Potential Strike - Washington
Submit Request
Pre-Op / Phase II - RN
Requirements
:
Washington State or Multistate compact RN license
BLS
PALS (preferred)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active Washington state RN license?
*
If Yes, what is your active Washington state RN license number?
If No, what is your compact state and RN license number?
What is your RN license Expiration Date?
*
Do you have BLS 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?
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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 Pre Op 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 Pre Op in the past year?
*
No
Yes
What Facility have you worked Pre Op at most recently?
*
Which phase of recovery are you comfortable caring for?
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Which ages can you recover?
Can you work Pre Op?
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No
Yes
Can you work Post Op?
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No
Yes
Can you assist with central lines procedures?
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No
Yes
Can you perform and interpret a 12 lead EKG?
No
Yes
Can you assist with nerve blocks procedures?
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No
Yes
Can you perform moderate sedation?
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No
Yes
Can you assist with central or A-line placement?
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No
Yes
Do you have a critical care background and can you recover ICU patients?
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No
Yes
Do you primarily work inpatient or outpatient?
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Inpatient
Outpatient
Both
Do you have experience with massive transfusions?
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No
Yes
Are you comfortable with drug titration?
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No
Yes
Are you able to implement malignant hyperthermia protocols?
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No
Yes
Can you start an IV?
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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?
*
