Requested by *Recruiter Email ID *First Name *Last Name *Phone Number *Today's Date *Your Email Address *GENERAL SKILLS EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Experience in level II nursing *012345(0/5)Experience in level III nursing *012345(0/5)Awareness of HCAHPS *012345(0/5)Setting: Childrens hospital *012345(0/5)Setting: University healthcare facility *012345(0/5)Setting: High risk delivery center *012345(0/5)Setting: Community hospital *012345(0/5)Family teaching *012345(0/5)Consents *012345(0/5)Specialty beds: giraffe incubator *012345(0/5)Specialty beds: radiant warmer bed *012345(0/5)Restrictive devices (restraints) *012345(0/5)Preparation for transport/transfer *012345(0/5)Air transport (jet or helicopter) *012345(0/5)Other transport experience: stable return transport *012345(0/5)Other transport experience: procedural transport *012345(0/5)Automated Medication Dispensing System, Pyxis, Omnicell, or other *012345(0/5)Wound assessment & care *012345(0/5)Automated Medication Dispensing System, Pyxis, Omnicell, or other *012345(0/5)Bar coding for medication administration *012345(0/5)Blood Glucose Monitoring (BGM) *012345(0/5)Insulin/dextrose administration *012345(0/5)National Patient Safety Goals *012345(0/5)Accurate patient identification *012345(0/5)Effective communication *012345(0/5)Interpretation & communication of lab values *012345(0/5)Medication administration *012345(0/5)Infant dosage calculations *012345(0/5)Delivery methods: IM/IV/SQ *012345(0/5)Medication reconciliation *012345(0/5)Labeling (medications & specimens) *012345(0/5)Anticoagulation therapy *012345(0/5)Steroids (inhaled/IV/PO) *012345(0/5)Monitoring conscious sedation *012345(0/5)Pain assessment & management *012345(0/5)Infection control *012345(0/5)Universal precautions *012345(0/5)Isolation *012345(0/5)Minimize risk falls *012345(0/5)Skin assessment *012345(0/5)Prevention of pressure ulcers *012345(0/5)Pericardial Window *012345(0/5)IV THERAPY EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Starting & maintaining IVs *012345(0/5)Blood draw: heel stick/venous *012345(0/5)Central venous insertion & management *012345(0/5)Blood draw: central line *012345(0/5)Maintain umbilical catheter (arterial/venous) *012345(0/5)TPN administration *012345(0/5)Administration of blood & blood products *012345(0/5)Infusion pumps *012345(0/5)CARDIOVASCULAR EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * CV assessment *012345(0/5)Invasive hemodynamic monitoring *012345(0/5)CARDIAC MONITORING & EMERGENCY CARE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * NRP protocols & medication *012345(0/5)Use of S.T.A.B.L.E. program & protocols *012345(0/5)Broslow system *012345(0/5)EKG interpretation & treatment *012345(0/5)Use of rapid response teams *012345(0/5)Defibrillation/cardioversion *012345(0/5)CARE OF INFANT WITH:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Congenital heart disease *012345(0/5)CHF *012345(0/5)Hemodynamic instability *012345(0/5)Hypovolemic shock *012345(0/5)Post cardiac surgery *012345(0/5)MEDICATION ADMINISTRATION:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Antidysrythmics *012345(0/5)Antihypertensives *012345(0/5)Cardiac glycoside (digoxin) *012345(0/5)Platelet inhibitors (aggrastat/integrillin/reopro) *012345(0/5)Vasoactive agents *012345(0/5)PULMONARY EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Respiratory Assessment *012345(0/5)Obtain & interpret blood gases *012345(0/5)Airway management (nasal/oral/ET) *012345(0/5)Tracheostomy care & management *012345(0/5)Oxygen therapy (NC/oxyhood) *012345(0/5)Pulse oximeter *012345(0/5)Ventilation & management *012345(0/5)High Frequency Jet Vent (HFJV) *012345(0/5)Partial liquid ventilation *012345(0/5)Nitric oxide therapy *012345(0/5)Surfactant therapy *012345(0/5)ECMO *012345(0/5)Assist with & manage chest tube *012345(0/5)CARE OF CHILD WITH:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Apnea *012345(0/5)Bronchopulmonary Dysplasia (BPD) *012345(0/5)Diaphragmatic hernia *012345(0/5)MAS (Meconium Aspiration Syndrome) *012345(0/5)Pulmonary edema *012345(0/5)Persistent Pulmonary Hypertension (PPHN) *012345(0/5)Respiratory Distress Syndrome (RDS) *012345(0/5)Pneumothorax *012345(0/5)MEDICATION ADMINISTRATION:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Bronchodilators *012345(0/5)NEUROLOGICAL EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Neurological assessment *012345(0/5)Drug withdrawal & abstinence scoring *012345(0/5)CARE OF INFANT WITH:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Seizures *012345(0/5)Meningitis *012345(0/5)External VP shunt/reservoirs *012345(0/5)ICP monitoring *012345(0/5)Spinal disorders *012345(0/5)Neurological development & positioning *012345(0/5)MEDICATIONS:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Anticonvulsants *012345(0/5)GASTROINTESTINAL EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * GI assessment (include palate & girth) *012345(0/5)Nutritional assessment *012345(0/5)FEEDINGS:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Assist with breast/bottle feeding *012345(0/5)Breastmilk handling & storage *012345(0/5)Gavage *012345(0/5)Placement of OGT/NGT *012345(0/5)Gastrostomy tubes *012345(0/5)Colostomy/ileostomy care *012345(0/5)CARE OF INFANT WITH:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Tracheoesophogeal fistula (TEF) *012345(0/5)Cleft lip/palate *012345(0/5)Necrotizing Entercolitios (NEC) *012345(0/5)Gastroenteritis/omphaloocele *012345(0/5)Inguinal hernia *012345(0/5)Post abdominal surgery *012345(0/5)RENAL/GU EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Urinary catheter insertion & management *012345(0/5)Peritoneal dialysis *012345(0/5)Assist with circumcision *012345(0/5)Post circumcision care *012345(0/5)CARE OF INFANT WITH:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Acute renal failure *012345(0/5)Malformations of GU tract *012345(0/5)Hydronephrosis *012345(0/5)INFECTIOUS DISEASES EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Assist with lumbar puncture *012345(0/5)CARE OF INFANT WITH:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Neonatal sepsis *012345(0/5)HIV positive mother *012345(0/5)HBsAg positive mother *012345(0/5)MEDICATION:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Immunizations *012345(0/5)Anti-infectives *012345(0/5)Respigam/synergis prophylaxis *012345(0/5)ADMISSION/ASSESSMENT EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Attending high risk deliveries *012345(0/5)APGAR scoring *012345(0/5)Gestational age *012345(0/5)Eye exam *012345(0/5)Hearing screen *012345(0/5)Thermoregulation *012345(0/5)Care of infant under phototherapy *012345(0/5)Experience in level II nursery *012345(0/5)Experience in level III nursery *012345(0/5)AGE-SPECIFIC COMPETENCIES EXPERIENCE:Rank each of the following sections on a scale of 1 to 3: Limited or no experience Experienced, but may need review or supervision Able to function independently * Neonatal (< 23 weeks) *012345(0/5)Neonatal (24-28 weeks) *012345(0/5)Neonatal (29-32 weeks) *012345(0/5)Neonatal (>33 weeks) *012345(0/5)Elderly (ages 80+ years) *012345(0/5)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. *Request Quote