[checklist name= "Operating Room RN" mailto="[email protected]" templatedoc="1rTC4RUeCuuqI0OnpGV-CNHR1Ed_7xxaPRHHvx-lUyfg" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Operating Room RN"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Ear, Nose & Throat"] [checklistInput type="scale"]Caldwell - Luc[/checklistInput] [checklistInput type="scale"]Laryngectomy[/checklistInput] [checklistInput type="scale"]Cleft lip/palate repair[/checklistInput] [checklistInput type="scale"]Radical neck dissection[/checklistInput] [checklistInput type="scale"]T&A[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="General Surgery"] [checklistInput type="scale"]Bronchoscopy[/checklistInput] [checklistInput type="scale"]Appendectomy[/checklistInput] [checklistInput type="scale"]Laparoscopic Appendectomy[/checklistInput] [checklistInput type="scale"]Cholecystectomy[/checklistInput] [checklistInput type="scale"]Laparoscopic Cholecystectomy[/checklistInput] [checklistInput type="scale"]Hernia Repair[/checklistInput] [checklistInput type="scale"]Laparoscopic Hernia Repair[/checklistInput] [checklistInput type="scale"]Colon Resection[/checklistInput] [checklistInput type="scale"]Rectal Surgery[/checklistInput] [checklistInput type="scale"]Pancreatectomy[/checklistInput] [checklistInput type="scale"]Splenectomy[/checklistInput] [checklistInput type="scale"]Thyroidectomy[/checklistInput] [checklistInput type="scale"]Vein Stripping[/checklistInput] [checklistInput type="scale"]Whipple Procedure[/checklistInput] [checklistInput type="scale"]Abdominal Perineal Resection[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Gynecology"] [checklistInput type="scale"]Hysterectomy, abdominal[/checklistInput] [checklistInput type="scale"]Tuba ligation[/checklistInput] [checklistInput type="scale"]Tuboplasty[/checklistInput] [checklistInput type="scale"]Anterior posterior repair[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Neurology"] [checklistInput type="scale"]Craniotomy for Tumor[/checklistInput] [checklistInput type="scale"]Craniotomy for Aneurysm[/checklistInput] [checklistInput type="scale"]Ventricular Peritoneal Shunt[/checklistInput] [checklistInput type="scale"]Lumbar Laminectomy[/checklistInput] [checklistInput type="scale"]Cervical Laminectomy[/checklistInput] [checklistInput type="scale"]Posterior Sitting Laminectomy[/checklistInput] [checklistInput type="scale"]Transsphenoidal Hypophysectomy[/checklistInput] [checklistInput type="scale"]Ulnar Nerve Transposition[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Ophthalmology"] [checklistInput type="scale"]Cataract extraction with IOL[/checklistInput] [checklistInput type="scale"]Corneal transplant[/checklistInput] [checklistInput type="scale"]Scleral Buckling[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Orthopedics"] [checklistInput type="scale"]Ankle Surgery[/checklistInput] [checklistInput type="scale"]Hand/Micro Hand Surgery[/checklistInput] [checklistInput type="scale"]Hip Prosthesis[/checklistInput] [checklistInput type="scale"]Knowles Pinning[/checklistInput] [checklistInput type="scale"]Spinal Fusion[/checklistInput] [checklistInput type="scale"]ACL Repair[/checklistInput] [checklistInput type="scale"]Shoulder Surgery[/checklistInput] [checklistInput type="scale"]Total Knee Surgery[/checklistInput] [checklistInput type="scale"]Total Hip Replacement[/checklistInput] [checklistInput type="scale"]ORIF[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Plastics"] [checklistInput type="scale"]Liposuction[/checklistInput] [checklistInput type="scale"]Rhinoplasty[/checklistInput] [checklistInput type="scale"]Face Lift[/checklistInput] [checklistInput type="scale"]Skin Graft[/checklistInput] [checklistInput type="scale"]Breast Reconstruction[/checklistInput] [checklistInput type="scale"]Breast Reduction[/checklistInput] [checklistInput type="scale"]Cleft