Intensive / Critical Care

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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 *

Inpatient Acute Care Facility *

Trauma Center *

Academic/Teaching Facility *

Outpatient Care Facility *

Long term care/Skilled Nursing *

Clinic/Ambulatory *

Home Health Setting *

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 *

Patient / family teaching *

Restrictive devices (restraints) *

Lift / transfer devices *

Specialty beds *

End of life care / palliative care *

Wound assessment & care *

Automated Medication Dispensing System, Pyxis, Omnicell, or other *

Bar coding for medication administration *

Diabetic care and education *

Blood Glucose Monitor (BGM) *

Cardioversion / defibrillation *

Electronic ICU *

National Patient Safety Goals *

Accurate patient identification *

Effective communication *

Interpretation & communication of lab values *

Medication administration *

Medication reconciliation *

Labeling (medications & specimens) *

Anticoagulation therapy *

Monitoring conscious sedation *

Pain assessment & management *

Infection control *

Universal precautions *

Isolation *

Minimize risk for falls *

Prevention of pressure ulcers *

Use of rapid response teams *

Awareness of HCAHPS *

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 *

Assessment of heart sounds *

Interpretation of arrhythmias *

Performing 12 lead EKG’s *

Interpretation of 12 lead EKG *

Interpretation of hemodynamic monitoring *

ASSIST WITH INSERTION & MANAGEMENT OF:

Rank each of the following sections on a scale of 1 to 5:

Limited or no experience
Experienced, but may need review or supervision
Able to function independently *

CVC (Central Venous Catheter) *

Arterial line *

Swanz Ganz catheter *

Flow trac or Vigileo monitoring caths *

Intra-Aortic Balloon Pump (IABP) *

Ventricular Assist Device (LVAD, RVAD) *

MAINTENANCE & MANAGEMENT OF:

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 *

Permanent pacemakers *

Implantable Cardioverter Defibrillator (ICD) *

External pacemakers *

Epicardial pacemaker wires *

Discontinuing venous / arterial sheaths *

Femostop / vasoseal *

CARE OF PATIENTS 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 myocardial infarction *

Pre / post: cardiac catheterization *

Congestive heart failure *

Cardiomyopathy *

Dysrhythmias / conduction disturbances *

Aortic aneurysm *

Thoracic / abdominal surgery *

Endoluminal graft *

Cardiogenic shock *

Hypertensive crisis *

Pericarditis / endocarditis *

MAZE procedure *

Post open heart (CABG / valve) *

Cardiac contusion / trauma *

Heart transplant *

Cardiac tamponade *

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 *

ACLS medications and protocols *

Antidysrhythmics *

Antihypertensives *

Vasoactive / vasopressor agents *

Anesthetics (propofol / precedex) *

Thrombolytics (retavase / activase) *

Platelet inhibitors (ReoPro / Integrilin / Aggrastat) *

Flolan for pulmonary hypertension *

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 *

Assessment of breath sounds *

AIRWAY MANAGEMENT, CARE & MAINTENANCE OF:

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 *

Oral / NT / ET airway *

Tracheostomy *

Arterial blood gas analysis / interpretation *

Obtaining ABG blood sample / arterial line *

Pulse oximetry *

VENTILATOR MANAGEMENT:

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 *

BiPAP (Bi-level Positive Airway Pressure) *

Oscillation / high-frequency ventilation *

Nitric *

Interpretation of weaning parameters *

Maintenance & management of pleural chest tubes *

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 *

Acute respiratory failure *

Adult Respiratory Distress Syndrome (ARDS) *

Sudden Inflammation Respiratory Syndrome (SIRS) *

Inhalation injuries *

Pneumonia *

Pulmonary edema *

Near drowning *

Chronic Obstructive Pulmonary Disease (COPD) *

Pre / post thoracic surgery *

Pulmonary embolism *

Pulmonary / chest trauma *

Pulmonary hypertension *

Status asthmaticus *

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 *

Rapid sequence intubation drugs / protocols *

Nebulizer treatments: Ventolin, Atrovent *

NEUROLOGY 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 *

Cranial nerve assessment *

Glasgow coma scale *

NIH stroke scale *

NIH stroke certification *

Seizure precautions *

Skeletal traction *

Cervical spine precautions / logroll positioning *

Halo vest/halo traction *

Monitoring of neuromuscular blocking agents / paralytics *

Assist with lumbar puncture *

INTRACRANIAL/CEREBRAL PERFUSION PRESSURE MONITORING VIA:

