Hospice Nurse

General Summary The Hospice Nurse Case Manager interacts with patients, families and caregivers as a member of the Hospice of Dubuque Interdisciplinary Team and is responsible for the supervision and provision of all nursing services for assigned patients. The Hospice Nurse Case Manager may admit patients to the hospice program, complete the initial assessment for the plan of care, and participate in access to hospice admissions 7 days per week.

The Hospice Nurse Case Manager is responsible for managing his/her assigned client case load and participates in completion of the comprehensive assessment and updates to the comprehensive assessment for assigned patients. The Hospice Nurse Case Manager performs nursing assessments, provides client care/interventions and implements plan of care changes. The Hospice Nurse Case Manager participates in on-call that allows patients/families access to nursing care 24 hours per day, 7 days per week.

The Hospice Nurse Case Manager performs all duties within agency policies and procedures and documents within agency recordkeeping policies. The Hospice Nurse Case Manager must maintain high standards of integrity and business ethics and provide patient care in accordance with current professional standards of practice.

Principal Duties and Responsibilities Serves as a member of the Interdisciplinary Team.

Serves as nurse case manager of assigned patients/families, demonstrating responsibility for the supervision and provision of all nursing services for assigned patients.

Visits patient in his/her place of residence to provide nursing care and perform interventions.

Assesses patient/family needs for development of the initial and/or comprehensive plans of care.

Performs the admission process, as assigned, including conducting the initial assessment of patient/family needs, developing the initial nursing care plan for the initial plan of care, and establishing the coordinated plan of care between Hospice of Dubuque and the patient’s facility of residence, if applicable.

Implements the plan of care that has been established to meet the assessed patient/family needs, by providing direct nursing services and treatments and evaluating interventions as a part of the comprehensive assessment update.

Participates in the comprehensive assessment updates to the plan of care.

Instructs patients and families in the care/services established in the plan of care, provides instruction in the care of the patient with a terminal illness and educates regarding disease progression.

Provides supportive counseling and facilitates communication among family members and healthcare providers.

Informs physician of patient status and significant changes in a timely manner.

Submits care plan and goals of individual patients for periodic review and evaluation by the attending physician.

Participates in access to hospice admissions 7 days per week, as assigned.

Participates in patient/family access to hospice nursing care 24 hours per day, 7 days per week through Hospice of Dubuque nursing on-call schedule.

Participates in the Hospice of Dubuque Quality Assessment and Performance Improvement Program.

Oversees completed filling of prescriptions, delegates as appropriate.

Prepares written instruction for, and performs supervision of, the hospice aide.

Supervises and teaches other nursing personnel, including the LPN and/or hospice aide.

Reviews prescribed diagnostic tests, and from this information, evaluates patient’s symptoms and healthcare needs.

Records physical findings, planned interventions and results of intervention in a timely and concise manner.

Recommends or initiates, when the IDT assesses it as a needed intervention, medications or other forms of symptom management such as PT, OT, ST…