New Jersey - Potential Strike
Submit Request
Antepartum - High Risk
Requirements
:
BLS
ACLS
NRP
AFM
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email Address
*
Phone
*
Do you have an active New Jersey or Multistate Compact RN license?
*
No
Yes
List your State and RN license number:
*
RN license expiration date:
*
Do you have BLS certification?
*
No
Yes
Do you have ACLS certification?
*
No
Yes
Do you have NRP certification?
*
No
Yes
Do you have FHM certifcation?
*
No
Yes
List any other certification you have:
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At what facility have you worked Antepartum most recently, and what dates?
*
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
Can you perform an NST (non-stress test)?
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No
Yes
Can you perform a BPP (biophysical profile)?
*
First
Second
Third
Have you cared for high risk moms post delivery?
*
No
Yes
Are you a lactation nurse?
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No
Yes
If yes, are you certified?"
No
Yes
How much Labor and Delivery experience do you have, if any?
*
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 Post Partum experience do you have, if any?
*
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 NICU experience do you have if any?
*
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
If you do have experience, which level?
None
Level 1
Level 2
Level 3
Level 4
Can you catch the baby and perform initial assessments?
*
No
Yes
Can you work independently in well baby nursery?
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No
Yes
Do you have charge nurse experience?
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No
Yes
Can you start an IV?
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No
Yes
Can you manage or titrate a Magnesium drip?
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No
Yes
Can you circulate C-sections?
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No
Yes
Do you scrub C-sections?
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No
Yes
Can you care for a patient on moderate sedation?
*
No
Yes
Can you work OB Triage?
*
No
Yes
Do you have experience caring for fetal demise during and after delivery?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
Until what date are you able to work? (include the dates of any absences you may require)
*