Registered Nurse First Assist (RNFA) Skills Checklist

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GENERAL SKILLS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Advanced directives	123
Patient / family teaching	123
Restrictive devices (restraints)	123
Lift / transfer devices	123
Specialty beds	123
End of life care / palliative care	123
Wound assessment & care	123
Automated Medication Dispensing System, Pyxis, Omnicell, or other	123
Bar coding for medication administration	123
Diabetic care and education	123
Blood Glucose Monitor (BGM)	123
Cardioversion / defibrillation	123
Electronic ICU	123
National Patient Safety Goals	123
Accurate patient identification	123
Effective communication	123
Interpretation & communication of lab values	123
Medication administration	123
Medication reconciliation	123
Labeling (medications & specimens)	123
Anticoagulation therapy	123
Monitoring conscious sedation	123
Pain assessment & management	123
Infection control	123
Universal precautions	123
Isolation	123
Minimize risk for falls	123
Prevention of pressure ulcers	123
Use of rapid response teams	123
Awareness of HCAHPS	123

GENERAL SKILLS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Cardiac arrest/adult CPR infant-child CPR	123
Advanced directives	123
Awareness of HCAHPS	123
Patient/family teaching	123
Lift/transfer devices	123
Specialty beds	123
Restrictive devices	123
End of life care/palliative care	123
Automated Medication Dispensing System, Pyxis, Omnicell, or other	123
Bar coding for medication administration	123
Diabetic management in the OR	123
National Patient Safety Goals	123
Accurate patient identifcation/surgical site verfcation with OR team	123
Effective communication	123
Interpretation & timely communication of lab values	123
Labeling (medications & specimens)	123
Medication reconciliation	123
Anticoagulant therapy	123
Monitoring conscious sedation	123
MDRO HAI	123
Hand hygiene WHO/CDC	123
CLABSI infections	123
CAUTI prevention	123
Identify patient suicide risk	123
Universal protocol	123
Surg site infection control	123

GENERAL SURGERY:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Bowel resection	123
Cholecystectomy/cholangiogram	123
Colostomy/ileostomy 0 1 2 3 4 5	123
Gastrectomy	123
Hemicolectomy	123
Hepatic resection	123
Herniorrhaphy-femoral/inguinal	123
Hiatal herniorrhaphy	123
Pancreatectomy	123
Organ procurement	123
Radical mastectomy	123
Saphenous vein ligation/stripping	123
Splenectomy	123
Thyroidectomy	123
Tracheostomy	123
Vagotomy	123
Familiarity with pediatric procedures	123
Abdominal perineal resection	123
Adrenalectomy bariatric surgery (gastric bypass)	123

ENDOSCOPY:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Bronchoscopy	123
Colonoscopy	123
Culdoscopy	123
Cystoscopy	123
Esophagoscopy	123
Gastroscopy	123
Hysteroscopy	123

GYNECOLOGY:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Caesarean section	123
Dilation & curettage	123
Hysterectomy - vaginal	123
Hysterectomy - abdominal	123
Radium insertion	123
Salpingo-oopherectomy	123
Shirodkar procedure	123
Termination of pregnancy	123
Tubal ligation	123
Vaginectomy	123

LAPAROSCOPIC PROCEDURES:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Appendectomy	123
Cholecystectomy	123
Colon resection	123
Gastric bypass	123
Hernia repair	123
Nephrectomy	123
Prostatectomy	123
Sinus surgery	123
Salpingo-oophorectomy	123
Splenectomy	123
Tubal ligation	123
Vaginal hysterectomy	123
Laryngoscopy	123
Mediastinoscopy	123
Pelviscopy	123
Sigmoidoscopy	123
Thoracoscopy	123
Whipple	123
Nissen fundoplication	123

ORTHOPEDIC:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Achilles tendon repair	123
Amputation	123
Arthroscopy/anthrotomy	123
Closed pinning & reduction of extremities	123
External compression devices	123
Hip compression nails & lag screws	123
Total joint replacement - knee	123
Total joint replacement - hip	123
Total joint replacement - shoulder	123
Spica cast	123
ORIF - shoulder, hip, humerus	123
Repair of dislocation	123
Patellectomy	123
Tendon implants & reanastomosis	123

UROLOGY:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Circumcision	123
Cystoscopy/ureteroscopy	123
Cystectomy	123
Hypospadias repair	123
Implants	123
Lithotripsy	123
Nephrectomy	123
Orchiectomy	123
Prostatectomy	123
Ureterolithotomy	123
TURP	123
PVP - Photo Vaporization of Prostate	123
Vasectomy	123

NEUROLOGY:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Kyphoplasty	123
A-V malformation	123
Laparoscopic spine procedures	123
Burr holes for subdural hematoma	123
Carotid ligation	123
Cervical sympathectomy	123
Cranioplasty	123
Craniotomy	123
Disectomy/laminectomy	123
Halo traction application	123
Insertion of nerve stimulator	123
Myelomeningocele repair	123
Shunt procedure	123
Spinal fusions	123
Ventriculostomy	123

