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Placer County Human Resources Department
Psychiatric Nurse - I
#2017-14329-01


Supplemental Questionnaire

Last Name First Name
 

 

Supplemental Questionnaire 2017 Psychiatric Nurse I

Part I (Not Scored)


1.

Do you possess the equivalent of a Bachelor's degree from an accredited college or university with major course work in nursing or a related field? If no, you are encouraged to review the job posting and the minimum qualifications for this position.

Yes No
2.

Do you possess a valid license as a Registered Nurse issued by the California Board of Registered Nursing? If no, you are encouraged to review the job posting and the minimum qualifications for this position.

Yes No
 

If yes, please provide the following: License number and issue date.

3.

Do you currently possess a valid CPR certificate?

Yes No

 

Part II (Scored)

Based on your checked responses to questions in Part II, your job-related training and experience will be scored and then ranked. Narratives provided by applicants describing training and/or experience will not be scored but will be available to the hiring authority and may be utilized for interview and selection determinations.

Please answer based on your training and/or experience:



4.

Providing nursing care in a:


 

a) Hospital Setting?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

b) Outpatient Setting?

I possess no or a very little amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

c) Residential Setting?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

d) In-Home Care Setting?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated any knowledge and/or skills in one or more of the above, please describe each setting.


5.

Providing nursing care to:


 

a) Children?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

b) Adolescents?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

c) Adults?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

d) Elderly?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated any knowledge and/or skills in one or more of the above, please describe.

6.

Communicating medical information and patient care instructions with providers and/or other health care professionals?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
7.

Interpreting a physician’s order regarding patient medication needs and care?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.

8.

Administering medications:


 

a) Orally?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

b) Injectables?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
9.

Providing specific medication, counseling and education to patients regarding the need, purpose and side effects of prescribed medications?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated any knowledge or skill, please describe.

10.

Administering psychotropic medications?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill, but have not applied it in this job setting.
I have appliend this knowledge or skill under close supervision.
I have appliend this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
11.

Interviewing, observing, and recording clients/patients as a means of collecting psychosocial and/or medical history?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated any knowledge or skill, please describe.

12.

Analyzing patient situations quickly and objectively in determining a proper course of action in a mental health setting?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.
 

If you indicated any knowledge or skill, please describe.

13.

Working with an Electronic Health Record (EHR) to document client/patient treatment for compliance/insurance purposes including progress notes, lab work, and ordering medications?

I have no or very limited experience in performing this task.
I have some experience performing this task but would need additional training.
I have performed this task under close supervision.
I have performed this task independently under normal supervision.
I have extensive experience performing this task and have trained and/or supervised others in the performance of this task.
 

Based on your selection above, please describe the electronic health record software and/or programs/systems you have utilized.

14.

Using clinical supplies and equipment, including blood pressure cuff, stethoscope, syringes and needles?

I possess no or a very limited amount of this knowledge or skill.
I possess this knowledge or skill but have not applied it in this job setting.
I have applied this knowledge or skill under close supervision.
I have applied this knowledge or skill independently under normal supervision.
I have used this knowledge or skill to train or provide consultation to others.

 

Thank you for completing the examination portion of the application process. We encourage applicants to review their answers for accuracy prior to submitting.

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