Registered Nurse - Transition Team

Overview

Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center in Washington.

With a track record of global leadership in bone marrow transplantation, HIV/AIDS prevention, immunotherapy and COVID-19 vaccines, Fred Hutch has earned a reputation as one of the world’s leading cancer, infectious disease and biomedical research centers. Fred Hutch operates eight clinical care sites that provide medical oncology, infusion, radiation, proton therapy and related services, and network affiliations with hospitals in five states.

Together, our fully integrated research and clinical care teams seek to discover new cures to the world’s deadliest diseases and make life beyond cancer a reality.

At Fred Hutch we value collaboration, compassion, determination, excellence, innovation, integrity and respect. Our mission is directly tied to the humanity, dignity and inherent value of each employee, patient, community member and supporter. Our commitment to learning across our differences and similarities make us stronger. We seek employees who bring different and innovative ways of seeing the world and solving problems.

The Transition Registered Nurse provides transition and discharge teaching/planning for patients along the continuum of care. Care planning includes assessment, evaluation and integration of care with a multi-disciplinary team, focusing on continuity of care throughout the system. The nurse also interfaces with home infusion/homecare agencies and SNFS.

This position is 0.71 FTE, 28.4 hours/week.

• Assesses physical, emotional, social, and spiritual needs and evaluates patients’ adaptation to health changes
• Develops a plan of care based on patients’ disease, symptoms, and response to treatment
• Educates patients, families, and caregivers on disease processes, treatment, side effects and symptom management
• Coordinates with inter-disciplinary team to ensure continuity of care
• Refers patients, families and caregivers as appropriate to other clinical resources/professionals such as social work, home health care, clinical nutrition, etc.
• Implements, evaluates and modifies plan of care
• Integrates research and evidence based knowledge into clinical practice

In addition to primary responsibilities, skills, education and experience listed in the job description, the Transition RN will have the following key responsibilities:

• Able to provide Transition Planning services at the UW Medical Center and the Fred Hutch Clinic
• Participate in assessment and evaluations of patient/family care throughout transitions.
• Participate in the nursing coordination for individual patient/families transitioning to various areas of care.
• Coordinate patient care plans with home infusion agencies, home care agencies and skilled facilities.
• Document assessments, interventions, plan in the Medical Record after each patient encounter.
• Collaborate with a multi-disciplinary team to ensure continuity of patient/family care throughout transition.
• Teach classes for patients and families both on a 1-on-1 basis and in a classroom setting.
• Function as liaison with insurance company case managers throughout treatment process including providing outpatient utilization review updates as needed.
• Communicates in a respectful and effective manner with other staff.
• Act as Clinic ambassador to Inpatient Units, infusion companies, and referring offices when appropriate.
• Facilitates as smooth a transition as realistically possible.
• Support a patient and family centered philosophy
• Listen to concerns of patient /families and/ caregivers in an objective manner.
• Review complicated discharges with Transition Supervisor to develop an overall plan and promote a consistent message.
• Informs Transition Supervisor of high-risk patient situations or operational issues.
• Discuss discharges briefly at beginning of each day with other Transition RN’s and assume appropriate workloads.
• Follows report guidelines for transition.
• Serves as a resource regarding transition to…