Name: Date: _ Years of Experience :
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- Bartholomew Scott Osborne
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1 R!.~.~~' 21"1:Ploor N New York, NY G Operating Room Nursing Skills Checklist Name: ate: Years of Experience : Use the following key as a guideline: A) Theory Only/No Experience-idactic instruction only, no hands on experience B) Limited Experience-Knows procedure/has used equipment, but has done so infrequently or not within the last six months C) Moderate Experience--Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed. ) Proficient/Competent--Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach. SCRUB CIRCULATE GENERAL Gastroscopy Gastrectomy Colostomyllleostomy Cholecystectomy Hemorroidectomy Appendectomy Sigmoidoscopy Hepatic resection Herniorraphv Radical Mastectomy Hemicolectomy Bowel Resection AP Resection Thyroidectomy Whipple Procedure Organ Procurement NEUROLOGICAL CARIOVASCULAR Coronary Artery Bypass Graft Cardiac Valve Replacement Transplant Surgery Thoracic Aneurysm
2 CARIOVASCULAR CON'T Atrial Septal efect Surqerv Abdominal Aortic Aneurysm A-V Shunts Porta-Systemic Shunt Pericardial Windows Pacemaker insertions Intra-Aortic Balloon Pump Catheter Femoral - Popliteal Bypass Thrombectomy Vena Cava Lioation Aorto-Femoral Bypass.Graft Insertion THORACIC Chest Tube Insertion Tracheotomy Laryngoscopy Bronchoscopy Thoracotomy Lobectomy/Pneumonectomy Wedge Resection Hiatal Hernia ORTHOPEIC Total Joint Replacement Knee Hip Shoulder Arthroscoov/Arthrotornv Amputation - Leg/Arm Fracture Using AO Compression Patellectomv Closed Pinninq/Reduction O.R.I.F. Tendon Implants/Reanastomosis Spinal Fusion/Harrington Rods OBSTETRICAL/GYNECOLOGIC Hysterectomy &C Gynecologic Laser Procedure Caesarean section Laparoscopy Colposcopy Vulvectomy Radium Insertion Salplnoo - Oophorectomy Tubal - Lioation Termination of Pregnancy Vaginectomy
3 EYE,EAR,NOSE,THROAT Tonsillectomy! Adenoidectomy Odontectomy Stapedectomy Myringotomy Larynegectomy Mastoidectomy Corneal Transplant Retinal etachment Cataract Mandibular Vitrectomy Caldwell-Luc Extraction Ethymoidectomy Radical Neck Resection Nasal Polypectomy PLASTICS Skin Grafts Treatment Tissue Expander of Burn Patients Flap or Pedicle Grafts Split Thickness Mammoplasty Rhytidectomy ermabrasion Blepharoplasty Scar Revision Rhinoplasty Mvelomeninqocele Cleft Lip!Palate Abdominoplasty Liposuction Reduction Insertion of Facial Fracture GENITOURINARY Vasectomy Nephrectomv Cystoscopy Vasovasostomy Penile Implant Insertion Renal Transplant Ileal Loop Circumcision Lithotripsy Orchiectomy Prostatectomy TURPITURB
4 EQUIPMENT Bear I Bear I! Bear V Bennett 7200 CPAP Emerson Enostrom/lirica EMV MA-I MA-II Monihan Ohio 560 PEEP Pressure Pre-Set Servo 900b Servo 900c Servo 900e Hewlett-Packard Soacelab Siemens Marquette Mennen Lifecare Nikon-Koder TA 30 or Roticulator 30 TA 30-V3 or Roticulator 40-V3 TA 55 or Roticulator 55 TA90 GIA-Type CEEA 21 EEA-21 Purstrinc- Tvoe Powered LS Suruictlo- Tvne FS Skin Stapler Poly Surqicltp ermatome-type Hall Micro-ototome Codeman rill Hall Sternal Saw Maxi river Mini river Wire river Svnthes rill Ansoack rill Zimmer Surqiairtome Stryker rill
5 EQUIPMENT CON'T Stryker/Zimmer Oscillating Saw Stryker Zimmer Reciorccatino vonics Intra-Articular Shaver yonics Advanced Arthroplasty Stryker Micro-electric Arthroplasty Midas Rex Cod man rill/perforator Giqli Saw 3M Craniotome 3M Air rill Ronialr AGE SPECIFIC PRACTICE Infants & Toddlers (ages 0-3 vrs) Young Children (4-6 yrs) Older Children (7-12 vrs) Adolescents (ages yrs) Young Adults (ages yrs) Middle Adults (ages yrs) Older Adults (ages yrs) Adults (ages> 80) The information I have given is true and accurate to the best of my knowledge. I hereby authorize Prime Staffing, LLC to release this Skills Checklist to client facilities of Prime Staffing, LLC in consideration for placement as a Traveler Nurse with those facilities. Signature Address Phone ate. ~
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2017 This hospital plan offers rich hospital benefits with some value-added benefits. Unlimited cover up to 100% in hospital 27 PMB chronic conditions covered Network specialists paid in full in hospital
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Summary of Services and Availability (by location) Each location has sufficient space, equipment, staffing and financial resources in place or available in sufficient time as required to support each requested
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