Potential Strike - Illinois
Submit Request
NICU - RN
Requirements
:
Illinois RN license
BLS
NRP
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email Address
*
Phone
*
Do you have an active Illinois RN license?
*
No
Yes
List your RN license number:
*
RN license expiration date:
*
Do you have BLS certification?
*
No
Yes
Do you have NRP certification?
No
Yes
List any other certification you have:
*
What other 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
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
Have you worked NICU in the past year?
*
No
Yes
At which facility have you worked NICU most recently?
*
What level NICU do you typically work in?
*
None
Level 1
Level 2
Level 3
Level 4
What is the earliest gestation you can care for?
*
How much recent experience do you have with Jets?
*
None
Minimal
Regularly
Daily
How much recent experience do you have with oscillators?
*
None
Minimal
Regularly
Daily
How much recent experience do you have with vents?
*
None
Minimal
Regularly
Daily
How much recent experience do you have with Cpap?
*
None
Minimal
Regularly
Daily
How much experience do you have caring for a neonate on ECMO?
*
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
Are you comfortable with applying and caring for total body cooling and/or head cooling?
*
No
Yes
Do you attend deliveries?
*
No
Yes
Have you transported neonates outside the hospital?
*
No
Yes
If yes, which mode?
None
Ambulance
Helicopter
Both
Do you have charge nurse experience?
*
No
Yes
Can you start an IV?
*
No
Yes
Do you have experience with Nitric Oxide?
*
No
Yes
Are you a lactation nurse?
*
No
Yes
If yes, are you certified?
No
Yes
Do you care for post-surgical NICU patients?
*
No
Yes
If yes, what surgeries?
Do you have any experience inserting PICC Lines?
*
No
Yes
Do you have experience with umbilical lines?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*