Potential Strike
New Jersey
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PICU - RN
Requirements
:
BLS
ACLS
PALS
APHON (preferred)
-- please complete this 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 RN license number and State:
*
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
Are you Chemo certified?
*
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
Can you work a Day shift?
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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 experience do you have as a PICU RN?
*
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 as a PICU RN in the past year?
*
No
Yes
What Facility, city and state, have you worked as a PICU RN most recently?
*
In which hospital units are you most comfortable working?
*
When was the last time you recovered a fresh heart immediately from the OR?
*
What age range of patients are you comfortable caring for?
*
Do you have recent transplant experience?
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No
Yes
If yes, which types of transplant are you experienced with?
*
Can you care for a pediatric patient after a heart catheter?
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No
Yes
Do you have LVAD experience?
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No
Yes
If yes, which types of LVAD are you familiar with?
Can you care for patients on ECMO?
*
No
Yes
Can you care for patients on CRRT or CVVH?
*
No
Yes
If yes, which CRRT machines are you familiar with, and can you set up and troubleshoot the circuit?
Have you transported NICU/PICU patients outside the hospital?
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No
Yes
Do you have experience with ICP monitoring?
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No
Yes
Do you care for patients on Oscillators?
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No
Yes
Do you care for patients on Jets?
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No
Yes
Describe any other duties you may assist with or types of cases you care for:
*
Are you able to travel and arrive in New Jersey on August 15 or 16 (orientation August 17)?
*
No
Yes
Are you able to work through August 31 (travel home September 1)?
*
No
Yes
If the strike extends indefinitely, until what date can you work? (include any time off you require)
*
Please supply an Emergency Contact name and phone number:
*
Until what date can you work? (include the dates of any absences you may require)
*
