We heard you've got skills

LTC RN

  • This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.

    • 0 = Not Applicable
    • 1 = No Experience
    • 2 = Some Experience
    • 3 = Intermittent Experience
    • 4 = Experienced
    • 5 = Very Experienced

    *Required fields

    Age 0 1 2 3 4 5

    Age of Patients Cared For:

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  • General Skills 0 1 2 3 4 5
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  • Medication-Knowledge and Use Of 0 1 2 3 4 5
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  • Phlebotomy/ IV Therapy 0 1 2 3 4 5
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  • Cardiac: 0 1 2 3 4 5
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  • Care of Patient With:

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  • Knowledge and Use of:

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  • Respiratory 0 1 2 3 4 5
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  • Knowledge and Use of:

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  • NEURO: 0 1 2 3 4 5
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  • Knowledge and Use of:

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  • Sensory Deficits-Care of Patients with: 0 1 2 3 4 5
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  • Gastrointestinal- Care of Patients with: 0 1 2 3 4 5
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  • GI General 0 1 2 3 4 5
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  • Endocrine- Care of Patients with: 0 1 2 3 4 5
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  • Endocrine General 0 1 2 3 4 5
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  • Knowledge and Use of:

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  • RENAL/ GU- Care of Patients with: 0 1 2 3 4 5
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  • Peritoneal Dialysis

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  • Orthopedic- Care of Patients with: 0 1 2 3 4 5
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  • Orthopedic General 0 1 2 3 4 5
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  • Wound/ Skin- Care of patients with: 0 1 2 3 4 5
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  • Wound/ Skin General 0 1 2 3 4 5
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  • Additional Skills- Care of Patients with: 0 1 2 3 4 5
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  • The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.
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