Potential Strike multi-state
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California RN - Operating Room
Requirements
:
BLS
ACLS (preferred)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active California RN license?
*
No
Yes
List your active 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 RN experience within the last two years?
*
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 OR 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 OR in the past year?
*
No
Yes
What Facility and City, state have you worked OR recently?
*
How much recent CVOR 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
Do you scrub CABG, valves, and triple-A?
*
No
Yes
Have you worked in an Inpatient setting?
*
No
Yes
Have you worked in an outpatient setting?
*
No
Yes
What specialty/cases do you circulate most?
*
Can you scrub?
*
No
Yes
If yes, what cases can you scrub?
Can you circulate and/or scrub in the open heart room?
*
No
Yes
Do you have experience with PEDS OR?
No
Yes
Which eye cases can you circulate?
*
How much robotic 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
Do you have any Davinci robotic experinece?
*
No
Yes
Do you have any Mazur robotic experience?
*
No
Yes
Do you have Neuro/Crani experience?
*
No
Yes
Can you circulate organ transplants?
*
No
Yes
If yes, which transplant cases can your circulate?
How much experience do you have with organ or tissue harvest?
*
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
Are you able to implement malignant hyperthermia protocols?
*
No
Yes
How much Endo experience do you have?
Do you have experience with plastics cases?
*
No
Yes
How much recent Trauma OR 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
Do you have experience with orthopedic cases including total joints?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
