Registered Nurse

Job Description Under the supervision of the Nursing Supervisor, the Registered Nurse (RN) is responsible for the overall oversight and supervision of the healthcare needs of the people we support. The RN will work in conjunction with medical providers to ensure the delivery of the highest quality of integrated health and continuity of care to the people supported across the FREE network. Essential Job Functions Review, modify and update the individual’s plan of nursing care in accordance with medical diagnoses and treatment plan. Ensure nursing care plans are updated annually and whenever a new diagnosis is added. Ensure staff are trained on individual plan of nursing service. Spot check medication count to ensure that the records for narcotics control and needle/syringe supply are accurate. Ensure supplies of medication and first aid materials are adequate and not expired, that medication is stored and disposed of according to agency policy. Complete monthly medication storage. Ensure individual-specific formulary is present for all medication administered to each individual. Validate the Medication Administration Record on a weekly basis for required information: medication given as ordered and started in a timely fashion; no blank signatures, record is initialed on front and signed on back, PRN symptoms are charted and result stated, note reason for any discontinued medications. Check that doctor’s orders and prescriptions are current, medication formularies are in place for each medication, and MARs are printed and completed correctly. Grab and Go books have current information. Ensure that procedures for new medication orders are accurately completed (are dated, signed, noted in Formulary and copied to all appropriate parties). Check that all medication administered has a matching label, order and medication sheet entry. Monitor effects of medication; document as needed. Track and document all medical appointments; illness or accident; current medication; medication changes; current diet (weight loss and gain) and all charts required by the individual’s nursing care. Ensure that all physician appointments and follow ups are scheduled as ordered. Review incoming physician summaries for instructions, medication changes and treatment orders and implement all changes. Ensure that all emergency room/hospital discharge instructions are followed up and documented. Maintain a tracking log for all individual’s appointments; ensure that recurring and annual appointments (vision; hearing; nutrition; dental exam and cleaning; special needs) are scheduled and attended. Complete all necessary nursing assessments per agency policy (quarterly, bi‑annually, annually), including, but not limited to, Fall Risk assessment, Nursing Visuals, Self‑Administration of Medication Evaluation, and Tardive Dyskinesia Screening. Braden Scale for predicting pressure under risk semi‑annually. Perform physical observation of individuals (skin/nails/hair/overall health). Review incident reports and occurrences; counsel and/or re‑train staff as needed to ensure accurate reports. Validate accuracy and timeliness of entries in all required individual’s charts. Conduct Nursing In‑service training of residential/day service to include: recognition of illness or dysfunction, disease, infestation and indicators of injury that warrant medical or nursing intervention; taking vital signs; addressing consumer‑specific health problems and needs (e.g. diabetic/daily foot care); administering any necessary treatment (e.g. warm soaks); performing first‑aid on occasion of accidents (injury); making a diagnosis; following proper emergency procedures; writing incident reports. Add topics as necessary. Maintain a record of dates when required in‐service sessions for residential/day program staff were conducted. Teach AMAP Certification/Recertification classes as well as the required curriculum for Agency orientation. Supervise AMAP staff during certification/recertification for accurate pouring and vital signs. Participate in meetings regarding the care and concerns of the individuals, including ISP’s, Interdisciplinary Team Meetings, Project Management and House Meetings. Maintain communication with physicians, Day Programs and family members regarding the individual’s care. Ensure that program nursing staff maintain communication log for each other; inform day/residential program nursing staff as appropriate. Review nursing communication log for summary of doctor’s visit; ensure that information is complete, accurate, and documented in the individual’s records including results of tests and recommendations for necessary follow up. Report possible violations of individual’s rights promptly, and complete and submit incident reports in accordance with NewYork State regulations and Agency policy. Participate in any investigation into incidents occurring within the program as requested and maintain confidentiality in regard to such investigations. Maintain the confidentiality of any information relating to the individual’s in the program as per HIPAA guidelines. Complete required documentation (paper and/or