Pre-Op RN

AGE OF PATIENTS CARED FOR

Newborn/Neonate (birth to 30 days)*

1
2
3
4

Infant (1 month to 1 year)*

1
2
3
4

Toddler (1 year to 3 years)*

1
2
3
4

Preschooler (3 years to 5 years)*

1
2
3
4

School Age Child (5 years to 12 years)*

1
2
3
4

Adolescents (12 years to 18 years)*

1
2
3
4

Young Adults (18 years to 39 years)*

1
2
3
4

Middle Adults (39 years to 64 years)*

1
2
3
4

Older Adults (64 years to 79 years)*

1
2
3
4

Elderly Adults (over 79+ years)*

1
2
3
4

General Skills

Standard Precautions*

1
2
3
4

Adult Respiratory/Cardiac Arrest*

1
2
3
4

Pediatric Respiratory/Cardiac Arrest*

1
2
3
4

Crash Carts*

1
2
3
4

Defibrillators*

1
2
3
4

Patient/Family Education*

1
2
3
4

Admit & Assess Patients*

1
2
3
4

Automated Med Dispensing Systems*

1
2
3
4

List Types:

Obtaining Cultures (Blood, Sputum, Swab, Urine)*

1
2
3
4

Advance Directives*

1
2
3
4

Collect Appropriate Data*

1
2
3
4

Discharge Teaching*

1
2
3
4

Preoperative Teaching*

1
2
3
4

Patient Prep*

1
2
3
4

CARDIOVASCULAR

Assess Heart Tones*

1
2
3
4

Bedside Tele Monitoring*

1
2
3
4

Interpretation of Coagulation Studies*

1
2
3
4

Perform Pulse/Circulation Checks*

1
2
3
4

Pre-Post Op Pacemaker Care*

1
2
3
4

PULMONARY

Assess Breath Sounds*

1
2
3
4

Apply Oxygen*

1
2
3
4

Interpret ABGs*

1
2
3
4

Thoracentesis*

1
2
3
4

Oximetry*

1
2
3
4

NEUROLOGY

Assess Neurological Signs*

1
2
3
4

Epidurals*

1
2
3
4

Selective Nerve Root Blocks*

1
2
3
4

Assess Level of Consciousness*

1
2
3
4

GI

Insertion/Monitoring NG Tubes*

1
2
3
4

Assessments*

1
2
3
4

Flexible Sigmoidoscopy*

1
2
3
4

Hemorrhoid Banding*

1
2
3
4

Liver Biopsy*

1
2
3
4

Paracentesis*

1
2
3
4

Lap Band Surgery*

1
2
3
4

GU

Bladder Biopsy*

1
2
3
4

Cystoscopy*

1
2
3
4

Urethral Dilation*

1
2
3
4

Nephrostomy*

1
2
3
4

Kidney Biopsy*

1
2
3
4

Suprapubic Catheter*

1
2
3
4

Prostate Biopsy*

1
2
3
4

ENDOCRINE

Care of Diabetic Patient*

1
2
3
4

Diabetic Teaching*

1
2
3
4

Blood Glucose Testing*

1
2
3
4

ENT & Mouth

Prosthodontics/Restorative Dentistry*

1
2
3
4

Mouth Biopsy*

1
2
3
4

Myringotomy*

1
2
3
4

Maxillofacial Prosthetics*

1
2
3
4

Nose Biopsy*

1
2
3
4

Thyroid Aspirate Biopsy*

1
2
3
4

Fiberoptic Laryngoscopy*

1
2
3
4

Tonsillectomy*

1
2
3
4

WOUNDS/INTEGUMENT

Application of Burn Dressing*

1
2
3
4

Dressing Changes*

1
2
3
4

Debridement of Wound*

1
2
3
4

Wound Care*

1
2
3
4

Wound Vac*

1
2
3
4

OB/GYN

Electrodesiccation and Curettage (ED7C)*

1
2
3
4

Assist with In-Office Procedures*

1
2
3
4

ORTHO

Arthrocentesis*

1
2
3
