CVOR Tech

This checklist was electronically signed on (Today’s date)

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.

Proficiency Scale:

1 . No Experience

2 . Need Training

3 . Able to perform with supervision

4 . Able to perform independently

GENERAL SURGERY

CARDIOVASCULAR

THORACIC

ORTHOPEDIC

NEUROLOGICAL

GENITOURINARY

GYNECOLOGICAL

EAR/NOSE/THROAT

CRANIOFACIAL/ORAL/PLASTICS

PLASTIC

TRANSPLANTS

EQUIPMENT

OTHER SKILLS

AGE SPECIFIC

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Abdominal Perineal Resection
Appendectomy/Cholescystectomy
Breast Biopsy
Colon Resection/Surgery
Gastrectomy
Gastric Bypass/Roux-en-Y
Hemorrhoidectomy
Herniorrhaphy
Laparoscopic General Surgeries
Laparoscopic Nissen Fundoplication
Mastectomy
Splenectomy
Thyroidectomy

Aorta Repair
Aorto-Bifemoral/Femoral-Pop Bypass
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

Endoscopic Thoracic Procedures
Esophagogastrectomy
Mediastinotomy/Sternotomy
Thoracoscopy/Nuss Procedure
Thoracotomy

Total Joint Replacement
Closed Reduction of Fracture
External Fixator
Cannulated Hip Screws
Bankhart Procedure
Birmingham Procedure
Carpal Tunnel Release
Arthroscopy
Anterior Cruciate Ligament
Open Reduction Internal Fixation

Craniotomy
Steriotactic Guided Brain Biopsy
Laminectomy
Laparoscopic Anterior Laminectomy
Insertion of Vagal Nerve Stimulator
Insertion of VP Shunt
Spinal Fusion
Anterior Cervical Discectomy Fusion
Posterior Cervical Laminectomy

Vasicaurethropexy
Marshall Marchetti
Circumcision
Cystoscopy/Cystogram/Pyelogram
Prostatectomy
Nephrectomy
Orchidectomy/Orchidopexy
Ureterostomy
Laparoscopic Assisted GU Procedures
Robotic Assisted GU Procedures

Abdominal Hysterectomy
Anterior Posterior Repair
C-Section
D & C
Laparoscopic Assisted Hysterectomy
Laparotomy with Microtuboplasty
Robotic Assisted GYN Procedures
Vaginal Delivery
Vaginal Hysterectomy

Endoscopic ENT Procedures
Laryngectomy
Mastoidectomy
Myringotomy with Insertion of Tubes
Radical Neck
Septoplasty
Tonsillectomy & Adenoidectomy
Tracheostomy
Tympanoplasty

Craniectomy
Craniofacial Reconstruction
Dental Surgery
Leforte 1 Maxillary
Sagittal Osteotomy
ORIF Mandibular Fracture
Otoplasty
Reconstruction of Ear
Removal of Arch Bars
Repair of Cleft Lip, Nose, Palate
Rhinoplasty

Blephoroplasty
Breast Reconstruction with Implant
Breast Reduction Mammoplasty
Face Lift
Mastectomy & Tram Flap Reconstruction
Split Thickness Skin Graft
Suction Lipectomy

Electrocautery (ESU)
Laparoscopy Systems
Neuro
OR Fracture Tables
Orthopedic Total Joint Systems
Power Equipment
Robotics Systems
Spinal Fusion Instrumentation

Malignant Hyperthermia Protocol
Infection Prevention
Isolation Precautionst
National Patient Safety Goal
Universal Protocol

Newborn/Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)

Heart
Lung
Liver
Pancreas
Eye
Organ Donation