NICU EXPERIENCE PROFILE

First Name: Last Name:Grad from nursing school:

Degree: RNC N/A RNP N/A

ACLS N/A Chemotherapy N/A

State of original License:

State of current License:

Phone Number:

Please indicate your level of experience with the following patient groups and clinical skills category according to the number of years of experience indicated below:

CATEGORIES 0, 1, 2, 3

0=No experience
1=limited experience
2=perform with review
3=perform independently

	Patient Groups	0	1	2	3
	Neonate 23-28 wks
	Neonate 28-32 wks
	Neonate >30 wks
	Infant 6 wks - 1 yr
NEONATAL INTESIVE CARE ASSESSMENT SKILLS

Apgar scoring
Developmental maturity
Vision exam (retinopathy)
Hearing exam
Suck/swallow reflexes
Neurological
ICP monitors
Cardiovascular
Pulmonary
Gastrointestinal
Fluid Balance
EQUIPMENT & PROCEDURES
Heelstick
Glucose testing
Hemocult testing
Urine testing, single specimen
Culture collection
Maternal lab correlation
IV starts, peripheral
Blood transfusion
IV pumps
Syringe pump
Percutaneous venous lines
Set up & run EKG
Assist with defib/cardioversion
Prep & Assist with CVP
Arterial lines, set up & assist
Arterial lines, maintenance
PA lines, maintenance
PA lines, assist & set up
Post cardiac surgery
Pre & post cardiac cath
Prep & assist UAC
Blood gases, UAC drawing
Blood gases, radial stick
Oxyhood
Nasal cannula
Mask oxygen
Bag/mask
Trach collar
Assist with intubation
Assist with extubation
Suctioning, ET
Suctioning, trach
Suctioning, nasal/oral
Assist & set up apnea monitor
Assist & set up cardiac monitor
Prep & assist thoracentesis
Set up & assist lumbar tap
Ventilator maintenance, CPAP
Ventilator maintenance, SIMV
Ventilator maintenance, pressure
Ventilator, weaning
Oral gavage feedings
Nasal gavage feedings
Maintenance & care of G tubes
Breast pump set up & use
Breast milk preparation
Set up & assist suprapubic cath
Urine bag collection devices
Urethral catheters
NEONATAL CONDITIONS
Pre & post circumcision care
Phototherapy
Cardiac arrest
Respiratory arrest
Pre & post transplant
Pre & post open heart
Cardiomyopathy
Atrial/septum defects
Ventricular/septum defects
Bronchopulmonary dysplasia
Pneumothorax
PPHN
Pre & post tracheostomy
Organ donation
VP shunt care
Hydocephalus
Meningitis/encephalitis
Neonatal sepsis
HIV positive mother
Drug/ETOH addicted mother
Seizures
Cleft palate
Pre & post cleft repair
Gestational diabetic neonate
Hydrocele
Congenital kidney defects
Dialysis, peritoneal
ECMO, prep & initiate
ECMO, maintain
Electrolyte imbalances
MEDICATIONS
Aminophylline
Cephalosporins IV
Amininoglycosides IV
Dopamine
Dobutamine
Epineprine
Phenobarbitol
Caffeine
Sodium bicarb

NICU NURSING WORK HISTORY
TO NAME OF HOSPITAL:
SUPERVISOR NAME:
NUMBER OF HOSPITAL BEDS:
NUMBER OF BEDS ON UNIT:
PATIENT TYPES		LDRP
TRAVEL ASSIGNMENT?
DESCRIPTION OF DUTIES:


TO NAME OF HOSPITAL:
SUPERVISOR NAME:
NUMBER OF HOSPITAL BEDS:
NUMBER OF BEDS ON UNIT:
PATIENT TYPES		LDRP
TRAVEL ASSIGNMENT?
DESCRIPTION OF DUTIES:


TO NAME OF HOSPITAL:
SUPERVISOR NAME:
NUMBER OF HOSPITAL BEDS:
NUMBER OF BEDS ON UNIT:
PATIENT TYPES		LDRP
TRAVEL ASSIGNMENT?
DESCRIPTION OF DUTIES:

Authorization (Please type your name and the date.)

By submitting this application, I hereby certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

Signature Date

Submit your information to have PRN contact you today!

Enjoy Your Career with Travel Nursing Jobs from PRN!