OR Nursing Skill Sheet
Name:
Email:
SCRUB SKILLS
GENERAL SURGERY
Abdominal Perineal Resection
0
1
2
3
Adrenalectomy
0
1
2
3
Bowel Resection
0
1
2
3
Cholecystectomy
0
1
2
3
Colostomy/Ileostomy
0
1
2
3
Gastrectomy
0
1
2
3
Hemicolectomy
0
1
2
3
Hepatic Resection
0
1
2
3
Herniorrhaphy-Femoral/Inguinal
0
1
2
3
Hiatal Herniorrhaphy-Transabdominal
0
1
2
3
Pancreatectomy
0
1
2
3
Organ Procurement
0
1
2
3
Radical Mastectomy
0
1
2
3
Saphenous Vein Ligation and Stripping
0
1
2
3
Splenectomy
0
1
2
3
Thyroidectomy
0
1
2
3
Tracheostomy
0
1
2
3
Whipple Procedure
0
1
2
3
LAPAROSCOPIC PROCEDURES
Cholecystectomy
0
1
2
3
Appendectomy
0
1
2
3
Hernia Repair
0
1
2
3
Colon Resection
0
1
2
3
GYNECOLOGY
Caesarean Section
0
1
2
3
Dilation & Curettage
0
1
2
3
Hysterectomy-Vaginal
0
1
2
3
Hysterectomy-Abdominal
0
1
2
3
Laser Surgery
0
1
2
3
Radium Insertion
0
1
2
3
Salpingo-Oopherectomy
0
1
2
3
Shirodkar Procedure
0
1
2
3
Termination of Pregnancy
0
1
2
3
Tubal Ligation
0
1
2
3
Vaginectomy
0
1
2
3
Vaginal Reconstruction
0
1
2
3
G.U. AND CYSTO
Circumcision
0
1
2
3
Cystoscopy/Cystostomy
0
1
2
3
Cystectomy
0
1
2
3
Hypospadius Repair
0
1
2
3
Ileal Loop
0
1
2
3
Lithotripsy
0
1
2
3
Nephrectomy
0
1
2
3
Orchiectomy
0
1
2
3
Penile Implant
0
1
2
3
Prostatectomy
0
1
2
3
Ureterolithotomy
0
1
2
3
T.U.R.P./T.U.R.B.
0
1
2
3
Vasectomy
0
1
2
3
ORTHOPEDIC
Amputation - Leg/Arm
0
1
2
3
Application of Halo Traction
0
1
2
3
Arthroscopy/Arthrotomy
0
1
2
3
Closed Pinning & Reduction of Extremities
0
1
2
3
External Compression Devices
0
1
2
3
Insertion of Finger Prosthesis
0
1
2
3
Total Joint Replacement - Knee, Hip
0
1
2
3
Shoulder
0
1
2
3
Spinal Fusion-Harrington Rods
0
1
2
3
Spica Cast Application
0
1
2
3
O.R.I.F.-Shoulder, Hip, Humerus etc.
0
1
2
3
Repair of Dislocation
0
1
2
3
Patellectomy
0
1
2
3
Tendon Implants & Reanastomosis
0
1
2
3
NEUROSURGERY
Anterior Cervical Fusion
0
1
2
3
Burrholes for Subdural Hematoma
0
1
2
3
Craniotomy
0
1
2
3
Laminectomy
0
1
2
3
Meningocele Repair
0
1
2
3
Shunt Procedures-VP/VA
0
1
2
3
PLASTICS
Abdominoplasty/Abdominal Lipectomy
0
1
2
3
Augmentation Mammoplasty
0
1
2
3
Cleft Lip/Palate Repair
0
1
2
3
Dermabrasion
0
1
2
3
Digital Flexor Tendon Repair
0
1
2
3
Liposuction
0
1
2
3
Myelomeningocele Repair
0
1
2
3
Otoplasty
0
1
2
3
Rhinoplasty
0
1
2
3
Reduction of Facial Fracture
0
1
2
3
Scar Revision
0
1
2
3
Skin Meshing
0
1
2
3
Split Thickness Skin Grafting
0
1
2
3
EYE
Excision of Chalazion
0
1
2
3
Canthotomy
0
1
2
3
Correction of Ectropian/Entropian
0
1
2
3
Corneal Transplant
0
1
2
3
Enucleation
0
1
2
3
I.O.I. Implants
0
1
2
3
Lacrimal Duct Probing
