PICU – unizon

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 *

Experience in level III nursing *

Awareness of HCAHPS *

Setting: Childrens hospital *

Setting: University healthcare facility *

Setting: High risk delivery center *

Setting: Community hospital *

Family teaching *

Consents *

Specialty beds: giraffe incubator *

Specialty beds: radiant warmer bed *

Restrictive devices (restraints) *

Preparation for transport/transfer *

Air transport (jet or helicopter) *

Other transport experience: stable return transport *

Other transport experience: procedural transport *

End of life care/palliative care *

Wound assessment & care *

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

Bar coding for medication administration *

Blood Glucose Monitoring (BGM) *

Insulin/dextrose administration *

National Patient Safety Goals *

Accurate patient identification *

Effective communication *

Interpretation & communication of lab values *

Medication administration *

Infant dosage calculations *

Delivery methods: IM/IV/SQ *

Medication reconciliation *

Labeling (medications & specimens) *

Anticoagulation therapy *

Steroids (inhaled/IV/PO) *

Monitoring conscious sedation *

Pain assessment & management *

Infection control *

Universal precautions *

Isolation *

Minimize risk falls *

Skin assessment *

Prevention of pressure ulcers *

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 *

Blood draw: heel stick/venous *

Central venous insertion & management *

Blood draw: central line *

Maintain umbilical catheter (arterial/venous) *

TPN administration *

Administration of blood & blood products *

Infusion pumps *

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 *

Invasive hemodynamic monitoring *

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 *

Use of S.T.A.B.L.E. program & protocols *

Broslow system *

EKG interpretation & treatment *

Use of rapid response teams *

Defibrillation/cardioversion *

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 *

CHF *

Hemodynamic instability *

Hypovolemic shock *

Post cardiac surgery *

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 *

Antihypertensives *

Cardiac glycoside (digoxin) *

Platelet inhibitors (aggrastat/integrillin/reopro) *

Vasoactive agents *

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 *

Obtain & interpret blood gases *

Airway management (nasal/oral/ET) *

Tracheostomy care & management *

Oxygen therapy (NC/oxyhood) *

Pulse oximeter *

Ventilation & management *

High Frequency Jet Vent (HFJV) *

Partial liquid ventilation *

Nitric oxide therapy *

Surfactant therapy *

ECMO *

Assist with & manage chest tube *

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 *

Bronchopulmonary Dysplasia (BPD) *

Diaphragmatic hernia *

MAS (Meconium Aspiration Syndrome) *

Pulmonary edema *

Persistent Pulmonary Hypertension (PPHN) *

Respiratory Distress Syndrome (RDS) *

Pneumothorax *

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 *

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 *

Drug withdrawal & abstinence scoring *

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 *

Meningitis *

External VP shunt/reservoirs *

ICP monitoring *

Spinal disorders *

Neurological development & positioning *

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 *

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) *

Nutritional assessment *

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 *

Breastmilk handling & storage *

Gavage *

Placement of OGT/NGT *

Colostomy/ileostomy care *

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) *

Cleft lip/palate *

Necrotizing Entercolitios (NEC) *

Gastroenteritis/omphaloocele *

Inguinal hernia *

Post abdominal surgery *

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 *

Peritoneal dialysis *

Assist with circumcision *

Post circumcision care *

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 *

Malformations of GU tract *

Hydronephrosis *

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 *

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 *

HIV positive mother *

HBsAg positive mother *

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 *

Anti-infectives *

Respigam/synergis prophylaxis *

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 *

APGAR scoring *

Gestational age *

Eye exam *

Hearing screen *

Thermoregulation *

Care of infant under phototherapy *

Experience in level II nursery *

Experience in level III nursery *

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) *

Neonatal (24-28 weeks) *

Neonatal (29-32 weeks) *

Neonatal (>33 weeks) *

Infant (31 days-1 year) *

Toddler (ages 2-3 years) *