Hudson Staffing Travel Nurses & Allied Health Careers
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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: * 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 1 2 3 4
     Intake Assessment
     Assessment Interview
     Physical Exam
     Coping Status
     Environmental Status
PLAN OF CARE 1 2 3 4
     Set Goals with Pt/Family
     Collaborate with Other Team Members
     Ensure Continuity of Care
SYMPTOM MANAGEMENT 1 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 (44.192.65.228) which will be used as a digital signature.



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Hudson Staffing
Phone: 1(866)256-8773
E-mail: info@hudsonstaffing.net

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