PEDIATRIC EXPERIENCE PROFILE

First Name: Last Name:Grad from nursing school:

Degree: RNC N/A PALS 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
	Infant
	Children
	Adolescent
PEDIATRIC NURSING
ASSESSMENT SKILLS
Cardiopulmonary
Developmental
Social/abuse
CLINICAL SKILLS
Starting IV's, peripheral
Starting IV's, cephalic
PICC line insertion
Maintenance of central lines
Administration of TPN
Blood draw from central lines
Implanted port access
Implanted port maintenance
Venipuncture-phlebotomy
Fingersticks
Infusion pumps
Feeding pumps
Buritrol
Apnea monitors
Radiant warmers
Isolette
Closed chest tube systems
Mist tent
Oxyhoods
Oximeters
Sodium Bicarbonate IV
Epinephrine IV
Dobutrex IV
Dobutamine IV
DISEASES/DISORDERS
Failure to thrive
Croup
Epiglottitis
Pyloric stenosis
Nasogastric tube placement
Gastrostomy tube care
Gastrostomy feedings
Cleft palate
Feeding the cleft palate child
Tracheoesophageal fistua
Cystic Fibrosis
Resp. Synovial Virus
Near drowning
Cardiac arrest
Respiratory arrest
Pediatric code team leader
Congenital heart defects
Atrial Septal defects
Ventricular Septal defects
Tetralogy of Fallot
CHF
Blood transfusion
Transfusion reaction
Sickle cell crisis
Spina Bifida
Intermittent catheterization
Indwelling catheter placement
Anaphyllactic reaction
Closed head injury
Pre/post craniotomy
Seizures
Reyes syndrome
Dilantin
Phenobarbitol
Tegretol
Meningitis
Hydrocepahalus
Diabetes
Hemodialysis, care
Peritoneal dialysis care
Skeletal traction
Cancer & radiation
Cancer & chemotherapy
Cancer & amputation
Terminal cancer
Burns
Pre/post transplant
Pre/post appendectomy
Pre/post hypospadius repair
Pre/post laparotomy

PEDIACTRIC 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!