Potential Strike - Illinois
Submit Request
PICU - RN
Requirements
:
Illinois RN license
BLS
PALS
-- 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
RN license number:
*
RN license expiration date:
*
Do you have BLS certification?
*
No
Yes
Do you have PALS 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
Which age of patients are you most comfortable caring for?
*
0-5 years
6-12 years
12 years +
Have you taken care of Peds after heart surgery?
*
No
Yes
Have you taken care of peds after a transplant?
*
No
Yes
If yes, which organ?
Have you taken care of peds after a heart cath?
*
No
Yes
Have you transported NICU / PICU patients outside the hospital?
*
No
Yes
Can you take care of patients on CRRT (continuous renal replacement therapy)
*
No
Yes
If yes, which machine?
Can you set up and take down and change the circuit?
No
Yes
Do you have experience with LVADs?
*
No
Yes
If yes, which type?
Can you take care of patients with an ICP?
*
No
Yes
Can you take care of patients on ECMO?
*
No
Yes
Can you take care of patients on Oscillators?
*
No
Yes
Can you take care of patients on Jets?
*
No
Yes
Do you have Oncology experience?
*
No
Yes
If yes, can you infuse chemo?
No
Yes
Do you have charge nurse experience?
*
No
Yes
Can you start an IV?
*
No
Yes
Can you recover a fresh open heart patient immediately from OR?
*
No
Yes
When was the last time you recovered a fresh heart?
None
Past Month
Past 3 Months
Past 6 Months
Past Year
Over a year ago
Do you have experience with Pediatric CVICU
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
