PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
Application for Employment: Employed Student Nurses (ESN)
DEADLINE FOR SUBMISSION of ESN Application is November 30th, 2015
Please Save & Email application to: esn@phsa.ca
1.APPLICANT INFORMATION
Last Name:
Given Name(s):
Address:
Postal Code:
City:
Email:
Phone:
Alternate Phone:
Current Nursing Program:
What is the name of the nursing school you are currently attending?
When did you start your nursing program? (yyyy/mm/dd)
When is your projected graduate date? (yyyy/mm/dd)
During your ESN experience in 2016 will you be (check one):
Between 2nd and 3rd year
(For Pediatrics you must have successfully completed your pediatric rotation)
Between 3rd and 4th year
(For Oncology ESN’s at BC Cancer you must have completed 3rd year)
Do you have a current student registration (i.e. CRNBC)?
No
Yes
If Yes, License Number#
Do you have current CPR – Current Level “C”: No
Yes
If Yes, Current Expiry Date (yyyy/mm/dd):
Have you applied to an ESN program with another Health Authority?
No
Yes
If Yes, which Health Authority?
Are you currently employed as an ESN?
No
Yes
If Yes, where?
** Please note you may only work as an ESN in one Health Authority at one time.
Page 1 of 9
Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
2. Please indicate your preferences for employment by indicating Site/Agency/Location & area with
1st, 2nd & 3rd choices:
Site/Agency
BC Cancer Agency (Adult Oncology)
PREFERENCE (1,2,3)
Please select the location preference for the ESN placement from the following (please only select one location)
Vancouver Cancer Centre (Vancouver)
Fraser Valley Cancer Centre (Surrey)
Vancouver Island Cancer Centre (Victoria)
Cancer Centre for the Southern Interior (Kelowna)
Cancer Centre for the North (Prince George)
Is your goal to work in Adult oncology after graduation?
No
Yes
If no, what is your goal for future?
Site/Agency
BC Children’s Hospital (Pediatrics)
PREFERENCE (1,2,3)
Please select your preferred area of placement in Pediatrics (please rank your top two):
Pediatric Oncology, Hematology, BMT/Oncology Clinic
Pediatric Medicine (3M, 3F)
Pediatric Surgery and Neurology (3R)
Pediatric Mental Health Program
(Eating Disorders Program, Child and Adolescent MH)
Pediatric Rehabilitation (Sunny Hill Health Centre)
Pediatric Emergency Program
Pediatric ICU
Pediatric Peri-Operative Program
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PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
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Site/Agency
BC Women’s Hospital & Health Centre (Perinatal)
PREFERNCE (1,2,3)
Please select your preferred area of placement in Perinatal (please rank your top two):
Single Room Maternity Care
Intermediate Nursery, NICU
Postpartum
Please tell us why have chosen the above Site/Agency as your FIRST choice:
3.AVAILABILITY
Successful candidates must be available to work full-time during their spring/summer breaks from April to
September 2016 as per a pre-determined rotation. Shifts will be days, nights, and weekends.
Please provide the dates when you are available to work full-time:
Start date (yyyy/mm/dd):
End date (yyyy/mm/dd):
If you will be available to continue working part time as an ESN once your fall 2016 courses begin, please provide
your availablity below (ideally you will be consistently available for 2-3 days per week):
Start date (yyyy/mm/dd):
End date (yyyy/mm/dd):
Are you available consistently?
No
Yes
If yes, how many days a week?
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Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
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4.FUTURE CAREER PLANS
Please describe briefly your future plans to develop for your nursing specialty:
1.
Upon graduation from a nursing program, where do you plan to work:
2.
Career goals in specialty nursing:
5. CLINICAL PLACEMENTS
Please provide detailed information about your clinical placements:
Clinical Placement
History
Facility
(e.g. BCCA, Richmond Hosp., Burnaby,
etc.)
Dates of
Placements
(yyyy/mm/dd)
Length of Placement
(No. of Hours)
Medical / Surgical
Pediatrics (If applicable)
Perinatal (If applicable)
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Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
6. RELEVANT WORK/VOLUNTEER EXPERIENCE IN ONCOLOGY, PEDIATRICS, PERINATAL OR OTHER AREAS:
Position Title
Employer
Dates Employed
(yyyy/mm/dd)
Hours Per Month
7.RECRUITMENT
How did you hear about the ESN opportunities with PHSA?
