Registered Nurse

The Home Health Registered Nurse is responsible for nursing care in accordance with the client's plan of care, and includes comprehensive health and psychosocial evaluation, monitoring of the client's condition, health promotion and prevention, coordination of services, teaching and training activities, and provision of direct nursing care and other duties as deemed necessary.

Responsibilities

• Coordinates total patient care.
• Conducts the admission and / or recertification of the patient to the Agency by :

Obtaining a medical history, particularly as it relates to the present condition, from the patient and / or family member(s).

• Completing an OASIS Assessment by performing a physical examination of the patient, including vital signs, physical assessment, mental status, appetite and type of diet, etc.
• Evaluating the patient, family member(s) and home situation to determine what health teaching will be required.
• Evaluating the patient's environment to determine what assistance will be available from family members in caring for the patient.
• Evaluating the patient's condition and home situation to determine if the services of a home health aide will be required and the frequency of this service.
• Interpreting nursing and other services of the Agency to patients and families as a part of planning for care.
• Provides skilled nursing care as outlined in the nursing care plan to include the following :

Nursing services, treatments and preventative procedures requiring substantial specialized skill and ordered by the physician.

• Initiating preventative and rehabilitative nursing procedures as appropriate for the patient's care and safety.
• Develops and implements the nursing care plan.
• Teaches, supervises and counsels the patient and caregivers regarding nursing care needs and other related problems of the patient at home.
• Reports to the physician reactions to treatments, including drugs, and changes in the patient's physical or emotional condition through observing signs and symptoms.
• Participates in the patients discharge planning process.
• Supervises the LPN or the LVN.

Supervisory visits are performed at a minimum every thirty (30) days.

• Is responsible for the care given by the home health aide to patients in her care by :

Preparation of a care plan for the Home Health Aide / Personal Care Aide.

• Supervising and evaluating the care given by the home health aide as needed and at a minimum of once every 14 days.
• Participating in periodic conferences with the home health aide supervisor concerning the aide's performance.
• Documents the services rendered to the patient by the staff nurse, changes noted in the patient's condition and / or family and home situation, makes revisions in the nursing care plan as needed, records supervisory visits conducted with the home health aide and LVN, evaluates patient care and progress and closes charts of discharged patients.
• Evaluates clients response to care and discusses progress of client with physician, supervisor and / or other caregivers.
• Consults and participates in the development and periodic revision of the physician's Plan of Care and processes change orders as needed.
• Evaluates the effectiveness of nursing service to the individual and family.
• Discusses with the supervisor any problems and concerns the patient may have requiring such as the home health aide, physical therapist, speech therapist, occupational therapist, social worker, etc.
• Obtains orders for paraprofessional service and submits referral to appropriate personnel.
• Cooperates with other agencies providing nursing or related services to provide continuity of care and to implement a comprehensive care plan.
• Prepares and participates in presents patient's record to the Clinical Record Review Committee as part of the QAPI Program.
• Participates in the planning, intervention implementation and evaluation of the plan of care.
• Conducts or participates in team meetings / case conferences to evaluate clients response to care, the need to recertify patient, alter the plan of care, or the need to add or discontinue a discipline.
• Uses appropriate communication strategies to affect positive client care outcomes.
• Practices with professionalism and accountability as employee of the home health agency.

Adheres to Agency policies.

• Organizes prioritizes and provides care and other work assignments in a timely and cost-effective manner.
• Practices fiscal responsibility by providing timely and accurate OASIS documentation including accurate ICD-10 coding.
• Submits clinical notes per policy, progress notes and other clinical record forms outlining the services rendered as indicated.
• Participate in the on-call rotation after house and weekends as necessary.
• Maintains an on-going knowledge of current drug therapy.
• Participates in staff development meetings, trainings and education in safety practices and procedures, such as annual OSHA training.
• Follows established federal, state or local policies, procedures and programs relating to health and safety in the workplace.
• Performs other duties as assigned.

Driving & Other Requirements

Must have and maintain a valid state driver license, have a registered and reliable vehicle that meets state law standards, and meets the insurance standards of company. Position requires travel between company sites as well as the community. Traveling by car or airplanes to local or out-of-town meetings, seminars, and conferences.

Education, Experience & Job Requirements

This position requires at least the following minimum requirements :

• Current and valid Registered Nursing license in the state(s) practicing.
• Related two years experience in related field preferred.
• Current CPR Certification.
• Knowledge of Medicare and Medicaid guidelines preferred.
• Skillful in organization of work and in principles of time management.
• Ability to contribute to the quality of care being rendered through constructive communication with nursing managers and nursing staff.
• Good communication skills and ability to establish good rapport with team members.
• Working knowledge of home health and / or hospice care and the principles and techniques of professional nursing and required documentation thereof.
• Demonstrated ability to work with patients and employees.
• Demonstrated ability to work in a proactively, diverse and inclusive organization.
• Must have excellent written communication by writing clearly and informatively, edits work and able to read and interpret legal written information.
• Demonstrates accuracy, thoroughness and follows through on commitments.
• Must practice a high level of confidentiality and be able to effectively responds to questions from employees, managers and outside entities.
• Must have excellent communication skills, both verbal and written.
• Must be able to work with others to resolve issues and maintain composure in an environment of changing priorities.
• Must have knowledge of all company policies and procedures.
• Must be able to work on a timetable, follow instructions, respond to management direction and solicit feedback to improve performance.
• Should have excellent character references and solid work background.
• Must be able to read, write and speak English. Spanish is preferred.
• Must have knowledge and proficiency of office computer equipment and EMR software.
• Demonstrate ability to multi task and work in a fast-paced office setting.
• Proven ability to cope with conflict, stress and crisis situations.