Field Registered Nurse - Home Health - Per Diem/Days - Req# 2080657866

Job Objective: To provide, supervise and coordinate skilled nursing care, personal care and other services given to her/his assigned patients. The Registered Nurse (RN) performs the comprehensive patient assessment, develops plan of care, oversees the execution of plan of care, ensures care is provided as ordered in the plan of care, delegates nursing services to Home Health Aides (CHHA) and Licensed Vocations Nurses (LVN) and provides skilled nursing care.

Duties and Responsibilities:

A. Patient Care

1. Acts as the patients advocate and protects patients’ confidentiality.

2. Distributes and explains patient’s rights and responsibilities.

3. Demonstrates knowledge regarding special needs and behaviors of age specific groups and demonstrates proficiency in age specific competencies.

4. Demonstrates knowledge of medical disease processes, surgical procedures, psychosocial behavior, and nursing care theory and practice.

5. Provides the initial nursing assessment on patients involving physical, physiological and psychosocial status. This assessment should include therapeutic regimen and environmental factors involved in the patient’s care.

6. Performs patient care according to plan of care and MD orders.

7. Counsels and instructs patients and caregivers in meeting nursing and related needs.

8. Coordinates care with physicians and other disciplines involved through collaboration with other agency staff and participation in case conferences.

9. Encourages and moves patients/caregivers towards self-management of patient’s care.

10. Initiates a plan of treatment and makes necessary revisions based on nursing assessment. The plan of care is established based on collaboration with patients, caregivers and physicians. Establishes appropriate goals and discharge plan. Established and revised plan of treatment in accordance with physician orders. Routinely re-evaluates plans of treatment and updates as needed.

11. Utilizes Best Practices as available in all aspects of patient care.

12. Utilizes Disease Management programs once established.

B. Communication

1. Able to communicate effectively while maintaining good working relationships with co-workers, managers and office staff.

2. Acts as a resource for patients to ensure understanding and compliance of the assessment plan.

3. Participate in interdisciplinary case conferences, in-service programs, and committee meetings.

4. Communicates to Case Manager, physicians and/or Director of Patient Care Services changes in the patient condition and needs.

C. Documentation

1. Prepares complete, concise and clear documentation of nursing interventions, goals, patient’s response to treatment, changes in patient condition and coordination with other services.

2. All documentation is completed timely within agency policies.

3. Effective oral and written communication skills for reporting and recording clinical findings.

D. Education

1. Participates in age specific educational and training programs.

E. Case Management

1. Responsible for the overall planning, ongoing care, and discharge planning of the patient’s care.

2. Responsible that the patient’s plan of care meets all regulations, and that payment is authorized when necessary.

3. Responsible for notifying physicians of changes to the plan of care and/or barriers to plan of care.

4. Responsible for communication with other disciplines as appropriate.

5. Responsible for maintaining an accurate schedule per agency process, including appropriate clinical needs ie. labs etc., completing or assigning recertification within CMS requirements, and scheduling supervision of CHHA/LVN.

6. Responsible for reporting patient’s care, progress and barriers to plan of care in Case Conferences and as needed to DPCS.

7. Responsible for appropriate follow up to patient’s labs as appropriate.

F. Supervision

1. Responsible for Supervision of CHHA by establishing CHHA plan of care, performing and documenting CHHA supervisory visits every 14 days, and updating the CHHA plan of care as needed.

2. Responsible for Supervision of LVN by overseeing patients’ care, communication with LVN, updating the plan of care as needed, performing and documenting LVN supervisory visits every 30 days.

Non-Essential Duties:

• Participates in Quality Improvement (QAPI) process as requested in utilization review (UR), chart audits and Performance Improvement committees.
• Provides support and direction for nursing students and other health care students.
• Participates in orientation of RN’s, LVN’s, and CHHA’s.
• Other duties as assigned.

Knowledge, Skills and Abilities:

Knowledge

• Knowledge of the Nursing Process includes assessment, and planning of patient’s care, overseeing appropriate patient’s care within scope of practice.

• Knowledge of Agency’s policies, procedures and practices.

Skills

• Caring bedside manner: ability to provide services with compassion and caring.

• Effective oral and written communication skills with case managers/DPCS and patient/caregiver as appropriate.

