Potential Strike - Washington
Submit Request
Tele Chemo - RN
Requirements
:
Washington State or Multistate compact RN license
BLS
ACLS
ONS Chemotherapy certification
NIH (preferred)
-- please complete this submission form honestly and accurately --
First Name
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Last Name
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Email
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Phone
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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:
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Do you have BLS certification?
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No
Yes
Do you have ACLS certification?
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No
Yes
Do you have Chemo certification?
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No
Yes
List any other certification you have:
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What specialties do you float to?
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Do you have the COVID Vaccination?
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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 MS Oncology Chemo 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 MS Oncology Chemo in the past year?
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No
Yes
What Facility have you worked MS Oncology Chemo at most recently?
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Do you access ports?
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No
Yes
What pediatric age group are you comfortable working or have you worked?
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What adult population are you comfortable working or have you worked?
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Have you worked in a Outpatient setting?
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No
Yes
Have you worked in a Inpatient setting?
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No
Yes
Do you have BMT experience?
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No
Yes
Can you administer stem cells?
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No
Yes
Can you start an IV?
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No
Yes
Can you insert PICC lines?
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No
Yes
Can you troubleshoot PICC lines ?
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No
Yes
What types of infusion are you able to perform other than Chemotherapy, if any?
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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:
*