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Medical Surgical Skills Checklist

My responses in this checklist represent a true reflection of my experience and comfort level. Please self-rate your comfort level in performing tasks in connection with the below checklist. Rate your level of comfort for each line item by following the below ranking system. Simply fill in the appropriate option immediately following the rating number.

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Certifications: (Check all that apply)

BLS/BCLS/CPR
ACLS
CHEMO
ONC

Level of Comfort/Experience

N/A=Non-applicable
1=Inexperienced in this area
2=Limited comfort/experience in this area
3=Comfortable/experienced in this area
4=Very comfortable/highly experienced in this area

Cardiovascular	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Basic 12 lead EKG interpretation	N/A	1	2	3	4
Use of Cardiac Monitor	N/A	1	2	3	4
Assessment of heart sounds (normal vs. abnormal)	N/A	1	2	3	4
Cardiac arrest/CPR	N/A	1	2	3	4
Heparin drip (Precautions and maintenance)	N/A	1	2	3	4
Peripheral Pulses	N/A	1	2	3	4
Use and administration of	N/A	1	2	3	4
Anticoagulants	N/A	1	2	3	4
Antihypertensives	N/A	1	2	3	4
Digoxin	N/A	1	2	3	4
Nitroglycerine	N/A	1	2	3	4
Permanent pacemaker	N/A	1	2	3	4
Cardiac surgery	N/A	1	2	3	4
Post acute MI	N/A	1	2	3	4
Congestive heart failure (CHF)	N/A	1	2	3	4
Femoral popliteal bypass/Vascular Procedures	N/A	1	2	3	4
Abdominal aortic aneurysm	N/A	1	2	3	4
Carotid endarterectomy	N/A	1	2	3	4
Thrombophlebitis	N/A	1	2	3	4
Pulmonary	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Assessment of breath sounds	N/A	1	2	3	4
Chest Physiotherapy	N/A	1	2	3	4
Oral suctioning	N/A	1	2	3	4
Nasotracheal suctioning	N/A	1	2	3	4
Chest tube (care and maintenance)	N/A	1	2	3	4
Oxygen Therapy Administration:	N/A	1	2	3	4
Bag and Mask	N/A	1	2	3	4
Nasal cannula	N/A	1	2	3	4
Facemask	N/A	1	2	3	4
Albuterol (Ventolin)	N/A	1	2	3	4
Corticosteroids	N/A	1	2	3	4
Tracheostomy	N/A	1	2	3	4
Mechanical ventilator	N/A	1	2	3	4
COPD	N/A	1	2	3	4
Emphysema	N/A	1	2	3	4
Pneumonia	N/A	1	2	3	4
Pulmonary edema	N/A	1	2	3	4
Neurology	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Assessment of neurological status	N/A	1	2	3	4
Use of Glasgow Coma Scale	N/A	1	2	3	4
Halo traction	N/A	1	2	3	4
Assist with Lumbar Puncture	N/A	1	2	3	4
Post craniotomy	N/A	1	2	3	4
Shunts (i.e. ventriculoperitoneal)	N/A	1	2	3	4
CVA	N/A	1	2	3	4
Seizure activity	N/A	1	2	3	4
Head injury/trauma	N/A	1	2	3	4
Spinal cord injury	N/A	1	2	3	4
Parkinson's	N/A	1	2	3	4
Multiple Sclerosis	N/A	1	2	3	4
DTs/ Impending Delirium Tremens	N/A	1	2	3	4
Orthopedic	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Total hip replacement	N/A	1	2	3	4
Total knee replacement	N/A	1	2	3	4
CPM (Constant Passive Motion)	N/A	1	2	3	4
Arthroscopic surgery	N/A	1	2	3	4
Amputation/stump care	N/A	1	2	3	4
Ortho trauma	N/A	1	2	3	4
Skeletal traction	N/A	1	2	3	4
Spika cast/body cast	N/A	1	2	3	4
Cast care	N/A	1	2	3	4