• Strong assessment skills.

• Strong clinical and critical thinking skills.

• Basic computer skills required.

Abilities

• Organization – must demonstrate basic ability to maintain schedule of home visits and complete paperwork according to agency procedures.

• Ability to connect with patients and families in their homes in a kind and compassionate way.

• Ability to project and maintain professionalism in all aspects of patient’s care.

• Ability to function independently seeking assistance when appropriate.

• Ability to supervise LVN’s and CHHA’s as required.

• Ability to take ownership of patient’s plan of care including establishing an appropriate plan of care, overseeing that care is done according to plan of care, communicating with physician and revising plan of care as needed.

• Ability to understand basic Home Health regulations and the financial impact of care being provided.

• Ability to oversee all aspects of the patient’s care, insuring it meets all regulations, and that payment is authorized as required.

AVMC Values: All AVMC employees will effectively demonstrate these values:

• Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.
• Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
• Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.
• Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.
• Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
• Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.
• Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.

Education and Experience:

Education

• Must have successfully completed an approved course and graduated from an approved school of nursing, prefer BSN degree.

Experience

• At least 1-year recent relevant clinical experience as an RN in an acute hospital setting or subacute setting such as SNF or long-term care facility.

• Home Health experience preferred. Must have strong clinical skills in order to function independently in the field.

Required Licensure and/or Certifications:

• Current licensure as an RN in California.
• Current CPR certification.
• Maintains a valid California driver’s license and evidence of current auto insurance.

AVMC Conduct/Compliance Expectations:

• Ability to adhere with AVMC Attendance and Punctuality Policy.

• Ability to adhere with AVMC Leaves of Absence Policy.

• Ability to adhere with AVMC Paid Time Off (PTO) Policy.

• Ability to adhere to the department dress code.

• Ability to organize work and establish priorities.

• Ability to expand on own initiative in performance of duties.

• Skill and ability to follow the telephone etiquette/standards.

• Ability to function effectively under pressure and meet time parameters.

• Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff.

• Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVMC.

• Ability to maintain the confidentiality of patients, hospital and department information.

• Ability to adhere to safety rules and regulations.

• Safely and effectively use all the equipment necessary to carry out duties.

• Ability to interpret and function under hospital and department policies and procedures.

• Conforms with required and appropriate accreditation and regulatory requirements.

• Conforms with and supports hospital quality assurance and improvement guidelines.

• Ability to participate effectively in department and hospital staff education.

• Display a willingness to work as a team player.

• Ability to give and support the highest level of patient/customer satisfaction at all times.

• Supports and adheres to the values and mission statement established by the AVMC Board of Directors.

• Ability to demonstrate knowledge and understanding of the Compliance & Integrity Program and its established policies.

• Ability to follow the Code of Conduct.

Key Physical Requirements and Working Conditions:

• Must meet job physical standards: vision, hearing, and manual dexterity, ability to walk and meet lifting requirements.
• Must be able to tolerate repetitive hand and arm movements
• Able to walk to and from patient home and employee vehicle
• Able to lift and/or carry up to 10 pounds
• Home Care: Exposure to a variety of home environments; may involve exposure to variable weather conditions.
• Hospital: If doing direct patient care a description of the physical requirements of the job is obtained in the Employee Health department.

A detailed description of the physical requirements of this job is maintained in the Employee Health Department.

NOTE: THE ABOVE STATEMENTS ARE INTENDED TO DESCRIBE THE GENERAL NATURE AND LEVEL OF WORK PERFORMED BY PEOPLE ASSIGNED TO THIS JOB. THIS DOCUMENT IS NOT INTENDED TO BE AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES, SKILLS, AND WORKING CONDITIONS FOR THE PERSONNEL SO CLASSIFIED.

Education and Experience:

Education

• Must have successfully completed an approved course and graduated from an approved school of nursing, prefer BSN degree.

Experience

• At least 1-year recent relevant clinical experience as an RN in an acute hospital setting or subacute setting such as SNF or long-term care facility.

• Home Health experience preferred. Must have strong clinical skills in order to function independently in the field.

Required Licensure and/or Certifications:

• Current licensure as an RN in California.
• Current CPR certification.
• Maintains a valid California driver’s license and evidence of current auto insurance.