Registered Nurse

Summary:

The Registered Nurse provides professional nursing care in the Medical Surgical unit. They provide direct nursing care by assessing patients needs, performing physical examinations, and taking health history and demographic information. In addition, the Registered Nurse plans, develops, implements, administers, evaluates and updates specialized plans of treatment and preventive care regimens in accordance with medical orders and nursing standards, and also annotates medical records in accordance with established procedures, implements infection control protocols, and ensures compliance with regulatory requirements.

RESPONSIBILITIES:

• Provides direct nursing care to patients by assessing their physical, psychological, emotional and spiritual status. 

• Develops a plan of care consistent with the patients condition and annotates medical records in accordance with established procedures and regulatory requirements and provides information to clinical and support staff to facilitate continued proper nursing care.

 • Includes the patients and family in the process of care planning.

 • Performs comprehensive patient assessments, noting any improvement or deterioration in the patients condition and implements and evaluates nursing care accordingly. 

• Assesses patients and administers treatments, medications, and general care according to nursing plan of care, best practices, established protocols and medical orders to treat actual or potential disorders and to optimize the physical and mental well-being of the patients.

 • Operates specialized medical equipment. 

• Evaluates and documents patients responses to care regimen and adds to; changes or resolves interventions on the nursing plan of care and/ or collaborates with physician regarding the need to revise the treatment plan.

 • Collaborates with appropriate members of the health team (i.e.: LPN, Nurses Aide, Attendants) to coordinate care for patients. 

• Coordinates care with other departments (i.e.: dietary, social services rehab services, etc.), serving as a liaison to ensure services are provided in a timely manner. 

• Provides education to the patient and family about medication, medical treatments; disease specific information, follow up care. 

• Resolves conflicts. 

• Participates in discharge planning in collaboration with other health care providers and community resources to ensure full utilization of support services which address patient needs. 

• Participates in Quality Assurance activities to ensure provision of optimum care and follow-up for patients. 

• Ensures continuity of nursing care by communicating a comprehensive handoff during transition to another nurse (at change of shift, change in assignment, transfer of patient, etc.). 

• Participates with other professional team members in a multi-disciplinary approach to nursing care.

 • Advocates the patient bill of rights and advocates on behalf of patients and families to ensure continuity and understanding of care given.

 • Participates in continuing education programs and in-service education in order to provide the most appropriate nursing care. 

• Completes continuing education programs on time. Complies with hospital policies and procedures.

 • Actively participates in the performance improvement process including data collection, analysis, plan for change and implementation of changes. 

• Precepts and mentors newer staff on the assigned unit. Attends staff meetings. 

• May act as preceptor to new graduate nurses to ensure appropriate orientation to assigned units. 

QUALIFICATIONS/REQUIREMENTS:

Experience: Previous professional nursing experience preferred.

Education: Graduation from an accredited school of Nursing required; a bachelor's degree in Nursing (BSN) preferred.

Licenses / Certifications: Must possess a limited permit to practice nursing, issued by the New York State Education Department, or a valid license and current registration, issued by the New York State Education Department, as a Registered Nurse. Current BLS and ACLS required.

Other: N/A

Special Requirements: N/A

OTHER:

If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.