Field Registered Nurse Homecare Dimensions

Registered Nurse – Home Health

The Registered Nurse will plan, organize, and direct home care services with an emphasis on community health education and family involvement. The role supports patients and their families to achieve independence and enhanced health outcomes.

• Complete initial patient and family assessments to determine home‑care needs, including physical assessment and health history.
• Re‑evaluate patient nursing needs regularly using health‑assessment data and the OASIS data set.
• Develop and update a Plan of Care that incorporates goals, therapeutic interventions, preventive and rehabilitative nursing actions.
• Include the patient and family in the planning process and make necessary revisions as patient status changes.
• Plan and implement patient health teaching and counseling regarding disease processes, self‑care, and prevention.
• Administer medications and treatments as prescribed and coordinate discharge planning.
• Coordinate all patient care, including communication with physicians, pharmacists, and other disciplines, and document all communications.
• Identify and report life‑threatening situations and respond appropriately.
• Provide information regarding home medical equipment and supplies and utilize equipment effectively.
• Perform care‑management duties such as notifying physicians of changes, obtaining orders, reassessing for recertification, attending case conferences, and coordinating care.
• Follow agency Standard Operating Procedures and documentation requirements.
• Maintain a trusting relationship with patients, caregivers, and team members and observe patient rights and privacy practices.
• Participate in educational programs, in‑service training, and performance‑improvement activities.
• Promote an environment compliant with federal, state, and local regulations, and assist with accreditation and licensing activities.

• Prepare clinical notes and update the primary physician at least every 60 days.
• Communicate with the physician regarding patient needs and obtain orders as required.
• Coordinate services and schedules with the Clinical Team Manager and Clinical Team Coordinator within 24 hours of Start of Care.
• Update clinical team and document patient status changes promptly.

• Participate in on‑call duties and weekend shifts as assigned.
• Ensure arrangements for equipment and necessary services are available.
• Instruct, supervise, and evaluate Home Health Aides every two weeks and Licensed Vocational Nurses every thirty days.
• Maintain daily patient case load and documentation standards.
• Work during business hours (8a.m.–6p.m.) and update electronic timecards daily.
• Contact patients the night before visits, provide arrival time windows, and arrange pre‑approval for overtime.
• Demonstrate flexibility, punctuality, and a positive, collaborative communication style.
• Adhere to the agency’s dress code and maintain privacy and confidentiality.

• High school diploma or equivalent; graduate of an accredited nursing school.
• Registered Nurse with an active unrestricted license to practice nursing in Texas.
• Valid Texas driver’s license and required auto insurance coverage.
• Current CPR certification.
• Minimum 2years of clinical experience, preferably in community, home‑health, or medical/surgical settings.
• Experience with electronic medical record applications.
• Thorough knowledge of current nursing practice, professional standards of care, and state/federal home‑care regulations.
• Bilingual proficiency in English and Spanish.
• Strong analytical, communication, and problem‑solving skills.
• Ability to lift, reach, bend, and stand for significant periods.
• Sound visual and hearing acuity needed for nursing tasks.
• Basic computer skills:
  Microsoft Word, Outlook, and e‑mail systems.
• Ability to comply with professional standards and practice independently.
• Prior experience in delivering nursing care in a home‑health environment.

• Bachelor’s degree in nursing.
• Experience with TB screening and proof of immunity to measles, mumps, rubella, varicella, tetanus, diphtheria, and pertussis.

Patient home settings that may involve exposure to…