Outpatient Registered Nurse - RN - Dialysis

Staff Registered Nurse

Functions as part of the hemodialysis health care team to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's mission, vision, values, and customer service philosophy. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies.

Principal duties and responsibilities include:

• Directing patient care technicians provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals, as well as regulations set forth by the corporation, state, and federal agencies.
• Delegating tasks to all direct patient care staff including but not limited to LVN/LPNs, Patient Care Technicians, and Dialysis Assistants.
• Assessing daily patient care needs and developing appropriate patient care assignments.
• Routinely monitoring patient care staff for appropriate techniques and adherence to facility policy and procedures.
• Participating in staff training and orientation of new staff as assigned.
• Participating in all required staff meetings as scheduled.
• Ensuring educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).
• Providing ongoing education to patients regarding their renal disease, vascular access and dialysis therapy, and other related health conditions.
• Discussing with patient, and recording education related to diet/fluid and medication compliance.
• Providing patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM).
• Ensuring transplant awareness, modality awareness, and drive catheter reduction.
• Educating patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid.
• Providing safe and effective delivery of care to patients with ESRD.
• Accurately implementing treatment prescriptions including Sodium (Na) modeling prescription, and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated.
• Assessing patients' response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicating problems or concerns to the Team Leader or physician.
• Identifying and communicating patient related issues to Team Leader or physician.
• Initiating Initial and Annual Nursing Assessment, and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.
• Actively participating in the pre-evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures.
• Taking appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights.
• Providing, supervising (if applicable), and monitoring hemodialysis access care according to established procedures.
• Implementing, administering, monitoring, and documenting patient's response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier.
• Ensuring accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet.
• Reviewing, transcribing, and entering physician lab orders accurately into the Medical Information System.
• Ensuring appropriate preparation of lab requisitions for Spectra or alternate lab.
• Ensuring correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.
• Identifying and ensuring appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures.
• Ensuring all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material.
• Ensuring that all labs are directed and delivered to appropriate labs.
• Reporting alert/panic and abnormal labs results to appropriate physician.
• Ensuring lab results are forwarded to physicians as requested.
• Enforcing all company approved policies and procedures, as well as regulations set forth by state and federal agencies and departments.
• Maintaining overall shift operation in a safe, efficient, and effective manner.
• Acting as a resource for other staff members.
• Routinely meeting with the Clinical Manager to discuss personnel and patient care status, issues, and information.
• Collaborating and communicating with physicians and other members of the healthcare team to interpret, adjust, and coordinate care provided to the patient.
• Providing assistance as needed to patients regarding prescription refills according to FMCNA Policies.
• Ensuring all physician orders are transcribed and entered into the Medical Information system in a timely manner.
• Overseeing all documentation of patient information.
• Maintaining facility drug list for all required stock medications.
• Maintaining competency with all emergency operational procedures, and initiating CPR and emergency measures in the event of a cardiac and/or respiratory arrest.
• Ensuring verification and availability of adequate emergency equipment.
• Ensuring provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.
• Administering medications as prescribed or in accordance with approved algorithm(s), and documenting appropriate medical justification if indicated.
• Administering PRN medications as prescribed and completing appropriate documentation of assessment of effectiveness.
• Maintaining appropriate recording of controlled substances as required by law.
• Assisting with the coordination of patient transportation if necessary.
• Ensuring a clean, safe, and sanitary environment in the dialysis facility treatment area.
• Ensuring competency in the operation of all dialysis-related equipment safely and effectively.
• Ensuring all patient stations, including machines and chairs, are clean and free of blood and placed appropriately.
• Ensuring that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.
• Ensuring all relevant data including physician orders, lab results, vital signs and treatment parameters, and patient status are documented appropriately and entered into Medical Information System.
• Ensuring all appropriate patient related treatment data is entered into the Medical Information System.
• Ensuring all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.
• Ensuring and verifying accuracy of Patient Care Technician documentation.
• Reviewing and ensuring appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
• Ensuring that all appropriate procedures are followed regarding opening and closing procedures, inclusive of monitoring that all staff and patients have safely left the premises.
• Initiating, documenting, and completing ongoing Continuous Quality Improvement (CQI) activities including monthly reports.
• Completing monthly nurses' progress note.
• Ensuring patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms).
• Reviewing transplant status and following established procedure regarding appropriate action to be taken.
• Completing patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.
• Completing any long-term programs that are due.
• Completing initial and annual Nursing History and Assessment physical.
• Ensuring completion of Annual Standing Order Review with each physician as required.
• Performing additional duties as assigned.

Physical demands and working conditions include:

• The position provides direct patient care that regularly involves heavy lifting and moving of patients, and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet.
• The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.
• Employees are required to take the Ishihara's Color Blind