K-wires/Steinman pins	N/A	1	2	3	4
Gastrointestinal	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
NG tube placement	N/A	1	2	3	4
Assessment of abdomen	N/A	1	2	3	4
Administration of tube feeding	N/A	1	2	3	4
Gastrostomy tube	N/A	1	2	3	4
Jejunostomy tube (J-tube)	N/A	1	2	3	4
Colostomy/ileostomy	N/A	1	2	3	4
GI bleed	N/A	1	2	3	4
GI surgery	N/A	1	2	3	4
Hepatitis	N/A	1	2	3	4
Inflammatory bowel disease	N/A	1	2	3	4
Renal/Genitourinary	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Foley catheter insertion	N/A	1	2	3	4
Care of three-way Foley Catheter	N/A	1	2	3	4
Bladder irrigations	N/A	1	2	3	4
Care of supra-pubic catheter	N/A	1	2	3	4
Nephrectomy	N/A	1	2	3	4
Renal failure	N/A	1	2	3	4
Renal transplant	N/A	1	2	3	4
Peritoneal dialysis	N/A	1	2	3	4
Fistula/shunt	N/A	1	2	3	4
T.U.R.P.	N/A	1	2	3	4
UTI (Urinary Tract Infection)	N/A	1	2	3	4
Gynecology	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
GYN exam/PAP (assist)	N/A	1	2	3	4
Hysterectomy	N/A	1	2	3	4
Ectopic pregnancy	N/A	1	2	3	4
Mastectomy	N/A	1	2	3	4
Repair of cystocele/rectocele	N/A	1	2	3	4
Endocrine	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Diabetic teaching	N/A	1	2	3	4
Insulin administration	N/A	1	2	3	4
Use and Administration of Oral Hypoglycemics	N/A	1	2	3	4
Blood glucose testing	N/A	1	2	3	4
Oncology	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Chemotherapy administration (precautions and side effects)	N/A	1	2	3	4
Isolation/reverse isolation	N/A	1	2	3	4
IV hydration	N/A	1	2	3	4
Nutritional requirements	N/A	1	2	3	4
Care of bone marrow transplant patient	N/A	1	2	3	4
Hickman catheter	N/A	1	2	3	4
Groshong Catheter	N/A	1	2	3	4
Infusa-port	N/A	1	2	3	4
Broviac	N/A	1	2	3	4
Chemotherapy Certification	N/A	1	2	3	4
IV Therapy	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Drawing venous blood	N/A	1	2	3	4
Administration of blood and blood products (precautions, recognizing transfusion reactions and taking appropriate actions)	N/A	1	2	3	4
Start peripheral IV's	N/A	1	2	3	4
Maintenance of IV's	N/A	1	2	3	4
Administration/mixing IV meds	N/A	1	2	3	4
Calculate doses	N/A	1	2	3	4
Calculate rates	N/A	1	2	3	4
Hanging IV piggybacks	N/A	1	2	3	4
Insertion of heparin lock	N/A	1	2	3	4
Maintenance of heparin lock	N/A	1	2	3	4
Care/maintenance of Central lines	N/A	1	2	3	4
Nutritional Infusions /Hyperalimentation	N/A	1	2	3	4
Wound and Skin Care	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Sterile dressing changes	N/A	1	2	3	4
Wound irrigations	N/A	1	2	3	4
Wound culture	N/A	1	2	3	4
Care of surgical incisions with drains (i.e. JP drain)	N/A	1	2	3	4
Assessment and care of pressure sores	N/A	1	2	3	4
Assessment and care of decubitus ulcers	N/A	1	2	3	4
Other Nursing Responsibilities	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Physical assessment	N/A	1	2	3	4
Use of restraints	N/A	1	2	3	4
Care of the patient with: HIV/AIDS	N/A	1	2	3	4
Knowledge of Normal Serum Lab Values	N/A	1	2	3	4
Charge Nurse Responsibilities	N/A	1	2	3	4