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 * Advanced directives *012345Cultural diversity *012345Patient teaching *012345Restrictive devices (restraints) *012345Ambulatory cuffs *012345End of life care/palliative care *012345Correctional admission & discharge *012345Correctional alarm systems *012345Automated Medication Dispensing System, Pyxis, Omnicell, or other *012345Diabetes mellitus *012345Blood Glucose Monitoring (BGM) *012345Insulin administration *012345National Patient Safety Goals *012345Accurate patient/inmate identification *012345Effective communication *012345Interpretation & communication of lab values *012345Medication administration *012345Labeling: obtain lab specimens *012345Anticoagulation therapy *012345Pain assessment & management *012345Infection control *012345Universal precautions *012345Isolation *012345Assist with treatment procedures *012345Wound care *012345IV THERAPY: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 peripheral IVs *012345Venous blood draw *012345CARDIAC 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 * Cardiac monitors *012345Interpretation of rhythm strips *012345Obtains 12 lead EKG *012345Treatment of dysrythmias *012345Cardiac arrest/CPR *012345O2 therapy & delivery *012345Pulse oximetry *012345Use of doppler *012345Assessment of heart sounds *012345Vascular assessment *012345Awareness of HCAHPS *012345CARE OF THE PATIENT 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 * Angina *012345CHF *012345Post MI *012345RESPIRATORY 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 * Assessment of breath sounds *012345Establishing an airway *012345Ambuing techniques *012345Suctioning *012345CARE OF PATIENT 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 * COPD *012345Pneumocystis *012345Pneumonia *012345Emphysema *012345Asthma *012345Tuberculosis *012345USE & ADMINISTRATION OF THE FOLLOWING: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 *012345Steroids *012345Expectorants *012345GYNECOLOGY 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 * Gyn exam/pap *012345Self breast exam *012345Ectopic pregnancy *012345Pelvic inflammatory disease *012345Endometriosis *012345NEUROLOGY 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 *012345Glasgow coma scale *012345Seizure precautions *012345Assist with lumbar puncture *012345CARE OF PATIENT 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 * Post CVA *012345TIA *012345Seizure activity *012345Head & spinal cord injury/trauma *012345Cranial hemorrhage *012345Delirium tremors *012345Neuromuscular diseases *012345USE & ADMINISTRATION OF THE FOLLOWING: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 * Antiepileptics *012345Steroids *012345PSYCHIATRIC DISORDERS 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 * Psych assessment *012345Suicide risk assessment *012345Suicide precautions *012345Major depression *012345Bipolar disorder (manic-depressive illness) *012345Anxiety disorders *012345Post Traumatic Stress Disorder (PTSD) *012345Psychotic disorders *012345Schizophrenia *012345Personality disorders *012345Antisocial *012345Passive / aggressive *012345Paranoia *012345Schizotypal personality disorder *012345Eating disorders *012345Anorexia nervosa *012345Bulemia nervosa *012345Pica *012345CRISIS MANAGEMENT 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 * Homicide *012345Suicide *012345Rape *012345Violent individual *012345SUBSTANCE USE/ABUSE 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 * Alcoholism *012345Alcohol withdrawal syndrome *012345Delirium Tremens (DTs) *012345Wernicke-Korsakoff syndrome *012345Drug use / abuse *012345Hallucinogenics *012345Opiates (heroin, morphine, oxycodone, codeine) *012345Stimulants (cocaine / amphetamines) *012345Benzodiaepams *012345CARE OF PATIENT 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 * Delusions *012345Hallucinations *012345Gastrointestinal Experience *012345GI assessment *012345NG tube insertion & management *012345Enterostomal care *012345CARE OF PATIENT 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 * Pancreatitis *012345Hepatitis *012345G.I. bleed *012345Esophageal bleeding *012345Bowel obstruction *012345USE & ADMINISTRATION OF THE FOLLOWING: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 * Anticholinergics (antispas, Bentyl or Robinul) *012345Cathartics *012345GENITOURINARY/RENAL 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 * AV shunt/fistula *012345Catheter insertion *012345GU irrigations *012345ORTHOPEDIC 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 * Splints *012345Cast care *012345Cast removal *012345Ortho trauma *012345OTHER 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 * Staple/suture removal *012345Oncology *012345Chemotherapy *012345Leadership skills (team leader or charge nurse) *012345Supervision of unlicensed assistive personnel *012345Post mortem care *012345Training in over familiarization with inmates *012345Training in potential/actual weapon recognition *012345AGE-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 * Newborn / neonate (birth-30 days) *012345Infant (31 days-1 year) *012345Toddler (ages 2-3 years) *012345Preschool (ages 4-5 years) *012345School age (ages 6-12 years) *012345Adolescent (ages 13-21 years) *012345Young adult (ages 22-39 years) *012345Adult (ages 40-64 years) *012345Older adult (ages 65-79 years) *012345Elderly (ages 80+ years) *012345Attestation * 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