New York - Potential Strike
Submit Request
PICC Line - Vascular Access - RN
Requirements
:
BLS
ACLS
-- please complete this submission form honestly and accurately --
First Name
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Last Name
*
Email
*
Phone
*
Do you have an active New York RN license?
*
What is your active RN license number?
*
What is your RN license Expiration Date?
*
Do you have BLS certification?
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No
Yes
Do you have ACLS certification?
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No
Yes
Do you have PICC certification?
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No
Yes
List any other certification you have:
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What other specialties do you float to?
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How much experience do you have in your float specialities?
*
Do you have the COVID Vaccination?
*
No
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 Nurse Experience?
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No
Yes
Can you work a Day shift?
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No
Yes
Can you work a Mid shift?
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No
Yes
Can you work a Night shift?
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No
Yes
What is your Primary Shift preference?
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Day
Mid
Night
100% Flexible
How many years PICC Vascular Access experience do you have?
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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
Have you worked PICC Vascular Access in the past year?
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No
Yes
What Facility have you worked PICC Vascular Access at most recently?
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Can you insert PICC lines in adults?
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No
Yes
Can you insert PICC lines in children ?
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No
Yes
Can you insert PICC lines in neonates?
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No
Yes
Which brands are you experienced with?
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Are you comfortable inserting a PICC lines solo?
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No
Yes
Do you use X-ray confirm placement?
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No
Yes
Do you use Ultrasound confirm placement?
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No
Yes
Are you able to place mid lines?
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No
Yes
Please supply an Emergency Contact name and phone number:
*
