Home Health Registered Nurse

Key Duties Follow Agency Policies and Procedures, Federal and State Regulations and Standards of Practice. Attend Agency In‑services, Case Conferences, or other meetings as requested. Provide skilled nursing services in accordance with the orders of a physician and under a plan of care in a patient’s home. Be responsible for the observation, assessment, nursing diagnosis, counseling, care and health teaching of the ill, injured, or confined, and the maintenance of health and prevention of illness of others. (See Tactical Deliverables) Record the health needs of the patient. Perform and complete start‑of‑care assessment, medication profile, initiate Nursing or Home Health Aide plan of care, and/or Homemaker/Companion service plan and associated paperwork in accordance with agency policy. Evaluate the effects of the care given and regularly reevaluate the patient’s nursing needs. Evaluate and revise the plan of care, as necessary. Provide those services requiring substantial specialized nursing skill based on the physician’s orders and the nursing diagnosis. Examples include, but are not limited to: physical assessment, patient and family teaching, urinary catheter insertion. Foster a positive relationship with patients/caregivers and doctors to improve patient outcomes. Performance Responsibilities Will strive to improve patient outcomes. Will strive to maintain positive internal and external customer service relationships. Must be able to demonstrate effective leadership skills. Must demonstrate effective communication skills by conveying necessary information accurately, listening effectively, and asking questions when clarification is needed. Must be able to be depended upon to plan and organize work effectively and ensure its completion. Must be able to demonstrate reliability by arriving at work on time and taking breaks in expected time frames. Will be expected to meet all productivity requirements. Must be able to demonstrate team behavior and must be willing to promote a team‑oriented environment. Is expected to always represent the organization professionally. Must be able to demonstrate initiative and strive to continually improve processes and relationships. Will exercise necessary cost‑control measures. Tactical Deliverables Notify patient/clients prior to visit and communicate further visits scheduled. Drive responsibly and safely to and from client’s home. Schedule own time based on priorities and maintain productivity using time management. Provide appropriate and thorough service to patients/clients, ensuring proper completion of services in an accurate and timely manner and in accordance with agency policy. Make the initial patient/client Start of Care (SOC) assessment within an appropriate time as scheduled by the agency. Always demonstrate respectable customer service and professionalism. Establish Home Bound Status and document. Provide skilled services and/or supervise, requiring substantial knowledge and skills in accordance with the Plan of Care (POC) and accepted standards of professional practice. Determine discipline frequencies according to physician order and/or assessed needs. Implement and adhere to physician’s orders where such orders are within the legal scope of professional nursing practice, performing venipuncture and/or obtaining specimen for lab and transport to appropriate testing site as ordered. Obtain physician order or verbal orders for Start of Care (SOC) or Resumption of Care (ROC) or Recertification (RECERT) within twenty‑four (24) to forty‑eight (48) hours from time of service. Notify physician with any changes to the initial plan of care (POC) and obtain any appropriate orders. Provide teaching to patient/client and answer health‑related questions and document patient/client/caregiver understanding of education. Complete Home Health Nursing Aide care plan and make supervisory visits on Home Health Aides at least every fourteen days (14). Perform supervisory visit at least every 30 days for LPN and document in supervisory note. Document patient’s/client’s care using appropriate agency forms and submit to agency within appropriate timeline. Assess any medication changes with each re‑visit and update Medication Profile Form in the home and in the agency’s medical record. Notify physician with any change in client condition, abnormal findings and new medications. Obtain orders as indicated with the appropriate form and submit in a timely manner. Complete Discharge Oasis and Discharge Summary when patient/client is discharged. Complete Recertification Oasis every sixty (60) days while on service and obtain new orders for new plan of care. Communicate with staffing coordinator with any scheduling concerns and/or changes in patient/client assignment. Communicate all Start of Cares (SOC), Resumption of Care (ROC) or Recertification (RECERT) to the clinical support division within twenty‑four (24) hours of completion. Maintain continuity of care and document communications with others within the health care team. Demonstrate work that meets quality standards. Assist in periodic auditing of paperwork of self/peers. Communicate regularly with Director of Nursing and Clinical Supervisor with all patient/client concerns or ideas for better patient/client outcomes. Adhere to Agency CodeofConduct, Standards of Practice, and Patients/Clients Rights/ Responsibilities. Demonstrate professionalism in appearance, adhering to agency dress code. Accessible transportation to and from patients/clients visits. Ability to lift 30 pounds, move intermittently throughout the work day, inclusive of sitting, standing and bending, pushing, pulling or moving objects and patients/clients. #J-18808-Ljbffr