Requested by *Recruiter Email ID *First Name *Last Name *Phone Number *Today's Date *Your Email Address *GENERAL SKILLS: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 *012345Patient/family teaching *012345Restrictive devices (restraints) *012345Lift/transfer devices *012345Specialty beds *012345End of life care/palliative care *012345Automated Medication Dispensing System, Pyxis, Omnicell, or other *012345Bar coding for medication administration *012345Checks & marks distal pulses *012345Performs allen test *012345MEDICATION 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 * Emergency meds (ACLS) *012345Antiarrthymics *012345Antibiotics *012345Antihistamines *012345Beta blockers *012345Nitrates *012345Vasopressors *012345Thrombolytics *012345Contrast medium *012345PRE-PROCEDURE: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 * Completion of pre-procedure checklist *012345Skin prep & shave *012345Lead placements *012345Time Out Protocol *012345POST-PROCEDURE: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 * Monitoring (procedure specific & documentation) *012345Sedation recovery scale (facility specific) *012345Maintain & monitor A/V sheaths *012345Set up & maintain arterial catheters *012345Set up & maintain Swanz Ganz catheter *012345GENERAL 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 * Obtain & monitor ACT *012345Removal of A/V sheaths *012345Manual pressure hold *012345Application & monitoring of vascular closure devices *012345Assists with IABP insertion *012345Manages IABP *012345Radiation safety *012345National Patient Safety Goals *012345Accurate patient identification *012345Effective communication *012345Interpretation & communication of lab values *012345Medication administration *012345Labeling *012345Anticoagulation therapy *012345Reconciliation *012345Monitoring conscious sedation *012345Pain assessment & management *012345Use of PCA (IV, intrathecal, epidural) *012345Infection control *012345Universal precautions *012345Isolation *012345Minimize risk for falls *012345Prevention of pressure ulcers *012345Wound care *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 * Obtains 12 lead EKG *012345Interpretation of rhythm strips *012345Treatment of dysrythmias *012345Use of rapid response teams *012345Cardiac arrest/CPR *012345O2 therapy & delivery *012345Ventilator management *012345Pulse oximetry *012345Use of doppler *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 *012345Blood draw: venous *012345Central line care *012345Blood draw: central line *012345GENERAL SKILLS - CONT 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 * Care & management of ports *012345Care & management of PICC / Groshong / Hickman *012345TPN & lipids *012345Administration of blood/blood products *012345Administration of chemotherapy *012345Monitoring chemotherapy (does not initiate) *012345Endometriosis *012345OTHER: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 * Diabetes mellitus *012345Blood Glucose Monitoring (BGM) *012345Insulin administration *012345Awareness of HCAHPS *012345INTERVENTIONAL RADIOLOGY (RN) 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 * Circulates for interventional procedures *012345Scrubs for interventional procedures *012345Angiogram / aortogram *012345Angioplasty *012345Vascular stenting *012345Declotting *012345Embolization *012345TIPS *012345Port placement *012345Dialysis catheter placement *012345Retrieval of foreign body *012345UAE (Uterine Arterial Embolization) *012345EVLT (Endovascular Laser Therapy) *012345Vertebro / kyphoplasty *012345Neuroradiology *012345Discogram *012345AGE-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) *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