Oregon - Potential Strike
Submit Request
Stepdown Cardiac
Requirements
:
BLS
ACLS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active Oregon RN license?
*
No
Yes
What is your active RN license number?
*
What is your RN license Expiration Date?
*
Do you have BLS certification?
*
No
Yes
Do you have ACLS certification?
*
No
Yes
Do you have NIHSS certification?
*
No
Yes
Have you taken an EKG Course?
*
No
Yes
List any other certification you have:
*
What specialties do you float to?
*
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?
*
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
Have you worked Stepdown in the past year?
*
No
Yes
What Facility have you worked Stepdown most recently?
*
Which patients do you typically care for?
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 manage a TR band?
No
Yes
Can you pull an arterial sheath?
*
No
Yes
How much experience do you have with post open heart patients?
*
None
Minimal
Regularly
Daily
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 experience in oncology?
*
No
Yes
If yes, can you infuse chemo?
No
Yes
If yes, are you chemo certified?
No
Yes
Do you have experience taking care of Stroke patients?
*
No
Yes
Have you cared for patients after carotid surgery?
Yes
No
Do you have experience in Neuro?
*
Yes
No
If yes, have you cared for patients after brain surgery?
Yes
No
Do you have Burn experience?
*
No
Yes
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 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?
Do you have experience in Rehab?
*
No
Yes
If yes, can you perform FIM scoring?
No
Yes
Do you have experience in Bariatrics?
*
No
Yes
Can you care for a patient on bipap or chronic vent?
*
No
Yes
How much recent experience do you have with trachs?
*
Can you start an IV?
*
No
Yes
Do you have experience caring for post op plastic surgeries?
*
Yes
No
If so, which ones?
Do you have experience with radial bands?
*
No
Yes
Do you have experience with LVADs?
*
Yes
No
If yes, which type?
How much recent experience do you have with wound care?
*
Do you have wound vac experience?
*
No
Yes
Do you have charge experience?
*
Yes
No
Please provide an Emergency Contact name and phone number:
*
