RN Hospice Nurse Case Manager – Wellspring Hospice – Akron, OH

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JOB DESCRIPTION

JOB TITLE: Registered Nurse

REPORTS TO: Director of Clinical Services

A. BASIC PURPOSE

Oversees primary caseload of Hospice patients and provides skilled professional nursing care to them, their families and caregivers as prescribed by the physician and in compliance with the
Hospice Medicare Conditions of Participation, Ohio Hospice licensure laws and agency policies and procedures. Provides the initial assessment and comprehensive nursing assessment of patient needs and collaborates to develop the Hospice Interdisciplinary Team (IDT) plan of care. Implements the plan of care and reevaluates and revises the plan of care relative to the patient’s nursing needs to provide appropriate, comprehensive and responsive goals and interventions. Works closely with other members of the IDT to ensure all patient and family care needs are being met. Communicates the patient’s progress with the patient/caregiver and other disciplines as well as directs, supervises and instructs direct care staff members and non- professional hospice aide staff to deliver quality care and coordinates delivery of care services.

B. PRIMARY RESPONSIBILITIES

Nursing Process

As a member of the IDT, the Registered Nurse (RN) utilizes the nursing process to contribute to each patient’s total plan of care.

1. Assessing and Planning

1. Seek and obtain sufficient information necessary to function effectively in the Hospice setting where the patient/family/caregiver is receiving care.

2. Conduct initial assessment, including physical, emotional and psychosocial aspects, of patient/family/caregiver in a thorough, accurate, compassionate and timely fashion.
Admitting paperwork and patient care plans must be submitted within 24 to 48 hours of admission. Assures that all paperwork is completed in full at time of submission for timely data entry, IDT and plan of care information.

3. Submits re-certification paperwork (new Medication Profile, updated plan of care, updated Hospice Aide plan of care) within 24 to 48 hours.

4. Reports significant patient status changes and needs due to changes to other disciplines and appropriate agency staff, Assistant Clinical Director and patient’s physicians. Submits change orders within 48 hours of occurrence.

5. Utilize the nursing body of knowledge to provide leadership and guidance to the IDT in formulating and individualizing the interdisciplinary plan of care to include problem identification, interventions and goals to address palliative comfort measures for the terminally ill patient, family and caregiver.

6. Contribute to identifying both active and potential needs of the patient and his/her family, which may affect the plan of care.

7. Consistently collaborate with the physician to plan and implement the medical and nursing plan of care.

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8. Review the nursing component of the comprehensive interdisciplinary plan of care with the IDT. Communicate in writing in the clinical record and verbally with the IDT to coordinate interventions and ensure continuity of care.

9. Facilitate and participate in the IDT care conference and contribute to patient care planning. Complete communication note for IDT that reviews patient’s needs, problems, level of care and any changes in the Plan of Care for the next cert period, which is agreed upon by the IDT and patient.

10. Submit completed skilled nursing notes, communication notes and hospice aide supervisory notes per agency policy.

11. Participates in on-call rotation, community programs and committees as requested.

2. Implementing and Evaluating
1. Provide nursing interventions and appropriate preventative and therapeutic nursing procedures.
2. Collaborates with IDT members to provide continuous assessment of assigned patients, interprets findings, initiates appropriate therapeutic actions and evaluates the results of these actions.

3. Accepts responsibility of assignment to perform a specialized procedure only when qualified with specialty training, proven competency, clinical background and expertise in the specialty area.

4. Provides appropriate information and explanation to the patient and patient’s family.
5. Facilitates patient and family education to promote continuity of care and optimal patient/family outcomes for quality of life as defined by the patient/family/caregiver.
6. Demonstrates expertise in the utilization of all IDT members including volunteers and community resources.
7. Fulfills productivity requirements on an average daily census basis as determined by acuity level and Assistant Clinical Director.
8. Documents accurate, complete and relevant clinical notes regarding patient’s condition and care given. Maintains documentation in a timely basis.
9. Reports identified performance related problems; patient complaints and/or deviation to the Assistant Clinical Director.
10. Assesses the dietary/nutritional needs of hospice patient and provides appropriate interventions relative to nutritional intake as the patient’s condition progresses.

Education

The RN is a mentor who is able to provide educational experiences and communicate knowledge of patient care to members of the IDT including, but not limited to, volunteers, hospice aide/homemaker, patient and family/caregivers, health care professionals and the general community.

1. Acts as a mentor to other personnel by participating in orientation and assisting with field training and in-service education to contractors and referral sources, as needed.
2. Participates in formal and informal in-services, and patient care conferences to promote professional growth of all IDT members.
3. Teaches the patient, family and/or caregiver regarding the progression of the disease process and self-care techniques as appropriate, which includes providing medication, dietary/nutritional counseling support and other instructions as ordered by physician, recognizing and utilizing opportunities for health counseling.

4. Supervises, provides direction and instruction related to the provision of personal care and related support services as needed to the Hospice Aides/Homemakers/STNAs.

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5. Performs hospice aide supervisory visits at least every 2 weeks (14 days) per Medicare
Conditions of Participation. Should biannually do this with aide present.

6. Evaluates effectiveness of educational experiences and teaching methods in order to promote ongoing professional development of Hospice staff and quality patient outcomes for patients, families and caregivers.

Case Management

The RN is responsible for managing all patients assigned to his/her primary caseload by utilizing the following methods:

1. Efficiency

1. Manages daily visits and assignments for maximum efficiency.
2. Provides skilled nursing visits according to visit schedule and notifies agency of need to alter schedule in any way.
3. Visit frequencies are according to individual patient needs and acuity; reviewed at least weekly and altered to meet patient needs and acuity.
4. Patient care visits are coordinated with all IDT members in order to utilize manpower resources and provide optimal patient care.

2. Communication a. Introduces self and clarifies role to patient/family/caregiver, physicians, nursing facility staff and other referral sources. b. Effectively communicate with all members of the healthcare team. Act as the patient’s advocate and liaison to assist in communicating the patient’s needs to the IDT team. c. Recognizes and responds appropriately to verbal and non-verbal cues. d. Communicates effectively with all members of the IDT by: i. Defending and supporting peer/team decisions and actions. ii. Asserting self with tact. iii. Supporting collaboration and team decisions/plans. iv. Maintaining open communication. v. Offering suggestions and criticisms constructively. vi. Asking questions and sharing information during IDT conferences and nursing facility care conferences. e. Relates complete and pertinent information in verbal and written communication.

Maintains clinical records, statistics, and reports as prescribed and in compliance with local, state and federal laws. f. Initiates and maintains open and effective communication with supervisor as well as members of the IDT as evidenced by improved patient outcomes.

Job Type: Full-time

Pay: $70,000.00 – $90,000.00 per year

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee discount
  • Flexible schedule
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Medical Specialty:

  • Geriatrics
  • Hospice & Palliative Medicine

Schedule:

  • 8 hour shift
  • Monday to Friday

Supplemental Pay:

  • Signing bonus

Experience:

  • Hospice care: 1 year (Required)

License/Certification:

  • RN (Required)
  • BLS Certification (Preferred)

Work Location: On the road

Source: Indeed.com
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