This checklist is for use by Emergency Room nurses with more than one year experience in their discipline and specialty.
Level of Proficiency 1. Can function independently with 2 or more year experience 2. 1-2 years experience but may need some review 3. Limited or no experience or theory only
PLACE THE NUMBER OF YEARS OF EXPERIENCE IN EACH AREA:
How Many years have you been a nurse:
How many total years have you worked in the Emergency Room:
Please read and agree to the statements below by marking 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 the Stat Staff Professionals to release this Emergency Room Checklist to the Client facilities in relation to consideration of employment with those facilities.