PLASTICS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Abdominal lipectomy	123
Blepharoplasty	123
Face lift	123
Mammoplasty	123
Augmentation	123
Reduction	123
Liposuction	123
Otoplasty	123
Scar revisions	123
Skin grafting	123

OPTHOMOLOGY:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Cataract extraction	123
IOL implants	123
Corneal transplant	123
Orbital implant	123
Enucleation	123
Repair of retinal detachment	123
Scleral buckle	123

EAR, NOSE & THROAT:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Caldwell-luc	123
Cleft lip/palate repair	123
Laryngectomy	123
Radical neck	123
Tonsillectomy & adenoidectomy	123
Mandibulectomy	123
Mastoidectomy	123
Rhinoplasty/septoplasty	123
Sinusotomy	123

VASCULAR:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Angiography	123
A-V access graft	123
Aortic aneurysm: abdominal	123
Peripheral vascular bypass procedures	123
Endarterectomy: carotid	123
Thrombectomy	123
Embolectomy	123
Vena cava ligation	123

ENDOVASCULAR:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Endoluminal AAA	123
Carotid revascularization endarterectomy	123
Cerebral aneurysm repair	123

TRANSPLANT:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Bone	123
Corneal	123
Harvesting	123
Heart/lung	123
Kidney	123
Liver	123
Multi organ	123
Pancreas	123
Skin	123

THORACIC/CARDIOVASCULAR:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Aortic femoral bypass graft	123
Femoral popliteal bypass	123
Pacemaker implantation/explanation	123
Care of patients with pacemaker	123
Care of patients with intra-aortic balloon pump	123
Septal defects, ASV, VSD	123
Coronary Artery Bypass & Graft (CABG) on pump	123
Valve replacement/repair	123
Aortic aneurysm	123
Thoracotomy/lobectomy	123
Endoscopic vein harvesting	123
Maze procedure	123

TRAUMA:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Burns	123
Gunshot/stab wounds	123
Motor vehicle accidents	123
Traumatic amputations	123

EQUIPMENT:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Argon beam coagulator	123
Camera/video systems	123
Cell saver	123
Cidex soak	123
Cryo-ophthalmic unit	123
Cavitron Ultrasonic Surgical Aspirator (CUSA)	123
Hypo/hyperthermia unit	123
Drill and saws	123
Electrosurgical unit	123
Fiber optic luminator	123
Cavitron	123
Autoclave	123
Fracture tables	123
Harmonic scalpel	123
Ligasure	123
Stapling devices	123
Mesh graft/dermatone	123
Microscopes	123
Nitrogen tank	123
Pneumatic tourniquet	123
Stealth	123
Steris unit	123
Pulsevac irrigation	123
Autotransfusion system	123
Laser equipment	123
Care of scopes & fberoptic equipment	123
Venodyne robotics (Da Vinci)	123

PROCEDURAL SKILLS (In Collaboration with Team/Surgeon):

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Position patient	123
Surgical draping	123
Creates sterile field	123
Maintains sterile field	123
Provides wound exposure	123
Use of instruments	123
Use of retractors	123
Suctioning and sponging techniques	123
Use of medical devices	123
Use of medications/solutions	123
Clamping blood vessels	123
Coagulating bleeding points	123
Ligating vessels	123
Other procedures in collaboration with surgeon	123
Safe tissue handling	123
Safe cutting of tissue	123
Suturing muscle	123
Suturing fascia	123
Suturing subcutaneous tissue	123
Suturing skin tissue	123
Assist with dressings/drains	123
Placing drains	123
Assist with cannulation	123
Assist with decannulation	123
Knot tying	123
Assists: SC local anesthesia	123
Preop nursing assessment	123
Periop nursing assessment	123
Write preop orders per hospital protocol	123
Environmental sanitation	123
Monitors surgical environment	123
Controls surgical environment	123
Working knowledge of equipment	123
Laser safety	123
Working knowledge of supplies	123
Sponge, needle, instrument count	123
Write post-op protocol orders per hospital protocol	123
Write opperative notes per hospital protocol	123
Participate in postop rounds & D/C planning	123
Electrosurgery experience	123
Recognize & intervene for safety hazards	123

AGE-SPECIFIC COMPETENCIES EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Newborn/neonate (birth-30 days)	123
Infant (31 days- 1 year)	123
Toddler (ages 2-3 yrs)	123
Preschool (ages 4-5 yrs)	123
School Age (ages 6-12 yrs)	123
Adolescent (ages 13-21 yrs)	123
Young Adult (ages 22-39)	123
Adult (ages 40-64)	123
Older Adult (ages 65+)	123

Attestation

ATTESTATION: *

I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *