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Placer County Human Resources Department
Psychiatric Nurse - II
#2017-14330-01


Supplemental Questionnaire

Last Name First Name
 

 

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
4.

Do you currently possess certification(s) in crisis intervention?

Yes No
5.

List the position(s) where you gained at least two (2) years' experience (equivalent to full-time experience) as a Registered Nurse/Psychiatric Nurse providing care to individuals with psychiatric and/or substance use disorders.

6.

Please describe, in detail, the range of mental health duties that you have performed within a mental health context, including but not limited to triage, assessment, brief treatment and/or crisis management, medication support, community consultation, education.


 

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:



7.

Providing nursing care in a:


 

a) Hospital Setting?

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.
 

b) Outpatient Setting?

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.
 

c) Residential Setting?

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.
 

d) In-Home Care Setting?

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.
 

If you indicated experience in one or more of the above, please describe each setting.


8.

Providing nursing care to:


 

a) Children?

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.
 

b) Adolescents?

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.
 

c) Adults?

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.
 

d) Elderly?

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.
 

If you indicated experience in one or more of the above, please describe.

9.

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

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.
10.

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

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.

11.

Administering medications:


 

a) Orally?

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.
 

b) Injectables?

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.
12.

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

If you indicated any experience, please describe.

13.

Administering psychotropic 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.
14.

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

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.
 

If you indicated any experience, please describe.

15.

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

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.
 

If you indicated any experience, please describe.

16.

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.

17.

Do you have experience utilizing the Diagnostic and Statistical Manual (DSM) systems for understanding the diagnosis?

Yes No
18.

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

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.
19.

Functioning in a lead role over other clerical and/or professional staff in a medical/psychiatric setting?

Yes No
 

If you indicated any experience, please describe.


 

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