24 Hour Staffing Solutions
24
Hour Solutions Inc.
415-648-6091
Last Name: ____________________ First Name:
_______________ Middle Initial: _____
Classification: __________________ Total Years of Experience: ___________
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Clinical Skill Competency: |
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Indicate clinical skill competency and level of proficiency for all procedures/equipment in the last 12 months. |
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SKILL LEVELS: |
0 = No experience. Theory only. |
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1 = Limited competence/proficiency. Supervision required. |
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2 = Acceptable competence/proficiency. |
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3 =
Competent/proficient. Have performed frequently |
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AGE SPECIFIC COMPETENCY: |
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Neonates/Newborns (birth - 30 days) |
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Adolescents (12 - 18 years) |
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Infants (30 days - 1 year) |
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Toddler (1 - 3 years) |
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Preschooler (3 - 5 years) |
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Older Children (5 - 12 years) |
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Young Adults (18 - 39 years) |
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Middle Adults (39 - 64 years) |
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Older Adults/Geriatrics (64+ years) |
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EXPERIENCE: |
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Medical (MED) |
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Telemetry (TELE) |
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Oncology (ONCOL) |
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Surgical (SURG) |
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Orthopedics (ORTHO) |
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Intermediate (IMC) |
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Stepdown (SDU) |
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Med/Surg (M/S) |
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Neuro (NEURO) |
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CHARTING: |
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Computer |
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DARE |
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APIE |
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SOAPIE |
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FOCUS |
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EXPERIENCE/EXPERTISE: |
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PATIENT CARE: |
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Acute MI, Angina, CHF |
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AIDS, ARCS |
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Aneurysms |
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Burns |
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Carotid |
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ENDERECTOMY |
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Cardiac/Respiratory Arrest |
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CPR |
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Craniotomy |
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Colostomy |
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CVA |
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Diabetic |
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Near Drowning |
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DTs/Alcohol Detox |
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Femoral - Popliteal Bypass |
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GI Bleeding |
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Isolation |
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Ileostomy |
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Nephrectomy |
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Obstructed Airway |
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Oncology |
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Overdose, Substance Abuse |
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Preparing Medications |
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PCA Patient Controlled Analgesia |
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Shock |
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Spinal Cord Injury |
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Seizures |
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Thoracic Surgery |
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Death and Dying |
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Family Intervention/Teaching |
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Patient Teaching |
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Psychiatric care |
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CARDIOVASCULAR: |
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Obtain 12-lead EKG |
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Interpret Rhythm Strips |
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Telemetry |
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Temp. Pacemaker Insertion (assist) |
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Ultrasonic Doppler |
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DRAINS: |
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Hemovac |
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Jackson Pratt |
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DRESSINGS: |
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Ace Wrap/Splints |
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Change |
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Transparent Occlusive |
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Wound Irrigation |
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GASTRO-INTESTINAL TUBES: |
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Insertion |
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Removal |
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Blakemore-Balloon/Traction |
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Ewal |
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Gastrostomy (PEG) |
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Jejunostomy |
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Kaslow (Kantor) |
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Miller-Abbott |
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Nasogastric Suction-Levine Tube |
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Nasogastric Suction-Sump Tube |
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T-tube |
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INTRAVENOUS THERAPY: |
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Angiocaths |
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Blood Precautions |
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Drawing Blood-Venous |
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Heparin-lock |
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Hickman/Broviac, Care of |
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Infusion Monitor |
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Infusion Pump |
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Med Administration IM SQ |
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Assessment & Care of Newborn |
MATERNAL CHILD CARE: |
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Ectopic Pregnancy |
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Hysterectomy |
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Infant Resuscitation |
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Labor Assessment |
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Labor Coaching |
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Mastectomy |
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Post-partum Care |
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Preeclampsia |
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Tubal Ligation |
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Vaginal (assist and deliver) |
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NEURO & ORTHO EQUIPMENT: |
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Amputation |
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Arthroscopic Surgery |
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Balanced Suspension |
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Balkan Frame |
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Bucks Extension |
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Cast Care |
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Casts, Soft |
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Casts, Spika |
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Cervical Devices, Other |
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Circo-electric Bed |
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Clinitron Bed |
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Crutchfield tongs |
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Crutch walking |
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Halo Traction |
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K Wires |
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Total Knee/Hip Replacement |
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Roto Bed |
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Skeletal Traction, other |
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Stryker Frame |
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TENS |
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Patient Teaching |
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Family Teaching |
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PEDIATRICS: |
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Pediatric Meds Conversion |
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Development Theory Age Related |
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Chronic Illness/Disabilities |
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RENAL/GU: |
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Catheters-Foley |
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Catheters-3 Way Foley |
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GU Irrigations-Continuous |
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GU Irrigations-Intermittent |
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Nephrostomy Tube |
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Renal Failure - Acute |
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Renal Failure - Chronic |
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Renal Transplant |
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Renal Trauma |
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Suprapubic Tube |
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Tidal Drainage |
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Patient Teaching |
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Family Teaching |
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RESPIRATORY THERAPY: |
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Apnea Monitor |
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Chest Tubes-H2O Seal |
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Chest Tubes-suction |
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Cough and Deep Breathing |
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Incentive Spirometer |
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Masks, Face, Rebreather, |
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Non-rebreather, Venturi, Cannula, |
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Nasal, Nasotracheal Suctioning |
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O2 Equipment |
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Postural Drainage & Percussion |
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Suctioning Oralpharyngeal |
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Tracheostomy Care |
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Tracheostomy Tubes, Cuffed |
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Chronic Disease Physiology |
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Tracheostomy Care |
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Tracheostomy Tubes, Cuffed |
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Chronic Disease Physiology |
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SURGICAL CARE: |
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Surgical Prep |
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Consents |
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Post-op Monitoring |
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OTHER: |
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Isolation Precautions |
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Diabetic Teaching |
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Accu Check |
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Knowledge of |
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Electrolyte Imbalance/ |
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I am certifying that the
information provided in this Clinical Skills Checklist is true, correct and
complete. I understand that any misrepresentation, omission or falsification on
this application is sufficient cause to prevent hiring, or if hired,
termination of employment.
PRINT NAME: _______________________ SIGNATURE: ____________________ DATE: _______