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Hudson Staffing Travel Nurses| Hospice Online Checklist
Hospice Online Checklist
Thank you for your decision to apply for a travel nursing position with
Hudson Staffing
! Before we can offer you a nursing employment opportunity in the Hospice field, an electronic skills assessment must be completed. Please, complete the nursing skills checklist below, and be sure to review your information thoroughly before clicking the submit button.
GENERAL INFORMATION
Note:
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Denotes a required field.
Please enter your full name as it appears on your Social Security Card:
First Name
Middle Name
Last Name
*
Please enter the Last Four digits of your Social Security Number:
-
-
*
Please check here if you do not hold a valid social security card.
Please provide your contact information:
Phone Number
*
E-mail Address
*
Confirm E-mail Address
*
Type your e-mail address again above.
This profile is for use by healthcare professionals in the Hospice discipline and specialty.
It will not be a determining factor for the program.
CHECKLIST INSTRUCTIONS
Please mark your level of experience
1. No theory and/or experience
2. Limited experience/need supervision and/or support
3. Experienced/minimal support needed to perform
4. Proficient/can perform independently
WORK SETTINGS
1
2
3
4
Home Hospice
Inpatient Hospice
Pediatric Hospice
Home Health/Hospice Setting
ASSESSMENT
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2
3
4
Intake Assessment
Assessment Interview
Physical Exam
Coping Status
Environmental Status
PLAN OF CARE
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2
3
4
Set Goals with Pt/Family
Collaborate with Other Team Members
Ensure Continuity of Care
SYMPTOM MANAGEMENT
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2
3
4
Urgent Assessment of Symptoms
Reduce Symptoms to Level Acceptable to Pt.
Report Symptoms/Management to Provider
Treat Underlying Cause
Severity Scale
Management of Nausea
Management of Constipation
Management of Fatigue
Anorexia/Cachexia
Restlessness
Educate Family on Symptom Management
PAIN MANAGEMENT
1
2
3
4
Identify Source of Pain
Pain Severity
PAINAD Scale for Non Verbal Patient
Reduce Pain to Level Acceptable to Patient
WHO 3 Step Ladder
Non-Pharmacologic Management of Pain
Pharmacologic Management of Pain
Effects of Pharmacologic Treatment
Nociceptive/Neuropathic/Mixed Pain
Management of Nociceptive Pain
Management of Neuropathic Pain
Educate Family on Pain Management
WOUND CARE
1
2
3
4
Positioning Techniques
Bed/Support Surface Selection
Pressure Ulcer Staging/Management
Response to Treatment
Evaluate Factors that Impede Healing
Educate Family on Positioning/Shearing
PEDIATRICS
1
2
3
4
Developmentally Appropriate Assessment
Parental/Sibling Support
Pediatric Support Team Collaboration
MEDICATION ADMIN
1
2
3
4
Equianalgesic Conversion Formula
Titration of opioids
IV Pump Management
Evaluate Effectiveness of Medications
Family Management of Medications
Disposal of Medications
AFTER DEATH
1
2
3
4
Facility Family/Cultural Rituals/Rites
Patient Care after Death
Coordinate Mortuary Services
Bereavement Services
COMPLIANCE
1
2
3
4
Scope and Frequency of Services
Medicare/State Regulations for Hospice
Document Progression of Decline
DME Authorization & Documentation of Need/Order
OASIS-C
PROFESSIONAL KNOWLEDGE AND SKILLS
1
2
3
4
Identify Source of Suffering
Palliative Care Philosophy
Patient/Family Directs Goals of Care
Maximize Quality of Life
Cultural Diversity
Supervision of Ancillary Staff
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Infection Prevention
Isolation Precautions
Interpretation and Communication of Lab Values
EMR
1
2
3
4
EPIC
Cerner
Eclipsys
Allscripts
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
EMR Conversion
Yes
No
Certifications
BLS
CHPN
ACHPN
CHPPN
Please read and agree to the statements below by marking the checkbox.
You will not be able to submit until you have marked the checkbox.
*
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Hudson Staffing to release this Hospice Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.
Privacy Note:
Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (3.230.1.126) which will be used as a digital signature.
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Hudson Staffing
Phone:
1(866)256-8773
E-mail:
info@hudsonstaffing.net
Your resource for traveling nurse and allied health career opportunities.
Copyright (C) 2013 Hudson Staffing. All rights reserved.
