Clinic / Urgent Care RN / Primary Care

Requested by *

Recruiter Email ID *

First Name *

Last Name *

Phone Number *

Today's Date *

Your Email Address *

WORK SETTING 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 *

Patient/family teaching *

National Patient Safety Goals *

Awareness of HCAHPS scores *

Automated Medication Dispensing System (Pyxis, Omnicell etc) *

Triage *

Lift/transfer devices *

Bar Coding for medication administration *

Computerized Charting *

AMA Procedures *

Labeling of lab specimens *

Electronic Medical Record *

Interpretation of lab values *

Wound care *

Isolation *

Reconciliation *

Prevention of pressure ulcers *

Universal Precautions *

Accurate Patient identification *

Fall Risks *

Wound vacs *

IV 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 *

Blood Draw: venous *

Blood Draw: ABG’s *

Care & Management of Port *

Care & Management of PICC, Groshong, Hickman *

TPN Lipids *

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 *

Obtain 12 lead EKG *

Interpretation of rhythm strips *

Treatment of dysrhythmias *

Interpretation of (cardiac enzymes, Troponin, BNP) *

Cardiac arrest/CPR/AED *

Oxygen therapy and delivery *

Pulse oximetry *

Use of doppler *

Defibrillation *

External Pacer *

CARDIOVASCULAR ASSESSMENT:

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 *

Auscultation/Irregular Heart Sounds *

Peripheral Edema *

PQRST Assessment *

CARE 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 *

Aneurysm *

Angina *

Angioplasty (pre/post) *

Arrhythmias *

Chest Tubes *

CHF *

Carotid Endarterectomy *

Post MI *

Pre/Post heart catherization *

Pre/Post cardiac surgery *

USE & 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 *

Anti-arrhythmic *

Antihypertensives *

Beta Blocker *

Diuretics *

Fibrinolytics *

Nitrates *

Nitroglycerin *

Pacemaker Insertion *

Arterial Stenting *

Morphine *

Epinephrine, Atropine, Anti-Arrhythmic *

RESPIRATORY 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 abnormal breath sounds (wheezing, stridor, crackles) *

Abnormal breathing patterns (rapid, labored,) *

Oral suctioning *

Nasotracheal suctioning *

Interpretation of labs/tests (abg’s, pulse oximetry) *

Tracheostomy care *

CARE 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 *

Aspiration *

Asthma/Reactive Airway Disease *

COPD *

Pneumonia *

Pulmonary Embolism *

Pulmonary Edema *

Oxygen therapy *

Manual resuscitation (AMBU bag, MRB) *

Metered Dose inhaler (MDI) *

Nebulizers *

Pneumothorax *

Inhalation injuries *

Tuberculosis *

Emphysema *

Thyroidectomy *

USE & 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 *

Diuretics *

Expectorants *

Steroids *

GYNECOLOGY KNOWLEDGE GENERAL SKILLS/CARE 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 *

Abnormal uterine bleeding *

Assist with cultures *

Doppler/ Fetal Heart Tones *

Ectopic Pregnancy *

endometriosis *

Gyn exam/ pap *

Pelvic Inflammatory Disease *

Pregnancy Induced Hypertension *

Post hysterectomy care *

Hemorrhage *

Vaginal bleeding *

Pelvic Tray *

NEUROLOGY:

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 *

CVA *

Altered level of consciousness *

Glasgow coma scale *

overdose *

Traumatic brain injury *

Delirium tremors *

Neuromuscular diseases *

Head Injury *

Meningitis *

Spinal Cord Injury *

Seizure Disorders *

USE & 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 *

Steroids *

Spine immobilization *

Cervical collar *

Seizure precautions *

Assist with lumbar puncture *

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 *

Assessment of bowel sounds/distention *

Nutritional state *

Interpretation of labs and electrolyte balance *

CARE 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 *

Ostomy/colostomy *

diarrhea *

Management of PEG tube/tube feeds *

Constipation/impaction *

Hepatitis *

Insertion of Ng tube *

pancreatitis *

enemas *

Nausea/vomiting *

Paralytic ileus *

USE & 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 *

Activated charcoal *

Antiemetics *

Antispasmodics *

Anticholinergics *

IV fluids *

Ipecac *

laxatives *

GENITOURINARY/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 *

Catheter insertion/exchange *

GU irrigation *

Suprapubic tube maintenance *

Kidney failure (acute/chronic) *

Fluid status *

CARE 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 *

Obstruction *

Kidney stones *

Renal trauma *

Pyelonephritis/UTI *

Priapism *

Testicular torsion *

Urine retention *

ORTHOPEDIC 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 Range of Motion *

Assessment of color, warmth, movement, sensation *

Assist in reduction of dislocation *

Cast Care *

Fracture *

Splints *

Traction *

Amputation *

Ortho Trauma *

Sprain/Strain *

Immobilization *

METABOLIC/ENDOCRINE 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 *

Interpretation of labs *

Hyperglycemia *

Hypoglycemia *

Blood glucose *

Ketones in urine *

Diabetic ketoacidosis *

Hyperosmolar Hyperglycemia *

USE & 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 *

POC Blood glucose monitoring *

Dextrose *

Insulin short acting *

Oral Hypoglycemic medications *

Insulin Long acting *

EENT 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 *

Visual Acuity *

Hearing Acuity *

Epistaxis *

Enlarged tonsils *

Ear irrigation *

Eye irrigation *

Nasal foreign body *

Eye foreign body *

Ears foreign body *

PSYCHIATRIC 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 *

Mental Status/Behavior *

Anxiety/Depression *

De-escalation techniques for violent behavior *

ETOH withdrawal *

Substance abuse over dose *

Suicide ideation *

Restraints *

Antipsychotics *

Psychiatric Hold *

Antidepressants *

INFECTIOUS/COMMUNICABLE DISEASE 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 *

Infectious Disease *

Isolation Precautions *

Use of PPE *

Handwashing *

Immunosuppression/Neutropenic *

OTHER 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 *

Acts of violence *

Hazardous exposure *

Disaster management *

bites *

Burn care *

lacerations *

Assist w/ Sutures/staples *

WORK SETTING 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 *

Hospital *

Clinic *

Urgent care *

AGE-SPECIFIC 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) *

Infant (31 days-1 year) *

Toddler (ages 2-3 years) *

Preschool (ages 4-5 years) *

School age (ages 6-12 years) *

Adolescent (ages 13-21 years) *

Young adult (ages 22-39 years) *

Adult (ages 40-64 years) *

Older adult (ages 65-79 years) *

Elderly (ages 80+ years) *