MATRIX PERSONNEL SERVICE, INC.
RN PROFICIENCY RECORD ( SKILLS CHECKLIST )
OPERATING ROOM

 


NAME DATE

E -MAIL ADDRESS

 

LEVEL OF PROFICIENCY
Theory - NO Experience
1
Minimal Experience
2
Competent and Experienced
3

SKILLS
1
2
3
NEUROLOGY 
Acoustic Neuromas
Aneurysm Repair
Cervical Laminectomy
Craniotomy
Endarterectomy
Hematoma Evacuation
Lumbar Laminectomy
Neuro Trauma
Shunts
EYE 
Blepharoplasty
Cataract with IOL
Chalazion
Corneal Transplant
Dacryocystorhinoplasty
Enucleation
Iridectomy
Muscle Repair
Removal Foreign Body
Retinal Detachment Repair
Trabeculectomy
Vitrectomy
ORAL   
Grafts
Letorte Osteotomies
Mandibular Procedures
Maxillary Procedures
TMJ Arthroplasty
EAR, NOSE, THROAT   
Laryngectomy
Mastoidectomy
Radical Neck
Septoplasty
Sinus Endoscopy
Stapedectomy
T & A Myringotomies
Tracheostomy
Tympanoplasty
Vocal Cord Stripping
GENERAL   
Abdominal Resection
Appendectomy
Cholecystectomy
Colon Resection
Colostomy
Gastrectomy
Hernia Repair
Lap Chole
Laparotomy
Mastectomy
Thyroidectomy
THORACIC/OPEN HEART   
Atrial Septal Defect
Bronchoscopy
CABG
Internal Defibrillator
Mediastienoscopy
Pacemaker Insertion
Pneumonectomy
Thoracotomy
Valve Replacement
Ventricular Septic Defect
VASCULAR
Aortic Aneurysm
Embolectomy
Fem-Fem Bypass
Fem-Pop Bypass
Fem-Tib Bypass
Vein Ligation
Carotid Endarterectomy
UROLOGY 
Archiotomy
Cystoscopy
Nephrectomy
Penile Prosthesis
Radical Prostate Resection
TURP
Ureterolithotomy
Urinary Diversion
ORTHOPEDICS 
Amputation
Arthroscopy
Bunionectomy
Carpal Tunnel Release
Closed Reduction
Hip Pinning
ORIF
Spinal Rodding/Fixation
Total Joint Replacement
Hip Replacement
Knee Replacement
Shoulder Replacement
Hand Surgery
GYNECOLOGY 
A&P Repair
Laparoscopy
Vaginal Hysterectomy
Abdominal Hysterectomy
C-Section
Marshall Marchetti
Lubal Ligation
PLASTICS 
Abdominoplasty
Breast Reconstruction
Cleft Lip/Palate
Flap Grafts
Mammoplasty
Rhinoplasty
TRAUMA   
Gunshot Wounds
MVA
Traumatic Amputations
TRANSPLANTS 
Harvest Organs
Heart
Kidney
Liver
Lung
PEDIATRICS 
Abdominal Procedures
Neonatal Procedures
Open Heart
Orthopedic Procedures
Plastics
Thoracotomy
EQUIPMENT 
Ceiling Mount Microscope
Doppler
Electrosurgery Unit
Endoscopy Scopes
Fracture Table
High Flow Insuflator
Intra Aortic Balloon Pump
Laser
Nerve Stimulators
Pacemakers
Portable Microscope
Ventilators
Anesthesia Equipment
Cardiac Monitors
Infusion Pumps
Drills/Saws
Tourniquet
Midas Rex



Certification
Expiration Date
Certification
Expiration Date
ACLS
Other  
BLS
Other  
CEN
Other  
PALS
Other  


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