New Jersey - Potential Strike
Submit Request
SS PACU/SDS - Pediatric
Requirements
:
BLS
ACLS
PALS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
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 PALS certification?
*
No
Yes
List any other certification you have:
*
What 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
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 PACU 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 in PACU in the past year?
*
No
Yes
What Facility and City, state have you worked PACU most recently?
*
Which ages can you recover?
*
Are you CHEMO/APHON certified?
Yes
No
Can you assist with A-lines procedures?
*
No
Yes
Can you assist with central lines procedures?
*
No
Yes
Can you assist with nerve blocks procedures?
*
No
Yes
Do you have a critical care background and can you recover ICU patients?
*
No
Yes
Can you work Inpatient?
*
No
Yes
Can you work Outpatient
*
No
Yes
Do you typically work Inpatient or Outpatient?
*
Inpatient
Outpatient
Both
Do you have experience with massive transfusions?
*
No
Yes
Are you comfortable with drug titration?
*
No
Yes
Are you able to implement malignant hyperthermia protocols?
*
No
Yes
Do you have experience assisting with conscious sedation?
*
Yes
No
Can you start an IV?
*
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)
*