4

External Hardware and Pin Care*

1
2
3
4

Arthroscopy*

1
2
3
4

Open Reduction and Internal Fixation*

1
2
3
4

Closed Reduction and Internal Fixation*

1
2
3
4

Trigger Point Injections*

1
2
3
4

PLASTICS

Rhinoplasty*

1
2
3
4

Liposuction*

1
2
3
4

Nipple Reconstruction*

1
2
3
4

MOHS Repairs*

1
2
3
4

Blepharoplasty*

1
2
3
4

Mole/Cyst Removal*

1
2
3
4

GENERAL MEDICATIONS/THERAPEUTIC INTERVENTIONS

Administer IM and SQ Medications*

1
2
3
4

Administer Inhalation Medications*

1
2
3
4

Administer PO Medications*

1
2
3
4

Bladder Irrigation and Installation*

1
2
3
4

Chemotherapy*

1
2
3
4

Needleless System*

1
2
3
4

IV THERAPY

Infusion Pumps*

1
2
3
4

Peripheral IV Insertion*

1
2
3
4

Syringe Pumps*

1
2
3
4

Vascular Access Devices Care/ Maintenance*

1
2
3
4

Administer IV Medications*

1
2
3
4

OXYGEN ADMINISTRATION

Nasal Cannula*

1
2
3
4

Ambu-Bag*

1
2
3
4

Non-Rebreather Mask*

1
2
3
4

Venti Mask*

1
2
3
4

Face Mask*

1
2
3
4

NUTRITIONAL THERAPY

Lipids*

1
2
3
4

TPN*

1
2
3
4

Procalamine*

1
2
3
4

Enteral Administration*

1
2
3
4

PAIN MANAGEMENT/ ANESTHESIA

Moderate Sedation*

1
2
3
4

Implantable Narcotic Pump*

1
2
3
4

Epidural*

1
2
3
4

Spinal*

1
2
3
4

Local*

1
2
3
4

General*

1
2
3
4

Bier Block*

1
2
3
4

Axillary Block*

1
2
3
4

GENERAL PROCEDURES/ EQUIPMENT

Apply Immobilizers (clavicle, knee, etc.)*

1
2
3
4

Assist with Code Resuscitation*

1
2
3
4

Assist with Lumbar Puncture*

1
2
3
4

Dermabrasion*

1
2
3
4

Laser*

1
2
3
4

Drain Removal*

1
2
3
4

Incision and Drainage*

1
2
3
4

NGT Insertion*

1
2
3
4

Patch Test*

1
2
3
4

Punch Biopsy*

1
2
3
4

Shave Biopsy*

1
2
3
4

Procedure Set Up*

1
2
3
4

Remove External Fixators with Pin*

1
2
3
4

Scrub*

1
2
3
4

Screw-Hardware Removal*

1
2
3
4

Set-Up/ Assist Suturing*

1
2
3
4

Staple Removal*

1
2
3
4

Suture Removal*

1
2
3
4

Foley/ Straight Catheter - Male*

1
2
3
4

Foley/ Straight Catheter - Female*

1
2
3
4

TENS Unit*

1
2
3
4

Use of Doppler*

1
2
3
4

SPECIMEN COLLECTIONS

Venipuncture*

1
2
3
4

Clean Catch Urine*

1
2
3
4

Sterile Urine Collection*

1
2
3
4

Stool*

1
2
3
4

Sputum*

1
2
3
4

Butterfly Stick*

1
2
3
4

Central Line Draw*

1
2
3
4

CLINICAL SETTINGS

Surgi-Center*

1
2
3
4

Out Patient Clinic*

1
2
3
4

Physician Office*

1
2
3
4

Ambulatory Surgery Clinic*

1
2
3
4

Please list the EMR systems you have used*

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*

I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*

Your Recruiter*

Name*

First Last

Email*

Phone*

TODAY'S DATE*

Pre-OP RN