0
1
2
3
Refractive Keratoplasty
0
1
2
3
Repair of Retinal Detachment
0
1
2
3
Vitrectomy
0
1
2
3
EAR, NOSE & THROAT
Caldwell-Luc
0
1
2
3
Ethymoidectomy
0
1
2
3
Frontal Flap Sinus Procedure
0
1
2
3
Laryngectomy
0
1
2
3
Open Reduction Facial Fractures
0
1
2
3
Radical Neck
0
1
2
3
Tonsillectomy & Adenoidectomy
0
1
2
3
Myringotomy
0
1
2
3
Mastoidectomy
0
1
2
3
Tympanoplasty
0
1
2
3
Stapedectomy
0
1
2
3
Nasal Polypectomy
0
1
2
3
Laryngoscopy
0
1
2
3
THORACIC
Chest Tube Set-Up
0
1
2
3
Hiatal Hernia
0
1
2
3
Pneumonectomy/Lobectomy
0
1
2
3
Sternal Splitting
0
1
2
3
Thoracotomy
0
1
2
3
Bronchoscopy
0
1
2
3
Lung/Wedge Resection
0
1
2
3
ENDOSCOPY
Bronchoscopy
0
1
2
3
Cystoscopy
0
1
2
3
Gastroscopy
0
1
2
3
Colonoscopy
0
1
2
3
CARDIOVASCULAR
A-V Shunts
0
1
2
3
Aortic Aneurysm, Abdominal
0
1
2
3
Aorto-Femoral Bypass
0
1
2
3
Graft Insertion
0
1
2
3
Cardiac Valve Replacement
0
1
2
3
Coronary Artery Bypass Graft-on pump
0
1
2
3
Endarterectomy-Carotid/Femoral
0
1
2
3
Femoral-Popliteal Bypass
0
1
2
3
External Temporary Pacemaker
0
1
2
3
Internal Pacemaker Insertion
0
1
2
3
Intra-Aortic Balloon Pump Catheter
0
1
2
3
Patent Ductus Repair
0
1
2
3
Pericardial Windows
0
1
2
3
Portasystemic Shunt
0
1
2
3
Repair of Septal Defects
0
1
2
3
Thrombectomy
0
1
2
3
Vena Cava Ligation
0
1
2
3
TRANSPLANTS
Pancreas
0
1
2
3
Heart
0
1
2
3
Lung
0
1
2
3
Liver
0
1
2
3
Kidney
0
1
2
3
Eye
0
1
2
3
EQUIPMENT
Robotics
0
1
2
3
List Type:
Fracture Tables
0
1
2
3
Video Systems
0
1
2
3
CUSA
0
1
2
3
Cell Saver
0
1
2
3
PACS Diagnostics
0
1
2
3
Drills
0
1
2
3
Stapling Devices
0
1
2
3
Ventilators
0
1
2
3
Cardiac Monitors
0
1
2
3
Crash Carts
0
1
2
3
Defibrillators
0
1
2
3
STERILIZATION OF EQUIPMENT
Log
0
1
2
3
Biological Indicators
0
1
2
3
Autoclave Operation
0
1
2
3
High Level
0
1
2
3
STERIS
0
1
2
3
Steam
0
1
2
3
Gas
0
1
2
3
Flash
0
1
2
3
MISCELLANEOUS
Universal Protocol
0
1
2
3
Patient Identification
0
1
2
3
Hand-off Communication
0
1
2
3
Standard Precautions
0
1
2
3
Isolation Precautions
0
1
2
3
Pediatric Respiratory/Cardiac Arrest
0
1
2
3
Adult Respiratory/Cardiac Arrest
0
1
2
3
Automated Med Dispensing Systems
0
1
2
3
Electronic Documentation
0
1
2
3
EXPERIENCE WITH THE FOLLOWING AGES:
Newborn/Neonate (birth to 30 days)
0
1
2
3
Infant (1 month to 1 year)
0
1
2
3
Toddler (1 year to 3 years)
0
1
2
3
Preschooler (3 years to 5 years)
0
1
2
3
School age child (5 years to 12 years)
0
1
2
3
Adolescents (12 years to 18 years)
0
1
2
3
Young Adults (18 years to 39 years)
0
1
2
3
Middle Adults (39 years to 64 years)
0
1
2
3
Older Adults (64 years to 79 years)
0
1
2
3
Elderly Adults (over 79+ years)
