Potential Strike - Washington
Submit Request
Mother-Baby / Postpartum - RN
Requirements
:
Washington State or Multistate compact RN license
BLS
NRP
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email Address
*
Phone
*
Do you have an active Washington State RN license?
*
No
Yes
If Yes, list your Washington state RN license number:
If No, list your compact state and RN license number:
RN license expiration date:
*
Do you have BLS certification?
*
No
Yes
Do you have NRP certification?
*
No
Yes
List any other certification you have:
*
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
Have you cared for high risk moms post delivery?
*
No
Yes
Do you have experience as a lactation nurse?
*
No
Yes
Can you take care of antepartum?
*
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 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 work independently in well baby nursery?
*
No
Yes
Do you have charge nurse experience?
*
No
Yes
Can you start an IV?
*
No
Yes
Can you manage or titrate a Magnesium drip?
*
No
Yes
Can you assist with circumcision?
*
No
Yes
Can you perform infant blood testing?
*
No
Yes
Can you perform state hearing test?
*
No
Yes
Can you perform NST?
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No
Yes
Can you perform a biophysial profile (BPP)?
*
No
Yes
How much recent EPIC 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
Please supply an Emergency Contact name and phone number:
*
