Potential Strike - California
Submit Request
Stepdown / Burn Unit - RN
Requirements
:
California RN license
BLS
ACLS
PALS
ABLS (preferred)
Fire Card (preferred)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active California RN license?
No
Yes
RN license number:
*
RN license expiration date:
*
Do you have BLS certification?
*
No
Yes
Do you have ACLS certification?
*
No
Yes
Do you have a PALS certification?
*
No
Yes
If you are certified for Burns, which certification do you have?
List any other certification you have:
*
What specialties do you float to?
*
Do you have the COVID Vaccination?
*
No - Requesting Exemption
Yes - Vaccinated
Yes - Vaccinated with Booster
Typically for strike assignments: 5x12/hr shifts (60/hrs week) Are you ok with this?
*
No
Yes
Do you have Charge RN experience within the last two years?
*
No
Yes
Can you work a Day shift?
*
No
Yes
Can you work a Mid shift?
*
No
Yes
Can you work a Night shift?
*
No
Yes
What is your Primary Shift preference?
*
Day
Mid
Night
100% Flexible
How many years Stepdown experience do you have?
*
None
6 Months or less
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
More than 10 Years
How much recent experience do you have with wound care?
*
None
Past Month
Past 3 Months
Past 6 Months
Past Year
Over a year ago
Have you worked a Stepdown/Intermediate Care assignment in the past year?
*
No
Yes
What Facility have you worked Stepdown most recently?
*
What type of unit do you typically work in?
MS
MS Tele
Tele
Stepdown
PCU
IMC
Can you care for maintenance drips?
*
No
Yes
If yes, which maintenance drips?
Can you titrate drips?
*
No
Yes
If yes, which drips can you titrate?
Can you take care of post Cath patients?
*
No
Yes
If yes, can you pull an arterial sheath?
*
No
Yes
If yes, Can you manage a TR band?
*
No
Yes
How much experience do you have with post open heart patients?
*
None
Minimal
Regularly
Daily
Can you independently care for TAVR patients?
*
No
Yes
Can you work comfortably and with minimal supervision in a trauma unit?
*
No
Yes
Can you care for a patient with a chest tube?
*
No
Yes
Can you care for a patient with Pacer Wires?
*
No
Yes
Do you have current wound vac experience?
*
No
Yes
Do you access ports?
*
No
Yes
Do you have experience in Neuro?
*
No
Yes
If yes, Have you cared for patients after brain surgery?
No
Yes
Do you have experience taking care of Stroke patients?
*
No
Yes
Do you have Burn experience?
*
No
Yes
If yes, do you have burn exp. with Peds, Adults, or both?
*
If yes, can you calculate total body surface area?
No
Yes
If yes, can you utilize the rule of 9?
No
Yes
Can you calculate TBSA?
*
No
Yes
Can you calculate fluid replacement?
No
Yes
Are you comfortable doing burn wound dressing changes?
No
Yes
Do you have experience in Renal?
*
No
Yes
Can you perform Peritoneal Dialysis?
*
No
Yes
Do you have experience in Ortho?
*
No
Yes
Do you have experience in Transplant?
*
No
Yes
If yes, which types of transplants?
How much recent experience do you have with trachs?
*
None
Past Month
Past 3 Months
Past 6 Months
Past Year
Over a year ago
Can you care for a patient on bipap or chronic vent?
*
No
Yes
Do you have experience with radial bands?
*
No
Yes
Can you care for post-op plastic surgery patients, and if yes, which cases?
*
Can you insert PICC lines?
*
No
Yes
Can you troubleshoot PICC lines?
*
No
Yes
Can you start an IV?
*
No
Yes
On a scale of 1 to 10, (10 being highest) how confident are you interpreting your own rhythm strips?
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0
1
2
3
4
5
6
7
8
9
10+
Can you pass a Tele test, if ordered?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