0
1
2
3
CIRCULATE SKILLS
GENERAL SURGERY
Abdominal Perineal Resection
0
1
2
3
Adrenalectomy
0
1
2
3
Bowel Resection
0
1
2
3
Cholecystectomy
0
1
2
3
Colostomy/Ileostomy
0
1
2
3
Gastrectomy
0
1
2
3
Hemicolectomy
0
1
2
3
Hepatic Resection
0
1
2
3
Herniorrhaphy-Femoral/Inguinal
0
1
2
3
Hiatal Herniorrhaphy-Transabdominal
0
1
2
3
Pancreatectomy
0
1
2
3
Organ Procurement
0
1
2
3
Radical Mastectomy
0
1
2
3
Saphenous Vein Ligation and Stripping
0
1
2
3
Splenectomy
0
1
2
3
Thyroidectomy
0
1
2
3
Tracheostomy
0
1
2
3
Whipple Procedure
0
1
2
3
LAPAROSCOPIC PROCEDURES
Cholecystectomy
0
1
2
3
Appendectomy
0
1
2
3
Hernia Repair
0
1
2
3
Colon Resection
0
1
2
3
GYNECOLOGY
Caesarean Section
0
1
2
3
Dilation & Curettage
0
1
2
3
Hysterectomy-Vaginal
0
1
2
3
Hysterectomy-Abdominal
0
1
2
3
Laser Surgery
0
1
2
3
Radium Insertion
0
1
2
3
Salpingo-Oopherectomy
0
1
2
3
Shirodkar Procedure
0
1
2
3
Termination of Pregnancy
0
1
2
3
Tubal Ligation
0
1
2
3
Vaginectomy
0
1
2
3
Vaginal Reconstruction
0
1
2
3
G.U. AND CYSTO
Circumcision
0
1
2
3
Cystoscopy/Cystostomy
0
1
2
3
Cystectomy
0
1
2
3
Hypospadius Repair
0
1
2
3
Ileal Loop
0
1
2
3
Lithotripsy
0
1
2
3
Nephrectomy
0
1
2
3
Orchiectomy
0
1
2
3
Penile Implant
0
1
2
3
Prostatectomy
0
1
2
3
Ureterolithotomy
0
1
2
3
T.U.R.P./T.U.R.B.
0
1
2
3
Vasectomy
0
1
2
3
ORTHOPEDIC
Amputation - Leg/Arm
0
1
2
3
Application of Halo Traction
0
1
2
3
Arthroscopy/Arthrotomy
0
1
2
3
Closed Pinning & Reduction of Extremities
0
1
2
3
External Compression Devices
0
1
2
3
Insertion of Finger Prosthesis
0
1
2
3
Total Joint Replacement - Knee, Hip
0
1
2
3
Shoulder
0
1
2
3
Spinal Fusion-Harrington Rods
0
1
2
3
Spica Cast Application
0
1
2
3
O.R.I.F.-Shoulder, Hip, Humerus etc.
0
1
2
3
Repair of Dislocation
0
1
2
3
Patellectomy
0
1
2
3
Tendon Implants & Reanastomosis
0
1
2
3
NEUROSURGERY
Anterior Cervical Fusion
0
1
2
3
Burrholes for Subdural Hematoma
0
1
2
3
Craniotomy
0
1
2
3
Laminectomy
0
1
2
3
Meningocele Repair
0
1
2
3
Shunt Procedures-VP/VA
0
1
2
3
PLASTICS
Abdominoplasty/Abdominal Lipectomy
0
1
2
3
Augmentation Mammoplasty
0
1
2
3
Cleft Lip/Palate Repair
0
1
2
3
Dermabrasion
0
1
2
3
Digital Flexor Tendon Repair
0
1
2
3
Liposuction
0
1
2
3
Myelomeningocele Repair
0
1
2
3
Otoplasty
0
1
2
3
Rhinoplasty
0
1
2
3
Reduction of Facial Fracture
0
1
2
3
Scar Revision
0
1
2
3
Skin Meshing
0
1
2
3
Split Thickness Skin Grafting
0
1
2
3
EYE
Excision of Chalazion
0
1
2
3
Canthotomy
0
1
2
3
Correction of Ectropian/Entropian
0
1
2
3
Corneal Transplant
0
1
2
3
Enucleation
0
1
2
3
I.O.I. Implants
0
1
2
3
Lacrimal Duct Probing
0
1
2
3
