RN FLOAT MS/ICU

Under the general direction of the Nurse Manager for the Medical-Surgical Unit, the RN is responsible for providing professional nursing care and related assistance to adult patients admitted for medical-surgical problems. The RN provides direction to Licensed Vocational Nurses and non-licensed nursing personnel in providing direct patient care. The RN supports the medical care of patients under the direction of the Medical Staff pursuant to the mission and objectives of the Hospital. Under the direct supervision of the Nurse Manager, Surgery Department, the Registered Nurse in the Surgery Department is responsible for the provision of safe and effective care of the Peri-operative patient both the out-patient and the in-patient inclusive of the immediate pre-operative period, during operative procedures, and immediately following surgery in the Post anesthesia care unit. The Registered Nurse assigned to the Surgery Department may also provide direct patient care for patients admitted for endoscopy procedure.

Requirements

III. ESSENTIAL FUNCTIONS:

• Organizes patient care and general unit activities to accomplish required functions with delegation of these activities to other staff as appropriate.
• Maintains required documentation of patient care and unit activities in accordance with standards.
• Provides ongoing supervision of patient care activities with reinforcement of correct principles, procedures, and techniques of patient care. Provides ongoing monitoring of the quality of care by nursing personnel on the unit with documentation of assessments as indicated. Ensures that all required diagnostic and therapeutic interventions are completed and documented.
• Ensures implementation of operational standards which promote the maintenance of patient rights including; informed consent, clarification of patient expectations, explanation of treatment processes, maintenance of confidentiality of patient information, maintenance of patient privacy through prevention of exposure during procedures, execution of Advance Directives-DNR, organ procurement program, ethical considerations, and the handling of patient complaints.
• Performs assessments utilizing appropriate techniques for data collection and data analysis to make decisions regarding patient care or treatment within scope of responsibility.
• Performs reassessments at designated intervals and as condition warrants with notification of responsible practitioners when significant changes are noted in patient's condition.
• In the assessment and reassessment of adults, considers the normal physiologic changes associated with the aging process and those that may be a result of chronic or debilitating disease processes.
• Reviews each patient's plan of care daily in accordance with standards to ensure that changes in patient status and nursing diagnoses/patient problems are incorporated in the plan of care.
• Delegates nursing care activities to members of the nursing team based on patient care needs and competencies of available nursing staff.
• Validates documentation of all required elements of patient care.
• Ensures that information is appropriately communicated to responsible staffing in any receiving facility when a patient is transferred including both verbal communication and transmission of medical records.
• Ensures that information is appropriately communicated to nursing personnel in receiving units when a patient is transferred for ongoing care to include provision of medical records.
• Provides health care teaching to the patient, family, or significant other with documentation of responses to this teaching.
• Adapts teaching to the age, developmental level, and cognition state of each patient to promote maximum understanding.
• When patient is unable to understand required instructions ensure that a responsible adult is provided with information.
• Encourages patient or family to make decisions regarding their care where appropriate.
• Identifies need for consultation with Social Services or other resource for family units who are experiencing possible psychosocial problems.
• Contacts appropriate resources for the provision of continuing care services where indicated.
• Assists patient in recognizing and coping with psychological stresses related to medical-surgical illness and resulting hospitalization.
• Facilitates patient self-care when appropriated.
• Performs technical skills proficiently in accordance with standards of care.
• Promotes patient comfort and assists patient in maintaining or regaining normal body functions when possible.
• Utilizes precautionary and preventive measures in providing patient care to prevent infection, protect skin and mucous membranes, use positioning and exercises to prevent injury or complications, avoid using potentially injurious techniques in administering care or managing intrusive treatments, observe and correctly assess physical signs, symptoms, or findings, and intervenes appropriately. Correctly assess severity or priority of patient's condition and provides necessary care.
• Provides patient and family education regarding medications and treatments with a focus on those medications or medications, which may be continued at discharge.
• Utilizes all equipment within the unit with maximum efficiency and effectiveness based on knowledge of equipment function.
• Utilizes specialized equipment in a manner appropriate to the patient's age, size, and developmental needs.
• Adapts patient care to individual patient needs and staff competencies.
• Recognizes own limitations and errors with corrective actions taken where indicated.
• Ensures that Standard Precautions and required protective apparel are used by all practitioners in the performance of procedures on the unit.
• Utilizes safety precautions in the cleaning and sanitation of all equipment and supplies used in the unit and ensures adherence to all guidelines regarding use of cleaning products.
• Plans, coordinates, provides, and supervises nursing care to promote continuity of patient care.
• Exercises judgment in the delegation of activities to ensure that patient care is provided by staff with identified competencies in meeting individual patient needs.
• Communicates effectively with the Nurse Manager to ensure that any problems or opportunities to improve services on the Unit are addressed.
• Communicates effectively with Medical Staff to facilitate coordination of patient care among all disciplines providing patient care services with a focus on any ongoing care required post-hospitalization.
• Acts as patient advocate in obtaining care with questioning of orders or other practices as indicated using appropriate channels of communication.
• Maintains current knowledge of developments and trends in the provision of nursing care to medical-surgical patients through use of inservices, professional organizations, and other self-directed learning activities.
• Maintains awareness of current Hospital and Departmental operational standards, which impact on position responsibilities.
• Performs effectively in stressful situations.
• Actively participates in Unit performance improvement activities.
• Consistently provides outstanding service to all patients, physicians, fellow employees, and guests as appropriate to position.
• Displays initiative to see processes to completion and offers assistance without being asked.
• Consistently responds to requests in a timely manner.
• Actively participates in department committees and group meetings with a focus on providing input to improve the quality of services.
• Consistently demonstrates behavior, which reflects that working as a team is more important than self-interest.
• Demonstrates interpersonal competencies such as problem-solving, negotiation, and conflict management to improve teamwork.
• Consistently maintains professional level of conduct.
• Facilitates communication with patients, physicians, guests, and co-workers as appropriate to position.
• Consistently demonstrates courteous and positive behaviors, i.e., smile, pleasant tone, good eye contact.
• Protects confidentiality of patients/co-workers, respecting their dignity, privacy, and differences.
• Shows respect for hospital property and the property of others.
• Provides continual observation to one or two patients as needed.

