RN SSU-Registered Nurse Surgical Specialty Unit

Job Summary

At Mercy One, health care is more than just a doctor’s visit or a place to go when you’re in need of medical attention. Our Mission is based on improving the health of our communities – that means not only when you are sick but keeping you well.

Full time

12 Hour Day Shift (RNs work 12‑hour shifts, day shift 7:00 a.m. – 7:30 p.m., rotating weekends and holidays).

• Conducts an initial assessment to gather data.
• Makes an initial assessment of new admissions within 30 minutes of the patient’s arrival to the unit.
• Completes all areas of the admission assessment database within 24 hours of admission.
• Identifies patient problems and develops them into an outcome/goal‑based plan of care.
• Initiates the patient problem list and incorporates relevant medical history into the plan of care.
• Analyzes and interprets the assessment data to identify desired patient outcomes/goals.
• Determines nursing interventions to achieve those outcomes/goals.
• Prioritizes patient care needs/activities.
• Identifies and makes appropriate referrals (i.e., Patient/Family Services, Nutritional Services, Spiritual Care, Diabetic Educator, etc.), and education needs.
• Collaborates with other health care disciplines to plan interventions/ patient outcomes/goals.
• Implements the outcome/goal‑based plan of care.
• Assigns and coordinates patient care incorporating patient acuity and the skills, knowledge and abilities of the team members.
• Organizes and prioritizes care for the patients within the team.
• Delegates tasks appropriately to other team members.
• Implements the plan of care including procedures, treatments, physicians orders, nursing orders, education plan and medications.
• Coordinates implementation of plan of care with the Case Manager, Social Worker and other health care disciplines.
• Assists to decrease the patient’s length of stay by helping the patient and family identify and secure appropriate services to satisfy health‑related needs upon discharge.
• Uses nursing judgment to determine the appropriate frequency and components of reassessment.
• Reassesses at regular intervals to determine patient response(s) to interventions (minimum RN reassessment every 24 hours).
• Focuses ongoing reassessment on actual and potential problems/needs of the patient including education and discharge needs.
• Participates in develop discharge plan.
• Documents discharge instructions for patient and/or significant other and/or other care provider.
• Evaluates patient progress and revises the outcome/goal‑based plan as needed.
• Evaluates patient response(s) to interventions.
• Review/modifies/revises the outcome‑based plan of care based on ongoing reassessments.
• Updates the problem list and outcomes/goals.
• Communicates relevant clinical information to the team to optimize patient outcomes/goals.
• Communicates relevant clinical information to physicians regarding the patient’s condition.
• Reports progress toward outcomes/goals and/or changes in condition to other health team members.
• Maintains ongoing communication with interdisciplinary team members throughout the shift, at shift change, and transfer of care.
• Communicates with other team leaders and members throughout the shift to reassess and prioritize the needs of the unit.
• Documents completely, comprehensively and legibly and in accordance with policy.
• Demonstrates clinical competence.
• Utilizes Patient Care Policies and Procedure as references to guide nursing practice.
• Assures medication safety by following the “5 Rights” of medication administration.
• Prioritizes and implements intervention according to patient assessment.
• Demonstrates competency in computer systems and applications required for role.
• Receives, transcribes and processes and implements physician orders per policy including dating, timing and verifying accuracy.
• Maintains communication with the manager/house supervisor and staffing office regarding admissions, unit needs, acuity numbers and significant events.
• Completes assigned shift duties and assures resolution of discrepancies.
• Manages telemetry and cardiac monitoring when applicable.
• Demonstrates clinical competency and technical knowledge in cardiac rhythm interpretation and…