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
Abdominal-Perineal Resection
Inguinal / Ventral Hernia Repair
Bowel Resection / Colostomy
Esophagascopy / Gastroscopy
Cardiac / Thoracic / Vascular
Mitral Valve Repair / Replacement
Multiple Valve Transposition
Ventricular Aneurysm Repair
Intra-Aortic Balloon Insertion
Heartport or Similar CABG
Insertion Vena Cava Filter
Pneurnonectomy / Lobectomy
Intra-Operative Angioplasty
Abdominal Aortic Aneurysm
Popliteal By-pass Graft (Insitu)
Popliteal By-pass Graft (Graph)
Portacath, Tesio, Hickman Placement
Intra-Operative Angioplasty
Subclavin / Carotid By-pass
Harrington Rod or Similar
Mini, Standard, Large Fragment
Radical Lymph Node Dissection
Insertion Penile Prosthesis
Laparoscopic Vaginal Hysterectomy
MMK (Marshall Marchetti Krantz)
BTL (Bilateral Tubal Ligation)
Cervical Laminectomy (Anterior)
Cervical Laminectomy (Posterior)
Lumbar Laminectomy Discectomy
Percutaneous Micro Discectomy
Transphenoidal Hypothypectomy
Harrington Rod or Similar
Organ Procurement (Harvest)
Age Specific Competencies
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)