Job Description

Provides, teaches, and demonstrates professional nursing activities in accordance with policies and procedures of the agency, and as defined by the Nurse Practice Act of the State of Maryland, District of Columbia or Virginia.
Education

• Bachelor's degree or Graduation from a diploma, Associate's degree program in Nursing Required
• BSN Preferred
Experience
• 1-2 years RN experience (ICU, CCU, Med-Surg, Oncology, Gerontology) within last 5 years Required
• 1-2 years Home health nursing experience or successful completion of LPN to RN competency assessment Preferred
Licenses and Certifications
• Valid RN license in the District of Columbia, Maryland or Virginia, or any combinations required based on work location(s) Required and
• CPR certification Required
Knowledge, Skills, and Abilities
• I.V. therapy skills.
• Organizational skills.
• Excellent verbal and written communication skills.
• Basic computer skills preferred.
• Smart Phone experience; wound care experience.
• Analyzes and documents patients' and family's responses to interventions. Evaluates measurable progress toward goals and revise plan of care. Identifies and modifies underlying factors that impede progress toward goals. Makes recommendations for updates in the plan of care, using knowledge of interventions and resources.
• Collaborates with the patient's physician and staff in planning and evaluating patient care. Provides timely, pertinent written and verbal information to physicians and insurance case managers. Establishes visit schedule and informs patient/family and team supervisor. Uses a wide variety of community and agency resources as needed to meet patient needs. Independently manages activities of caseload mix for patients. Independently organizes patient assignments for completion of tasks within acceptable time frames. Seeks assistance from Clin III, or supervisor regarding complex patient problems. Maintains necessary clinical records, collects data, and prepares reports on activities. Submits completed admission records within 48 hours. Submits daily records within 24 hours. Recertification completed prior to recent date. Maintains caseload mix and productivity for acuity level of patients.
• Contributes to the achievement of established goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Completes annual Code of Conduct, Compliance, and other mandatory training. Complies with governmental and accreditation regulations.
• Independently develops and documents an individualized plan of care and includes patient and family in the development and revision of plan and goal setting. The care plan includes specific care interventions with expected measurable patient outcomes. Establishes and documents teaching plans for patients/families.
• Independently identifies comprehensive learning needs of designated patients. Independently develops teaching plans that specify time frames. Bases teaching and counseling plan on patient's level of knowledge, diagnosis, prescribed treatment, and available resources. Utilizes demonstration, verbal, and written instruction in order to carry out the care plan. Independently evaluates the effectiveness of the teaching plan in meeting patient/family goals. Revises as needed
• Independently implements and documents plan of care for patients with a routine to complex problems to facilitate continuity of care. Documented interventions are related to the planning of care. Interventions reflect the standard of care for patient condition/diagnosis. Interventions include utilizing agency and community resources. Performs nursing procedures consistent with home care protocols. Interventions reflect knowledge of standard home care supplies and equipment used in inpatient care.
• Is responsive to and communicates respectfully with patients/families, peers, and other health team members. Initiates and participates in regularly scheduled case conferences; includes all disciplines. Includes patient and family in mutual goal setting and care plan revision.
• Maintains effective working relationships with other departments and participates in multidisciplinary quality and service improvement teams. Participates in meetings and on committees and represents the department and agency in community outreach efforts. Enhances growth and development and enriches personal knowledge and skill through participation in educational programs and affiliations.
• Performs history and assessment related to an episode of patient illness. Identifies primary patient problems from assessment. Identifies discharge planning needs. Interprets abnormal clinical data to anticipate problems associated with changing patient status.
• Performs other duties as assigned.
• Demonstrates basic leadership skills as a Case Manager and with other responsibilities as required.
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