Overview
Collaborates with the HSP Clinical Manager and/or Peer Mentor to provide, coordinate, and direct the application of competent hospice nursing services and case management processes according to the assigned patient's individualized plan of care and care center policies and procedures.
Responsibilities
- Demonstrates knowledge of hospice care and competency in discipline specific patient care skills, required by policy and procedures for the provision of patient care.
- Performs patient comprehensive assessments and collaborates with the interdisciplinary care team (IDT) and other health care professionals to develop/modify and implement an individualized patient plan of care as per physician orders which ensures quality, proper discharge planning, and the achievement of desired outcomes and goals.
- Provides clinical episode management according to company processes including oversight of patient's individualized plan of care and care plan changes as deemed necessary by patient's status or physician's ordered care.
- Utilizes a combination of care center resources, standards of best practice, and appropriate specialty programs to deliver high quality care, desired outcomes, excellent pain and symptom management, and high-quality end-of-life care.
- Works collaboratively with the interdisciplinary team members to ensure patient identified needs and support are met, making referrals as needed.
- Initiates appropriate hospice and palliative care interventions.
- Works in cooperation with the family/caregiver and interdisciplinary team to meet the emotional needs of the patient/family/caregiver.
- Utilizes accepted company teaching materials and provides patient/family/caregiver teaching regarding pain and symptom management. Advocates and ensures patient participation in care planning and goals of care.
- Once deemed competent, supervises caseload including LPN's and Hospice Aides. Facilitates care coordination with PRN staff when care is provided for caseload.
- Completes documentation timely, accurately, and at the point of care, according to industry standards, interventions, and guidelines, including Admissions, Recertifications, Deaths, ABNs, physician orders, care coordination etc.
- Helps to achieve and maintain continuity of patient care by communicating information timely, effectively, and systematically with all team members providing care for the patient including MSW, Chaplain, Bereavement Coordinators, Volunteer Coordinators, Hospice Aides, paraprofessionals, physicians, family members and community resources. Facilitates
- interdisciplinary communication and follow up through care coordination on assigned caseload for duration of service.
- Participates in interdisciplinary team conferences. Leads discussion on multidisciplinary cases as appropriate.
- Maintains ongoing communication with Clinical Manager regarding progress of patients for assigned caseload.
- Remains knowledgeable of organization's quality improvement programs, participates in care center performance improvement initiatives and incorporates into patient care planning as appropriate.
- Demonstrates competency in skills for required patient care. Initiates, plans, and provides staff education, and performs competency and skills validation for care team staff such as LPNs, HSP Aides, and other RNs as appropriate. (Note: The Registered Nurse (Graduate Nurse) may not perform HSP Aide initial competency evaluations or the 12-hour HSP Aide in-service requirements.)
- Performs on-call responsibilities and on-call services to patients/families as assigned.
- Monitors assigned cases to ensure compliance with requirements of third-party payers.
- Protects, honors, and respects patient and co-worker confidentiality and right to privacy.
- Stays informed of industry knowledge and nursing best clinical practice standards.
- Participates in clinical development and continuing education programs.
- Complies with policies, procedures and regulatory mandates including but not limited to abiding to the terms of the Amedisys Compliance Program.
- Performs other duties, as assigned.
Qualifications
Required-
- Current, unencumbered license to practice as a Registered Nurse specific to the state(s) the employee is assigned to work/cover for the company. May possess either a single state license in each noncompact state and/or a compact license in their state of residence that is accepted in all Nurse License Compact (NLC) participating states.
- Nurse License Compact (NLC) documents the following: The mutual recognition model of nurse licensure allows a nurse to have one license (in his or her state of residency) and to practice in other states (both physical and electronic), subject to each state's practice law and regulation. Nurses must legally reside in an NLC state to be eligible to have a multi-state license. See list of Nurse Licensure Compact States (NLC).
- Current CPR certification.
- Less than one (1) year of clinical experience as a Registered Nurse (RN).
- Candidate must be approved by VP of Clinical.
- Demonstrated knowledge of the appropriate skills for communicating with individuals of all ages and/or cognitive abilities.
- Demonstrates interpersonal skills including verbal and written communication skills.
- Demonstrates knowledge of Federal/State rules and regulations, ACHC standards, and other regulatory requirements.
- Valid Driver's License.
- Reliable transportation and company required liability insurance.
- Must be familiar with general use and functions of the computer, such as, usernames, password concepts, internet, email, navigation of computer desktop, including starting programs, using files, and windows, effective use of navigation buttons and tool bars, ability to self-manage online HR services and online training programs.
Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.