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 *

Ventriculostomy *

Subarachnoid screw / bolt *

CARE OF PATIENTS 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 *

Lumbar drains *

Cerebral aneurysm *

Subarachnoid hemorrhage *

Status epilepticus *

TBI (Traumatic Brain Injury *

Spinal cord injury *

CerebroVascular Accident (CVA) *

Pre / post cranial surgery *

Meningitis *

Myasthenia gravis *

Clipping and/ or coilings of aneurysms *

Pituitary Tum *

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 *

Steroids: Decadron, Solu-Medrol *

Anticonvulsants: Dilantin, phenobarbital *

Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium *

Mannitol *

Antipsychotics: Haldol *

TRAUMA & BURNS 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 *

Mass casualty *

Electrocution *

Amputation *

Gangrene *

Multiple fractures *

Thermo-regulation: hypothermia / hyperthermia *

BURNS: CALCULATION OF TOTAL BODY SURFACE AREA (BSA):

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 *

Berdow Formula / "Rule of Nines" *

Lund and Browder chart *

Fluid resuscitation *

Care & management of burns *

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 *

Small bore feeding tube insertion (Dobhoff or Keofeed) *

Nasogastric tube insertion *

Post pyloric feeding tube insertion *

Gastric lavage *

Use of activated charcoal *

Maintenance of gastric / jejunostomy tube *

Stoma care *

Maintenance & management of enteral tube feedings *

Assisting / monitoring bedside procedures: endo / chest tubes / bronchs / trach insertion / PEG tubes *

CARE OF PATIENTS 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 *

Abdominal trauma *

Acute gastrointestinal hemorrhage *

Esophageal varices *

Balloon tamponade devices (i.e. Blakemore tube) *

Peritonitis *

Acute pancreatitis *

Bowel obstruction *

Liver / pancreas transplant *

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 *

Antiemetics: Reglan, Zofran *

H2 receptor antagonists *

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 *

Foley catheter insertion *

Suprapubic tube *

Nephrostomy tube *

Peritoneal dialysis *

Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT) *

Hemodialysis of the critically ill patient *

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 *

Acute renal failure *

Chronic renal failure *

AV fistulas, shunts & dialysis catheters *

Nephrectomy *

Renal transplant *

Renal / urinary tract trauma *

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 *

Diabetic Ketoacidosis (DKA) *

Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK) *

Diabetes Insipidus (DI) *

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) *

Administration & monitoring of insulin infusion *

Use of Endo tool *

INTRAVENOUS 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 *

Starting peripheral IV’s *

Care of patient with Peripherally-Inserted Central Catheter (PICC) *

Administration / monitoring of Total Parenteral Nutrition (TPN) *

Administration of blood / blood products *

Administration of narcotics / sedatives: (fentanyl, Valium, Ativan, Versed, morphine) *

Bispectral monitoring *

TELE-ICU (ICU-E) 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 *

Mentoring *

Communication *

Video assessment *

Utilize tele-ICU system *

Multi-tasking *

Troubleshoot equipment *

Giving directions over AV system *

Interpretation of data *

Critical thinking *

Diplomacy *

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 *

Drug or chemical overdose (TCA, ethanol, ASA) *

Poisoning (CO, cyanide) *

Substance abuse (ETOH, stimulants, narcotics) *

Human Immunodeficiency Virus (HIV) *

Disseminated Intravascular Coagulation (DIC) *

Multisystem Organ Dysfunction Syndrome (MODS) *

Anaphylaxis *

Septic shock *

Cancer *

Administration of chemotherapy *

Monitoring of chemotherapy (does not initiate) *

Hyperbaric oxygenation *

Organ / tissue donation procedures *

Suicide precautions *

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) *

Older adult (ages 65-79 years) *

Elderly (ages 80+ years) *