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
(PROFICIENCY)
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
(FREQUENCY)
1 = Never performed observed only
2 = Less than 6 times per year
3 = 1-2 times per month
4 = Daily or Weekly
PROFICIENCY / FREQUENCY
PROFICIENCY
FREQUENCY
Start peripheral IV - angio cath
IV Therapy - Assist with:
Insertion of CVP - jugular
Insertion of CVP - sublavian
Drawing blood from central line
Administration of blood and products
Abdominal perineal resection
Herniorrhaphy - umbilical
Herniorrhaphyhiatal transabdominal/transthoracic
Imperforate anus reconstruction
Pancreatectomy / pancreatogram
Saphenous vein ligation and stripping
Tenchknoff duct cyst excision
Thyroglossal duct cyst excision
Correction pectus excavatum
Mitral or aortic valve replacement
Cardiac valve replacement
Patent ductus arteriosus repair
Pacemaker implanation - endocardial
Pacemaker implanation - myocardia
Resection coarctation aorta
Transthoracic diaphragmatic heniorrhaphy
Aortic aneurysm with graft replacement
Endarterectomy/carotid - femoral
Peripheral vascular bypass procedures
Resection carotid aneurysm with graft
Vena cava filter/umbrella
Anterior laparoscopic spine procedures
Anterior lumbar interbody fusion (ALIF)
Burr holes for subdural hematoma
Craniectomy for decompression fracture
Insertion nerve stimulators
Insertion medication pumps
Posterior lumbar interbody fusion (PLIF)
Shunt procedure/VP, VA/LP
Ventriculography / ventriculoscopy
Neurology - Cranioplasty/craniotomy
Implants - penile and testicular
Prostatectomy - supra-pubic
Scott incontinence device
Dilation and curettage (DandC)
Marsupialization, Bartholin cyst
Anterior cruciate ligament repair
Application of external fixators - extremeties
Application of external fixators - pelvis
Application of halo traction
Closed reduction fracture
Hand surgery with implants
Harrington rod instrumentation and / or Dwyer procedure
Olecranon bursa, excision of
ORIF, internal fixation with compression set
PuttiPlatt/Bankart procedure/rotator cuff repair
Reduction with compression sets
Sacro-iliac (SI) joint screws
Tendon transplants (hand and foot)
Orthopedics - Arthroscopy
Orthopedics - Hip compression nails and lag screws
Insertion Austin Moore hip prosthesis
Orthopedics - Intramedullary rods
Orthopedics - Total joint replacements/revisions
Split thickness skin grafting
Tramflaps with reconstructive mammoplasty
Closed reduction nasal fx
Excision of salivary gland tumor
Frontal flap sinus procedure
Maxillary advancement with graft
Myringotomy with PE tube insertion
Open reducation facial fx
Pharyngeal flap procedure
Selective osteotomy of maxilla/mandible
Closed reducation facial fractures/wiring
Excision of deciduous teeth
Extraction of impacted molars
Fractured jaws, mandibular and zagomatic
Maxillary procedure with graft
Temporomandibular (TMJ) with arthroplasty
Cataract extraction with IOL
Correction of ectropian/entropian
Lid and muscle procedures
Repair orbital blowout fracture
Repair of retinal detachment
Cholecystectomy / cholangiogram
Larynoscpy and microlaryngoscopy
Motor vehicle accidents (multiple injuries)
Trauma - Gunshot/stab wounds
Cardiac monitor and pacemaker
Microscopes Nerve stimulator Nitrous oxide bank
Orthopedic arm board with drain
Pleurevac disp. chest drainage
Steri-vac aeratopm cabinet
Equipment - Fracture tables
Equipment - Intestinal stapling devices
Disposable grounding pads
Stryker drills - large battery
Stryker drills - small battery
Conscious sediation administration
Conscious sediation monitoring
Management of malignant hypertensive crisis
Able to assure a safe environment for the specific needs of various age groups
A.Newborn/Neonate (birth - 30 days)
B.Infant (30 days - 1 year)
D.Preschooler (3 - 5 years)
E.School age children (5 - 12 years)
F.Adolescents (12 - 18 years)
G.Young adults (18 - 39 years)
H.Middle adults (39 - 64 years)
Able to communicate and/or instruct patients according to their age, maturity, comprehension
A.Newborn/Neonate (birth - 30 days)
B.Infant (30 days - 1 year)
D.Preschooler (3 - 5 years)
E.School age children (5 - 12 years)
F.Adolescents (12 - 18 years)
G.Young adults (18 - 39 years)
H.Middle adults (39 - 64 years)
Evaluate age-appropriate behavior, motor skills and physiological norms
A.Newborn/Neonate (birth - 30 days)
B.Infant (30 days - 1 year)
D.Preschooler (3 - 5 years)
E.School age children (5 - 12 years)
F.Adolescents (12 - 18 years)
G.Young adults (18 - 39 years)
H.Middle adults (39 - 64 years