Hospice Registered Nurse Case Manager

Job Description Summary

The registered nurse plans, organizes and directs hospice care and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds on the resources of the community to plan and direct services to meet the needs of individuals and families within their homes and communities.

• Completes an initial, comprehensive and ongoing assessment of patient and family to determine hospice needs. Provides a complete physical assessment and history of current and previous illness(es).
• Provides professional nursing care by utilizing all elements of the nursing process.
• Assesses and evaluates patient’s status by writing and initiating plan of care, regularly re‑evaluating patient and family/caregiver needs, participating in revising the plan as necessary, and initiating the plan of care and making necessary revisions as patient status and needs change.
• Uses health assessment data to determine nursing diagnosis.
• Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process.
• Initiates appropriate preventive and rehabilitative nursing procedures; administers medications and treatments as prescribed by the physician in the physician’s plan of care.
• Counsels the patient and family in meeting nursing and related needs.
• Provides health care instructions to the patient as appropriate per assessment and plan.
• Assists the patient with activities of daily living and facilitates the patient’s efforts toward self‑sufficiency and optional comfort care.
• Acts as Case Manager when assigned by Clinical Supervisor and coordinates patient care for the assigned caseload.

• Completes, maintains and submits accurate and relevant clinical notes regarding patient’s condition and care given. Records pain/symptom management changes/outcomes as appropriate.
• Communicates with the physician regarding the patient’s needs, reports changes in the patient’s condition, and obtains/receives physicians’ orders as required.
• Communicates with community health related persons to coordinate the care plan.
• As a mandatory reporter, reports failures to comply with the requirements of FL Dept. of Health within 14 calendar days using Dept. of Health forms.
• Reports suspected abandonment, abuse, financial exploitation, or neglect of a person in violation to the department of social and health services and the proper law enforcement agency immediately when reasonable cause exists.
• Teaches the patient and family/caregiver self‑care techniques as appropriate; provides medication, diet and other instructions as ordered by the physician and recognizes opportunities for health counseling with patients and families/caregivers; works in concert with the interdisciplinary group.
• Provides and maintains a safe environment for the patient.
• Assists the patient and family/caregiver and other team members in providing continuity of care.
• Works in cooperation with the family/caregiver and hospice interdisciplinary group to meet the emotional needs of the patient and family/caregiver.
• Attends interdisciplinary group meetings.

• Participates in on‑call duties as defined by the on‑call policy; also must be available every other weekend.
• Ensures that arrangements for equipment and other necessary items and services are available.
• Supervises ancillary personnel and delegates responsibilities when required.
• Assumes responsibility for personal growth and development; maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in‑service classes.
• Fulfills the obligation of requested and/or accepted case assignments.
• Actively participates in quality assessment, performance improvement teams and activities.

• Graduate of an accredited school of nursing.
• Registered Nurse with a License in good standing to practice in the state of Florida.
• Registered nurses shall have a minimum of one (1) year of experience as a professional nurse within the last three (3)…