Potential Strike - Washington
Submit Request
Operating Room - RN
Requirements
:
Washington state RN license or multistate compact
BLS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active Washington state RN license?
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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?
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No
Yes
Do you have PALS certification?
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No
Yes
Are you certified to First Assist (RNFA)?
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No
Yes
If yes, which cases do you First-Assist?
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?
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No
Yes
Do you have Charge Nurse Experience?
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No
Yes
Can you work a Day shift?
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No
Yes
Can you work a Mid shift?
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No
Yes
Can you work a Night shift?
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No
Yes
What is your Primary Shift preference?
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Day
Mid
Night
100% Flexible
How many years OR experience do you have?
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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?
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No
Yes
What Facility and City, state have you worked OR recently?
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Have you worked in an inpatient setting, outpatient setting, or both?
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Inpatient
Outpatient
Both
Do you scrub?
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No
Yes
Which cases do you scrub, if any?
What specialty/cases do you circulate most?
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Which eye cases can you circulate?
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Can you circulate and/or scrub in the open heart room?
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No
Yes
How much recent experience do you have in a PEDS OR?
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No
Yes
How much recent robotic experience do you have?
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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?
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No
Yes
Do you have any Mazur robotic experience?
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No
Yes
How much recent Neuro experience do you have?
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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
Can you circulate organ transplants?
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No
Yes
If yes, which transplant cases can your circulate?
How much recent Ortho experience do you have?
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No
Yes
Are you proficient in total joint and spine?
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No
Yes
How much experience do you have with organ or tissue harvest?
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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?
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No
Yes
How much Endo experience do you have?
Do you have current Trauma OR experience?
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No
Yes
Can you perform wound debridement?
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No
Yes
How much recent plastic surgery experience do you have?
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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
Which plastic surgery cases are you experienced with?
*
Are you experienced with Otolaryngology cases?
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No
Yes
How much recent Epic experience do you have?
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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:
*