Refractive Keratoplasty
0
1
2
3
Repair of Retinal Detachment
0
1
2
3
Vitrectomy
0
1
2
3
EAR, NOSE & THROAT
Caldwell-Luc
0
1
2
3
Ethymoidectomy
0
1
2
3
Frontal Flap Sinus Procedure
0
1
2
3
Laryngectomy
0
1
2
3
Open Reduction Facial Fractures
0
1
2
3
Radical Neck
0
1
2
3
Tonsillectomy & Adenoidectomy
0
1
2
3
Myringotomy
0
1
2
3
Mastoidectomy
0
1
2
3
Tympanoplasty
0
1
2
3
Stapedectomy
0
1
2
3
Nasal Polypectomy
0
1
2
3
Laryngoscopy
0
1
2
3
THORACIC
Chest Tube Set-Up
0
1
2
3
Hiatal Hernia
0
1
2
3
Pneumonectomy/Lobectomy
0
1
2
3
Sternal Splitting
0
1
2
3
Thoracotomy
0
1
2
3
Bronchoscopy
0
1
2
3
Lung/Wedge Resection
0
1
2
3
ENDOSCOPY
Bronchoscopy
0
1
2
3
Cystoscopy
0
1
2
3
Gastroscopy
0
1
2
3
Colonoscopy
0
1
2
3
CARDIOVASCULAR
A-V Shunts
0
1
2
3
Aortic Aneurysm, Abdominal
0
1
2
3
Aorto-Femoral Bypass
0
1
2
3
Graft Insertion
0
1
2
3
Cardiac Valve Replacement
0
1
2
3
Coronary Artery Bypass Graft-on pump
0
1
2
3
Endarterectomy-Carotid/Femoral
0
1
2
3
Femoral-Popliteal Bypass
0
1
2
3
External Temporary Pacemaker
0
1
2
3
Internal Pacemaker Insertion
0
1
2
3
Intra-Aortic Balloon Pump Catheter
0
1
2
3
Patent Ductus Repair
0
1
2
3
Pericardial Windows
0
1
2
3
Portasystemic Shunt
0
1
2
3
Repair of Septal Defects
0
1
2
3
Thrombectomy
0
1
2
3
Vena Cava Ligation
0
1
2
3
TRANSPLANTS
Pancreas
0
1
2
3
Heart
0
1
2
3
Lung
0
1
2
3
Liver
0
1
2
3
Kidney
0
1
2
3
Eye
0
1
2
3
EQUIPMENT
Robotics
0
1
2
3
List Type:
Fracture Tables
0
1
2
3
Video Systems
0
1
2
3
CUSA
0
1
2
3
Cell Saver
0
1
2
3
PACS Diagnostics
0
1
2
3
Drills
0
1
2
3
Stapling Devices
0
1
2
3
Ventilators
0
1
2
3
Cardiac Monitors
0
1
2
3
Crash Carts
0
1
2
3
Defibrillators
0
1
2
3
STERILIZATION OF EQUIPMENT
Log
0
1
2
3
Biological Indicators
0
1
2
3
Autoclave Operation
0
1
2
3
High Level
0
1
2
3
STERIS
0
1
2
3
Steam
0
1
2
3
Gas
0
1
2
3
Flash
0
1
2
3
MISCELLANEOUS
Universal Protocol
0
1
2
3
Patient Identification
0
1
2
3
Hand-off Communication
0
1
2
3
Standard Precautions
0
1
2
3
Isolation Precautions
0
1
2
3
Pediatric Respiratory/Cardiac Arrest
0
1
2
3
Adult Respiratory/Cardiac Arrest
0
1
2
3
Automated Med Dispensing Systems
0
1
2
3
Electronic Documentation
0
1
2
3
EXPERIENCE WITH THE FOLLOWING AGES:
Newborn/Neonate (birth to 30 days)
0
1
2
3
Infant (1 month to 1 year)
0
1
2
3
Toddler (1 year to 3 years)
0
1
2
3
Preschooler (3 years to 5 years)
0
1
2
3
School age child (5 years to 12 years)
0
1
2
3
Adolescents (12 years to 18 years)
0
1
2
3
Young Adults (18 years to 39 years)
0
1
2
3
Middle Adults (39 years to 64 years)
0
1
2
3
Older Adults (64 years to 79 years)
0
1
2
3
Elderly Adults (over 79+ years)
0
1
2
3