electronic) in a timely, accurate fashion and as per compliance regulations. Ensure all required documentation is maintained in records in the prescribed manner. Duties and Responsibilities Report ongoing problems and suggest solutions to improve working/environment conditions. Receive and communicate effectively on feedback from management, peers, other staff and consumers in a cooperative manner. Handle program equipment, consumable materials and resources in a cost‑conscious manner. Keep updated and review any regulation changes in State or Federal policy and/or Agency procedures. Provide your projected weekly schedule to your supervisor. If position includes being “on call”, ensure timely response to calls from the residence, day program, family members, etc. Obtain/maintain certification in CPR and SCIP as needed per Agency policy. Maintain copy of your current license with the Human Resources Department. Follow the Code of Conduct and Agency Standards as outlined in the Employee Handbook. Accurately and positively communicate Agency philosophy and administrative decisions to other staff in a timely and professional manner. Attend and complete training in accordance with NewYork State regulations and Agency Policy. Assist in maintaining Agency property in a neat, orderly and safe manner and report all repair needs in a timely manner as per site‑specific needs. Observe Agency policy and procedures for building security and identification of authorized personnel. Follow HIPAA and OSHA regulations, including universal precautions. Check that the following are posted and used correctly: Poison Control number, emergency numbers, pharmacy telephone numbers, medical providers, and nursing on‑call information. Provide transportation as required. Report all violations and/or accidents in Agency or personal vehicle in accordance with NewYork State regulations and Agency policy. Address emergency situations as they occur in the program according to established policies and procedures, and ensure communication of such situations in a timely manner. Provide coverage in emergency situations until relieved of the responsibility. Ensure the physical safety and security of the individual by taking precautionary and preventative measures against conditions in the environment which might cause physical harm. Ensure the appropriate protective and preventive measures for both staff and consumers in the control of communicable and infectious diseases including identification, assessment and reporting of same. Ensure that the individual’s needs are met and intercede on the individual’s behalf as necessary. Treat each individual with dignity and respect in accordance with NewYork State regulations and Agency policy. Complete and submit occurrence forms and incident reports in a timely, accurate fashion and as per agency policy and State regulations; counsel or re‑train staff as needed regarding reporting procedures. Utilize information acquired through training, meetings, education and experience to benefit individuals. Perform additional responsibilities as requested and/or necessary, including supporting alternate locations when assigned. Education, Work Experience, and Competencies NYS Licensed Registered Nurse. Associates in Nursing or related field. Bachelors in Nursing or related field preferred. Experience working with the differently‑abled population preferred. Knowledge of OPWDD, DOH, or OMH state and federal regulations preferred. Ability to manage multiple priorities and ability to be flexible to meet the needs of a diverse population in a variety of settings. Strong verbal and written communication and organizational skills. Valid NYS Driver’s License. Work Environment Duties are performed in a classroom or residential environment. The noise level in the work environment varies. The job risks exposure to disease/pathogens; blood and bodily fluids; medications; and toxic or caustic chemicals. Physical Demands The employee must frequently lift or move items weighing up to 10 pounds. Occasional lifting, pushing, pulling, transferring, carrying and/or moving adult individuals receiving services. Equal Employment Opportunity Statement FREE is an equal opportunity employer and provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, gender identity, sexual orientation, national origin, age, disability, genetics, or any other protected characteristic. In addition to federal law requirements, FREE complies with applicable state and local laws governing non‑discrimination in employment in all of its locations. This policy applies to all terms and conditions of employment, including, but not limited to, recruiting, hiring, placement, promotion, termination, recall, transfer, leaves of absence, compensation, and training. Affirmative Action Family Residences and Essential Enterprises’ affirmative action efforts related to protected veterans and individuals with disabilities are set out and described in our affirmative action plan for protected veterans and individuals with a disability. If you have any questions or would like to view the affirmative action plan, please visit our website. #J-18808-Ljbffr