A B C	A B C
	7. Liver	A B C	A B C
	8. Lung	A B C	A B C
	9. Multi-organ	A B C	A B C
	10. Pancreas	A B C	A B C
	11. Skin	A B C	A B C


L. TRAUMA			SCRUB	CIRCULATE

	1. Burns		A B C	A B C
	2. Gunshot/stab wounds
		a. Abdomen	A B C	A B C
		b. Chest	A B C	A B C
		c. Head	A B C	A B C
	3. Motor vehicle accidents (multiple injuries)		A B C	A B C
	4. Traumatic amputations		A B C	A B C


M. UROLOGY			SCRUB	CIRCULATE

	1. Adult circumcision		A B C	A B C
	2. Cystectomy		A B C	A B C
	3. Cystoscopy/ureteroscopy		A B C	A B C
	4. Hypospadias repair		A B C	A B C
	5. Implants; penile, testicular		A B C	A B C
	6. Lithotripsy		A B C	A B C
	7. Nephrectomy		A B C	A B C
	8. Nephrolithotomy		A B C	A B C
	9. Orchiopexy		A B C	A B C
	10. Prostatectomy
		a. Perineal	A B C	A B C
		b. Supra-pubic	A B C	A B C
	11. Pyeloplasty		A B C	A B C
	12. Radical node dissection		A B C	A B C
	13. Scott incontinence device		A B C	A B C
	14. TURP		A B C	A B C
	15. Ureterolithotomy		A B C	A B C
	16. Vasectomy		A B C	A B C
	17. Vasovasostomy		A B C	A B C
	18. Waterhouse procedure		A B C	A B C


N. VASCULAR		SCRUB	CIRCULATE

	1. A-V access graft	A B C	A B C
	2. Aortic aneurysm with graft replacement	A B C	A B C
	3. Endarterectomy/carotid - femoral	A B C	A B C
	4. Peripheral vascular bypass procedures	A B C	A B C
	5. Resection carotid aneurysm with graft	A B C	A B C
	6. Thrombectomy/embolectomy	A B C	A B C
	7. Vena cava filter/umbrella	A B C	A B C
	8. Vena cava ligation	A B C	A B C


O. ANESTHESIA

	1. Assist with intubation	A B C
	2. Conscious sedation - administration and monitoring	A B C
	3. Management of malignant hyperthermia crisis	A B C


P. EQUIPMENT

	1. Argon beam coagulator			A B C
	2. Bair Hugger			A B C
	3. Blood/fluid warmer			A B C
	4. Camera/video systems
		a. Camera controller		A B C
		b. Light source		A B C
		c. Printers		A B C
		d. VCRs		A B C
	5. Cardiac monitor and pacemaker			A B C
	6. Cell saver			A B C
	7. Cidex soak			A B C
	8. Cry-ophthalmic unit			A B C
	9. Defibrillator/pacer			A B C
	10. Dermatome
		a. Brown		A B C
		b. Padgett		A B C
		c. Zimmer		A B C
	11. Disposable grounding pads			A B C
	12. Drills
		a. 3-M Maxi driver		A B C
		b. Codman craniotome		A B C
		c. Hall air driver		A B C
		d. Hall dental		A B C
		e. Hall neurotome		A B C
		f. Midax Rex/Anspach		A B C
		g. Minidriver		A B C
		h. Stryker drills
			(1) Large battery Stryker	A B C
			(2) Small battery Stryker	A B C
		i. Surgairtome		A B C
		j. Synthes A-O Drill		A B C
	13. Electrosurgical unit			A B C
	14. Emerson thoracic pump			A B C
	15. Ethylene oxide sterilizer - AMSCO			A B C
	16. Eye magnet			A B C
	17. Fiber optic luminator - list types
	18. Flash autoclave - AMSCO			A B C
	19. Fracture tables
		a. Chick table/Marquet table		A B C
		b. Jackson table		A B C
		c. Rush table/Skytron table		A B C
	20. Hypo/hyperthermia unit			A B C
	21. Intestinal stapling devices
		a. EEA		A B C
		b. GIA		A B C
		c. LDS		A B C
		d. TA		A B C
	22. Kreiselman resuscitator			A B C
	23. Laser
		a. CO₂		A B C
		b. Eye		A B C
		c. Yag		A B C
		d. Other
	24. Mesh graft			A B C
	25. Microscopes, list type
	26. Nerve stimulator			A B C
	27. Nitrous oxide bank			A B C
	28. Ohio suction units			A B C
	29. Orthopedic arm board with drain			A B C
	30. Pleurevac disposable chest drainage			A B C
	31. Pneumatic tourniquet			A B C
	32. Sterad machine			A B C
	33. Steri-vac aeration cabinet, 3-M, portable			A B C
	34. Steris unit			A B C
	35. Suction unit, disposable			A B C
	36. Tele-thermometer			A B C
	37. Ultrasonic cleaner - AMSCO			A B C
	38. Vac-pac positioner			A B C
	39. Vacuum curettage			A B C
	40. Washer sanitizer - AMSCO			A B C
	41. Washer sterilzer - AMSCO			A B C


Q. PHLEBOTOMY/IV THERAPY

	1. Equipment & procedures
		a. Administration of blood/blood products
			(1) Packed red blood cell	A B C
			(2) Whole blood	A B C
		b. Assist with IA/IV therapy
			(1) Insertion of A-lines	A B C
			(2) Insertion of CVP - jugular/subclavian	A B C
			(3) Insertion of Swan-Ganz	A B C
		c. Drawing blood from central line		A B C
		d. Drawing venous blood		A B C
		e. Starting IVs
			(1) Angiocath	A B C

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. Newborn/Neonate (birth - 30 days)	F. Adolescents (12 - 18 years)

B. Infant (30 days - 1 year)	G. Young adults (18 - 39 years)

C. Toddler (1 - 3 years)	H. Middle adults (39 - 64 years)

D. Preschooler (3 - 5 years)	I. Older adults (64+)

E. School age children (5 - 12 years)

EXPERIENCE WITH AGE GROUPS:	A	B	C	D	E	F	G	H	I
Able to adapt care to incorporate normal growth and development.
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level.
Can ensure a safe environment reflecting specific needs of various age groups.

My experience is primarily in: (Please indicate number of years.)
	Total Years OR	year(s)
	Endoscopy	year(s)	Ortho care	year(s)
	ENT	year(s)	Neuro	year(s)
	Trauma	year(s)	Plastics	year(s)
	Thoracic/Open Heart	year(s)	GYN	year(s)
	Opthalmology	year(s)	Urology	year(s)
	Transplant	year(s)	Vascular	year(s)
	Other (specify)			year(s)

Certification: (mo/day/yr)
	Computerized charting system:	date:
	Medication administration system:	date:
	ACLS Exp. date:
	BCLS Exp. date:
	CNOR Exp. date:
	CRNFA Exp. date:
	Other (type):	Exp. date:

The information I have given is true and accurate to the best of my knowledge. I hereby authorize Berean Healthcare Staffing to release this Perioperative Skills Checklist to Client facilities of Berean Healthcare Staffing in relation to consideration of my employment with those facilities.

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