RN Nursing Coordinator - Children's Complex & Palliative Care

** Description*
* ** Children's Complex & Palliative Care Joint Nurse Position*
* The Children's Supportive Care Team (CSC), the pediatric palliative care service at UNC Children's, is expanding its clinical activities to the outpatient setting. The Children's Complex Care (CC) program continues to grow its clinician capacity and patient base. A nurse shared between the two related services would (a) grow clinical capacity in both services; and (b) increase care quality and safety for vulnerable patients, particularly around hospital-to-home transitions.

** Role

Description:

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* This role will provide transitional (inpatient-outpatient and outpatient-inpatient) and outpatient support for Complex and Palliative Care patients to improve care continuity, reduce hospital length of stay (LOS), prevent readmissions, and enhance patient satisfaction. The nurse will collaborate across teams to increase the outpatient reach of complex care and to support the development of outpatient pediatric palliative services while conducting continuous quality improvement.

Key responsibilities include the following:

+ Screen and refer eligible inpatients to complex care program.

+ Conduct check-in visits for inpatients as they approach discharge.

+ Ensure post-discharge follow-up for complex and palliative care patients.

+ Provide close follow-up for high-risk discharged patients to prevent hospital readmissions by managing symptoms and supporting care goals.

+ Offer phone triage and schedule same/next-day visits to reduce ED visits and hospitalizations.

+ Identify themes in care transitions, especially "near misses," and address gaps in care.

+ Coordinate with inpatient and outpatient teams through TCM and Epic In-Basket support to optimize transitions and ongoing care.

+ Contribute to continuous quality improvement efforts, expanding outpatient reach and developing palliative care services to improve patient satisfaction and outcomes.

This position qualifies for a $10,000 commitment incentive.

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Summary:

Provides clinical administrative nursing care coordination in support of a patient care area. Duties include one or more of the following care coordination, discharge planning, data analysis and performance metrics, and patient/staff education.

Responsibilities:

1. Assesses patient status of a specialized population. Rounds with an interdisciplinary health care team to determine patient care needs and coordinate ongoing acute care and long-term needs. Uses expertise and experience in specialty practice to facilitate patient care. Acts as a liaison between the patient, family and health care team to communicate patient care needs including coordination of patient/family care conferences.

2. Collaborates with health care team to provide information and resources to facilitate patient care. Provides in services and formal presentations to nursing, medical and ancillary staff on topics related to the specialized patient population. Assist staff in the development of patient education materials for the patient population. Perform patient teaching related to specific topics and patient needs. Documents patient teaching in the medical record in the appropriate sections

3. Collects data related to specialized patient population and analyzes for trends. Enters data or coordinates its entry into databases and registries for benchmarking purposes. Participates in performance improvement activities to promote quality patient care. Analyzes data for trends and makes suggestions for revisions to patient care protocols for the patient population. Monitors outcomes of care for patient population and collaborates with the interdisciplinary health care team on evaluation of outcomes.

4. Coordinates patient care for post-hospitalization care and discharge planning. Makes referrals to other care providers during acute care episode and for post-discharge care. Communicates discharge needs to interdisciplinary health care team, patient and family. Coordinates appointments with clinics, outside referral sources, home care, durable medical equipment providers and other providers to ensure continuity of care for the patient. Attends care conferences and interdisciplinary care rounds.

Documents care planning and communication with health care providers in the medical record.

5. Promotes own professional development through attending in services and presentations. Keeps current in practice through conferences, reading current literature and research. Role models professional nursing practice to others through use of the nursing process and professional behaviors

** Other Information*
* Other information:

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* Education Requirements:

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* ● Graduation from a state-accredited school of professional nursing

** Licensure/Certification Requirements:*
* ● Licensed to practice as a Registered Nurse in the state of North…