Registered Nurse - Discharge Planner; Acute Care

Position: Registered Nurse - Discharge Planner (Acute Care)
The Registered Nurse (RN) Discharge Planner is responsible for providing competent, evidence-based care to patients with oversight of licensed vocational nurses/nursing assistants as appropriate to the setting. The nurse is an active member of an interdisciplinary team whose primary focus is on care transitions to and from an inpatient setting.

General Description of Assigned Duties:

Demonstrate proficiency in practice based on conscious and deliberate planning. Self-directed in goal setting for managing complex client situations. Assumes responsibility for the coordination of care focused on patient education, self-management, and customer satisfaction throughout the continuum of care. Administers medications and procedures per established policies and guidelines. Influences outcomes by collaborating with members of the interdisciplinary team

Functions or Scope of Assigned Duties:

The Discharge Planner is a professional registered nurse responsible for devising and implementing discharge plans within the acute care setting. Discharge needs are identified through thorough interviews with patients/family members, care providers, medical providers, social work, and chart reviews. The registered nurse possesses the knowledge and skills to effectively apply all aspects of the nursing process with collaborative, interdisciplinary, evidence-based practice, which will enable effective care coordination and implementation of health promotion and disease prevention practices.

The Discharge Planner has the skill, knowledge, and experience to assume the following leadership roles:
Team Leader for inpatient and outpatient discharge planning, patient advocate, and patient educator.

The Discharge Planner works as Team Leader in bridging the communication gaps between the medical care team, patients, family members and care providers within the interdisciplinary team to create a well-coordinated continuum of inpatient and outpatient care.

The Discharge Planner is an effective advocate as she/he is found to be skillful in problem solving, communicating, influencing, and collaborating.

The Discharge Planner provides patient/family members/care providers with education on disease(s) or disease process with a focus on self-management, prevention, and wellness, based on the patient's health care needs and choice goals.

The Discharge Planner ensures all necessary medical equipment has been provided, (setup in the home if applicable) and patient has been educated on use.

The Discharge Planner provides pertinent information in a timely manner to the Primary Care Manager and to other service partners such as:
Community Health Coordinators for home health care setup, Home Oxygen Coordinators for home oxygen setup, Telehealth Coordinators, and other Medical Care Team members involved in the patient's care both inpatient and outpatient to ensure understanding of the patient's medical condition and post discharge needs.

The Discharge Planner ensures follow through of care has been achieved through post discharge phone calls to patient(s).

The Discharge Planner reviews patient(s) chart reviews throughout their hospital stay. Through chart reviews the Discharge Planner ensures consults, labs, test, imagining, and procedures are scheduled/completed and documented in a timely manner to avoid increase in Bed days of care.

The Discharge Planner ensures the scheduling of non-VA fee base consults and other follow up appointments as ordered or directed by the Attending provider.

The Discharge Planner ensures medication reconciliation is completed prior to discharge, discharge medications are ordered, and post discharge appointments have been made.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards

Pay:
Competitive salary, regular salary increases, potential for performance awards

Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year)

Retirement:
Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA

Insurance:
Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement)

Licensure: 1 full and unrestricted license from any US State or territory

Pay Scale: NG42

Work Schedule:

Full Time (rotational shifts)

Telework:
Not available

Virtual:
This is not a virtual position.

Relocation/Recruitment

Incentives:

Not authorized

Permanent Change of Station (PCS):
Not authorized