lip/palate repair[/checklistInput] [checklistInput type="scale"]Free/TRAM Flap[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Thoracic & Open Heart"] [checklistInput type="scale"]Open Heart By-Pass[/checklistInput] [checklistInput type="scale"]Open heart Valve Replacement[/checklistInput] [checklistInput type="scale"]Aortic Aneurism Repair[/checklistInput] [checklistInput type="scale"]Thoracotomy[/checklistInput] [checklistInput type="scale"]Lung Resection[/checklistInput] [checklistInput type="scale"]Pneumonectomy[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Urology"] [checklistInput type="scale"]Cystectomy[/checklistInput] [checklistInput type="scale"]Kidney Transplant[/checklistInput] [checklistInput type="scale"]Percutaneous Nephrolithotomy[/checklistInput] [checklistInput type="scale"]Nephrectomy[/checklistInput] [checklistInput type="scale"]Prostatectomy[/checklistInput] [checklistInput type="scale"]TURP[/checklistInput] [checklistInput type="scale"]Ureterolithotomy[/checklistInput] [checklistInput type="scale"]Vasectomy[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Vascular"] [checklistInput type="scale"]A-V access graft[/checklistInput] [checklistInput type="scale"]Carotid Endarterectomy[/checklistInput] [checklistInput type="scale"]Peripheral vascular bypass procedures[/checklistInput] [checklistInput type="scale"]Thrombectomy/embolectomy[/checklistInput] [checklistInput type="scale"]Vena cava filter/umbrella[/checklistInput] [checklistInput type="scale"]Vena cava ligation[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Equipment"] [checklistInput type="scale"]Argon beam coagulator[/checklistInput] [checklistInput type="scale"]Bair Hugger[/checklistInput] [checklistInput type="scale"]Blood/fluid warmer[/checklistInput] [checklistInput type="scale"]Cell saver[/checklistInput] [checklistInput type="scale"]Use of Cavitron machine[/checklistInput] [checklistInput type="scale"]Lasers[/checklistInput] [checklistInput type="scale"]Pleur-evac disposable chest drainage[/checklistInput] [checklistInput type="scale"]Steri-vac aeration cabinet, 3-M, portable[/checklistInput] [checklistInput type="scale"]Steris unit[/checklistInput] [checklistInput type="scale"]Suction unit, disposable[/checklistInput] [checklistInput type="scale"]Washer sanitizer - AMSCO[/checklistInput] [checklistInput type="scale"]Washer sterilizer - AMSCO[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Phlebotomy/IV Therapy"] [checklistInput type="scale"]Administration of blood/blood products[/checklistInput] [checklistInput type="scale"]Drawing blood from central line[/checklistInput] [checklistInput type="scale"]Starting IVs with Angiocath[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age Specific Criteria"] [checklistInput type="scale"]Pediatric (1-12 years)[/checklistInput] [checklistInput type="scale"]Adolescents (12-18 years)[/checklistInput] [checklistInput type="scale"]Adult (19-65 years)[/checklistInput] [checklistInput type="scale"]Older Adult (Older than 65 years)[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Experience With Age Groups"] [checklistInput type="scale"]Calculate body weight to verify correct dosing of medication[/checklistInput] [checklistInput type="scale"]Assess immunization status for pediatric, and adolescent[/checklistInput] [checklistInput type="scale"]Set age-appropriate short-term and long-term goals in care planning[/checklistInput] [checklistInput type="scale"]Provide age-appropriate education, considering possible vision and hearing impairment for Older than 65 years[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Certification"] [checklistInput type="date"]BCLS (Exp. Date)[/checklistInput] [checklistInput type="date"]CNOR (Exp. Date)[/checklistInput] [checklistInput type="date"]ACLS (Exp. Date)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]