Reporting to Hospice/Homecare Program Director, provides professional nursing care as assigned. Coordinates care planning with other disciplines.
- Graduate of accredited RN program
- 3 to 5 years of directly related nursing experience
- RN license - NH or other Compact State
- CPR certified or within 30 days of hire
- Driver license - valid
1. Provides nursing coverage for Home Care and Hospice patients, covering all visits, related scheduled, and unanticipated and triaging of all calls. Documents all calls and visits same day as visit, per agency standard.
2. Ensure there are physician orders prior to delivering services. Complete a comprehensive assessment including physical, psycho/social, and spiritual aspects of patient/family. Ensure OASIS accuracy. Perform services/treatments for patient as indicated in plan of care based on physician orders.
3. Develop and implement plan of care (within 48 hours for Hospice patients) for the patient. Analyze plan on going and develop interventions/changes as necessary. Review and complete comprehensive assessment within 5 days of the notice of election for Hospice patients.
4. Effectively integrate educational, medical, social and psychological factors when evaluating progress towards attainment of goals and outcomes.
5. Complies with medical, regulatory, educational and records management requirements (e.g. insurance authorization, consents, physician's referral, documentation) and maintains patient confidentiality in accordance with HIPAA guidelines and patient rights and responsibilities.
6. Communicates with all physicians and other health care practitioners (as appropriate) involved in the patient's plan of care to exchange, discuss, and evaluate patient information for planning, modifying, and coordinating an appropriate treatment plan and goals.
7. Assess for patient, caregiver, and/or representative and family counseling needs and make appropriate referrals. Provide patient caregiver, and/or representative education including but not limited to: diagnosis, interventions, community resources, medications, safe and therapeutic environment, coping strategies, and discharge, etc.
8. Documents assessment, interventions, medication reconciliation, and discharge planning in appropriate clinical notes and plan of care. Completes documentation same day as visit, per agency standard. Participates in the agency's quality assessment process improvement (QAPI) program to improve health outcome, patient safety and quality of care.
9. Meets agency obligations for scheduling, on call, weekend and evening coverage, and expected productivity standards. Meets agency obligations for, holiday coverage, weekend coverage, and on call shifts. Complies with Agency standards for productivity, patient and staff schedules, and attendance at meetings.
10. Enhances professional growth and development through participation in educational programs, current literature, community based and home health agency in services, meetings, workshops, and provides training to staff, agency, and community groups. Complies with professional licensure standards and code of ethics.