School (i.e., Faculty, students)
Word of mouth (i.e., Classmates)
Website
Other (please specify):
Please note: Although every effort will be made to honor your requests, placements will depend on your clinical
experiences and the availability of agency and unit placements.
Thank you for your interest with PHSA.
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Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
ESN Competencies Assessment
8.ASSESSMENT OF POTENTIAL ESN
Please rate your own competencies using this scale as a guide to your assessment: Place an X in the box of the number
that best represents your level on each competency.
Assessment Scale
1 = I have not performed/demonstrated this and may require more education and support.
2 = I perform/demonstrate fairly consistently and may require support and more practice.
3 = I perform/demonstrate consistently, independently and with confidence.
4 = Not Applicable
For example:
COMPETENCIES
1
1. Assumes responsibility for maintaining self-
2
3
N/A
X
regulation/self-mastery
How do you rate yourself on these competencies? Type an X in the box of the number that best represents your level.
COMPETENCIES
1
2
3
N/A
2. Assumes responsibility for maintaining self-regulation/selfmastery
3. Establishes, maintains effective relationships with clients,
families and members of the health care team.
4. Ensures comprehensive communication and documentation of
care.
(focus charting, creating and individualizing care plans, using
flow sheets to communicate care
5. Provides timely and effective teaching with clients,
children/women and families (assesses learning needs, uses
teaching resources, accesses resources, documents teaching
and family comprehension of learning,
6. Organizes, plans and coordinates care effectively
7. Provides safe nursing care to patients and families (safety
assessments, environmental safety checks,)
8. Provides family-centered care.
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Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
Assessment Scale
1 = I have not performed/demonstrated this and may require more education and support.
2 = I perform/demonstrate fairly consistently and may require support and more practice.
3 = I perform/demonstrate consistently, independently and with confidence.
4 = Not Applicable
How do you rate yourself on these specific skills? Place an X in the box of the number that best represents your level.
SKILLS
1
2
3
4
1. Assessments
•
Head to toe
•
Body systems
•
Mental health
•
Pain assessment
•
Safety & Environment assessment
2. Medication Administration
•
oral
•
topical
•
IV (specify pediatrics)
•
Inhalation/nebulizer meds
•
IM (specify ages)
•
Dose & dilution calculations
•
Other, please specify:
•
Other, please specify:
3. Parenteral/Infusion Therapy
•
Site to source assessment
•
Troubleshooting
•
Infusion Pumps (syringe, volumetric)
•
Changed/added solutions
•
Infusion system set-up (primed lines, checked solutions)
•
Discontinued infusions
•
Administered blood products
Page 7 of 9
Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
Assessment Scale
1 = I have not performed/demonstrated this and may require more education and support.
2 = I perform/demonstrate fairly consistently and may require support and more practice.
3 = I perform/demonstrate consistently, independently and with confidence.
4 = Not Applicable
How do you rate yourself on these specific skills? Place an X in the box of the number that best represents your level.
SKILLS
1
2
3
4
4. GI
•
N/G tube insertion
•
Administering tube feedings
•
Administering enema
•
Infant feeding
•
Other please specify:
5. Skin and Wound Care
•
Skin and wound assessments
•
dressings
•
Other please specify:
6. Respiratory Care
•
Oxygen therapy
•
Suctioning
•
Other please specify:
7. Basic Care & Patient Mobilization
•
Transfers
•
Ambulation
•
Bedbaths
•
Turning/Repositioning
•
Play therapy
•
Other please specify:
8. Infection Control
•
Isolation techniques
•
Other please specify:
9. Patient & Family Teaching
• Medication teaching
• Other (e.g. asthma teaching, baby bath etc.)
Page 8 of 9
Nov 2015
PHSA Talent Acquisition
Recruiting and Retaining the Best Talent to
PHSA Agencies, Services, Programs & Divisions
9. Additional comments (if applicable)
Please note:
•
Save the application in Word and email to: esn@phsa.ca
•
Include updated resume.
•
Refer to the ESN checklist to ensure application is complete.
•
Please do not convert to a PDF Document.
Name
Date (yyyy/mm/dd):
Thank you for your interest in Provincial Health Services Authority! Due to the large number of
applications we are unable to confirm that status of your application. Only short-listed applicants will be
contacted.
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Nov 2015