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Job Application
Services
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- REFER A FRIEND
Travel
Travel Nursing
Resource
- NEW EMPLOYEE INFORMATION
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Personal Information

Name *

First

Last

Please enter your full legal name as it appears on your Social Security Card.

Email *

Phone

No experience: requires education, training and supervision
Intermittent experience: may need support or supervise
Proficient: consistent experience, independent
Expert level: can teach/supervise others.

Work settings

Adult Care Facility/ Assisted Living

1
2
3
4

Children’s Hospital

1
2
3
4

Inpatient Acute Care

1
2
3
4

Level I Trauma Center

1
2
3
4

Level II/III Trauma Center

1
2
3
4

LTAC Facility

1
2
3
4

Rehab Facility

1
2
3
4

Skilled Nursing Facility

1
2
3
4

Clinical Practice Knowledge by Specialty

ER

1
2
3
4

ICU

1
2
3
4

MS TELE

1
2
3
4

NICU

1
2
3
4

Pediatrics

1
2
3
4

PICU

1
2
3
4

Surgical Services

1
2
3
4

Women’s Services

1
2
3
4

Emergency Care

Cardiac arrest / CPR

1
2
3
4

Code Management

1
2
3
4

Crisis Intervention/Management

1
2
3
4

De-escalation techniques

1
2
3
4

Disaster Management

Internal

1
2
3
4

External

1
2
3
4

Emergency preparedness

1
2
3
4

Facility/Bed Diversion

1
2
3
4

Managing Assaultive Behavior

1
2
3
4

Rapid response teams

1
2
3
4

Restraints – physical/chemical

1
2
3
4

Legal Aspects

Advanced directives

1
2
3
4

Confidentiality – HIPPA Compliance

1
2
3
4

Discharge AMA

1
2
3
4

Fitness for duty

1
2
3
4

Quality Management

1
2
3
4

Risk Management4

1
2
3
4

Sentinel events-monitoring and reporting

1
2
3
4

Voluntary /involuntary commitment

1
2
3
4

Medications/Methods of delivery

Medication Management

1
2
3
4

Automated Medication Dispensing Systems

Omnicell

1
2
3
4

Pyxis

1
2
3
4

Accudose

1
2
3
4

Bar Code Medication Administration

1
2
3
4

Professional knowledge/skills

Bed Management

1
2
3
4

New Admissions

1
2
3
4

Post Surgery

1
2
3
4

Post Procedures

1
2
3
4

Transfer to higher level care

1
2
3
4

Customer Service

1
2
3
4

Employee wellness program

1
2
3
4

Experience managing narcotic diversion

1
2
3
4

Experience with Magnet Designation

1
2
3
4

Experience with project management: EMR conversions, new equipment

1
2
3
4

implementation

1
2
3
4

Experience with shared leadership/council management

1
2
3
4

Experience working with staffing models

Centralized staffing

1
2
3
4

Decentralized staffing

1
2
3
4

Scheduling

1
2
3
4

Fall prevention

1
2
3
4

Functions as clinical expert resource

1
2
3
4

HCAHPS

1
2
3
4

Incident reporting

1
2
3
4

Infection control

1
2
3
4

Isolation procedures

1
2
3
4

Knowledge of regulatory requirements- DPH, TJC, OSHA, etc.

1
2
3
4

Multidisciplinary provider team

1
2
3
4

National Patient Safety Goals

1
2
3
4

Organizational escalation process for facility

1
2
3
4

Prevention of pressure ulcers

1
2
3
4

Root Cause Analysis process

1
2
3
4

Supervising nursing care delivered on all units organizationally

1
2
3
4

Universal Precautions

1
2
3
4

Workplace safety

1
2
3
4

Wound Care

1
2
3
4

Financial Management

Basic understanding of healthcare economics including reimbursement, Medicare, Medicaid, etc.

1
2
3
4

Experience with productivity standards and staffing requirements

1
2
3
4

Understands census as it relates to expense control and budgeted HPPD

1
2
3
4

Human Resource Management

Advanced communication skills:

1
2
3
4

Advocacy

1
2
3
4

Negotiation

1
2
3
4

Confrontation

1
2
3
4

Conflict Resolution

1
2
3
4

Coaching and counseling to performance standards

1
2
3
4

Employee Evaluations

1
2
3
4

Federal and State scope of practice labor laws – FMLA

1
2
3
4

Hiring process/interviewing skills and techniques

1
2
3
4

Orientation of new employees

1
2
3
4

Performance Improvement

Knowledge of CMS quality indicator data initiatives

1
2
3
4

Knowledge of performance improvement tools

1
2
3
4

Participates in process improvement activities

1
2
3
4

Promotes survey preparedness at all times

1
2
3
4

Promoting intradepartmental /interdepartmental communication

1
2
3
4

COMPUTERIZED CHARTING

Allscripts

1
2
3
4

Cerner

1
2
3
4

EPIC

1
2
3
4

McKesson

1
2
3
4

Meditech

1
2
3
4

Other:

1
2
3
4

If other, please specify

Age specific competency

Neonate

1
2
3
4

Infant

1
2
3
4

Child

1
2
3
4

Adolescent

1
2
3
4

Young Adult

1
2
3
4

Middle Adult

1
2
3
4

Older Adult

1
2
3
4

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