Registered Nurse; RN

Nursing services are provided in accordance with accepted standards of practice under the supervision of the Director of nursing and clinical operations and in accordance with the patient’s plan of care and under the guidance of the IDT.

• Administer prescribed medications and treatments as prescribed and according to the laws of scope of practice.
• Initial and ongoing assessment of the impact of the terminal diagnosis on the patient’s physical, functional, psychosocial and environmental needs and activities of daily living.
• Development, revision and implementation of the individualized plan of care and recommending revisions to the plan as necessary with the partnership of the patient, representative if any and caregiver.
• Provide consultation and continuing education to the patient/family regarding patient’s condition, medications, function, decline, diagnosis, services.
• Prepare clinical and progress notes that demonstrate progress towards established goals.
• Prepare clinical and progress notes that support the patient’s terminal diagnosis and decline (Hospice).
• Coordinate all patient/family services with prioritization of needs with the members of the interdisciplinary team.
• Use of case management approach and referring to other services as needed.
• Inform the physician and other personnel of changes in patient’s needs and outcomes of intervention.
• Provide services that are ordered by the physician as indicated in the plan of care.
• Provide counseling for the patient, caregiver and family.
• Provide patient and caregiver education.
• Determine the scope and frequency of services needed based on acuity and patient/family needs.
• Provide supervision of LPN’S/LVN’S and paraprofessionals providing services to the patient according to regulatory guidelines.
• Participate in in service programs.
• On-going evaluation of patient/family response to care.
• Assess the ability of the caregiver to meet the patient’s immediate needs upon admission and throughout care.
• Evaluate own need for support and using identified systems to meet the needs.
• Apply specific criteria for admission and re-certification to hospice care to establish appropriate levels of care and the patient’s eligibility.
• Communicate information using current process and technology available to the organization.
• Participate in the hospice performance improvement program.
• Assess risk for pathological grief.
• Assess for cultural and spiritual implications.
• Assess for verbal and non-verbal communication patterns.
• Manage discomfort providing symptom relief.
• Attend training and educational events, case conferences to continually work on specialized nursing skills related to palliative and end-of-life care. This is to include the disease process, self-care techniques, end-of-life care, process for dealing with issues of ethical concern.
• Nursing services include seeing, treating and writing orders for hospice patients in accordance with state laws.
• Provide care ordered and written in accordance with the plan of care.
• Complete initial and on-going assessments and care plans on all patients assigned. This includes preparing IDT notes q14 days prior to meeting that reflect on-going eligibility.
• Coordinate with physician to ensure completion of face to face visits on 60 day re-certifications.
• Write a clinical or progress note for all contact with patient including actual visits or phone communications and record in patient’s record.
• Teach patient and caregiver self-care techniques.
• Participation in the Home Health and Hospice QAPI programs.
• Case Management of patient’s assigned. Re-evaluate the patient with any change in condition and notify physician as well as IDT members of changes.
• Work under the direction of the hospice physician in regards to all changes in patient status and needs.
• Provide communication with all physicians involved in the plan of care and other health care practitioners as appropriate related to the current plan of care.
• Order equipment and medications patients need ensuring medications are filled before patient runs out.
• Assist DON/clinical manager in monitoring quality assurance areas, providing input in measures being monitored as well as measures that…