A. Administrative Functions

• Assists in the scheduling of surgical and endoscopy procedures for both inpatients and out patients. Ensures that all practitioners requesting to perform procedures have delineated clinical privileges for specific procedure(s). Ensures availability of space, personnel and equipment for requested procedures. Ensures proper distribution of schedule to different departments requiring them. Maintains appropriate charges for individual procedures/ surgeries performed in the department.

• Ensures that standard precautions and required protective apparel is utilized by all practitioners in the performance of procedures in the department. Helps in updating the logbook on surgical procedures, endoscopy and PACU logbook. In collaboration with the Nurse Manager, assists in developing and maintaining operational standards unique to the department. Teaches, supervises and serves as a resource person for nursing and other staff in the department with reinforcement of correct principles, procedures and techniques of patient care.

• Assumes responsibility for the smooth function of the department in collaboration with the Nurse Manager. Ensures that required diagnostic and therapeutic interventions are completed and documented for each patient being served by the department. Ensures implementation of operational standard, which promote the maintenance of patient rights including right to confidentiality, explanation of treatment processes, ethical and privacy consideration and handling of patient complaints. Delegates nursing care activities to members of the nursing team based on patient care needs and competencies of available nursing staff.

• Communicates information appropriately with medical staff and other members of the health care team to promote continuity of care and attainment of patient expected outcome. Checks daily the crash carts in surgery, PACU and endoscopy. Maintains medication availability in the unit, inclusive of narcotics with thorough knowledge of usual dosage, side effects, compatibilities and indication for use of each medication. Assist in monthly medication check and outdates with pharmacy, when needed.

• Participates in rotational call system as needed to provide for continuous availability of service. Acts as patient advocate in obtaining care with questioning of orders or other practices as indicated using appropriate channels of communication. Maintains current knowledge of developments and trends in the provision of perioperative nursing care through the use of in-services, professional organizations and other self-directed learning activities. Maintains awareness of current hospital and departmental operational standards, which impact on position responsibilities. Assists in housekeeping chores of the department when needed.

B. Registered Nurse in the Out-Patient Department

• Effectively utilizes the Nursing Process both in preparing the patient for surgery/ Procedure and discharging the patient after a surgery/procedure. Organizes patient care and general outpatient unit activities to accomplish required function with delegation of these activities to other staff as appropriate to their competencies. Maintains required documentation of patient care in accordance with standard. Ensures that required diagnostic and therapeutic interventions are completed and documented for each patient. This includes consents, labs, surgical site markings, with special consideration to confidentiality and ethical/privacy rights of the patient.

• Assessment/ reassessment is performed utilizing appropriate techniques of data collection with special consideration to the patient's developmental age, educational needs and family's involvement in the treatment and care of the patient. Performs patient care activities proficiently with focus on preparing the patient for surgery/ procedure physically, mentally, emotionally, inclusive of treatment process explanation and discharge instructions.

• Assists patient in recognizing and coping with psychological stresses related to the procedure. Utilizes precautionary and preventive measures in providing patient care to prevent infection, prevent injury and protect skin and mucous membranes. Utilizes equipment in the Out Patient Surgery unit with maximum efficiency and effectiveness based on knowledge of function. Initiates intravenous therapy utilizing aseptic technique with appropriate catheter and fluids as needed.

C. Registered Nurse in the Intra-operative Area

• Assumes responsibility for the efficient management of preoperative patients admitted to the Holding Area, preparing them for the operative procedure that they require. Possesses comprehensive knowledge of clinical components of care required in the immediate preoperative and intraoperative period to provide for direct patient care in a circulating position in the operating room. Possesses comprehensive knowledge of medicolegal responsibilities in completing documentation and checking for the presence of required consents and preoperative documents, including chart review and surgical checklist, verification of surgical site, appropriate operative orders and consent.
• Applies principles of surgical asepsis required for the surveillance of the operating room suite environment. Assumes responsibility as circulator on assigned cases, assisting both the anesthesiologist and the sterile surgical team when needed, or as surgical scrub nurse if competencies are appropriate. Care for specimens according to standards ensuring proper identification, proper handling and delivery to lab with appropriate documentation. Proficient in the utilization of specialized equipments and gadgets to provide care to patient applying principles of surgical asepsis and care to prevent burns and injury.

• Provides direct supervision to other personnel ensuring that patient care is provided by staff with identified competencies in meeting individual patient needs. Possesses comprehensive knowledge of clinical components of care required from the time of completion of the procedure until transport to the Post Anesthesia Care unit or the Intensive Care Unit. Provides appropriate information to nursing personnel regarding the patient's status on transfer of patients to the Post Anesthesia Care Unit or the Intensive Care unit or other designated area.

D. Registered Nurse in the Post Anesthesia Care Unit

• Assumes responsibility for the efficient management of patient in the immediate post anesthesia period. Possesses comprehensive knowledge of clinical components of care required in the Post Anesthesia Care unit to provide for direct patient care. Maintains communication with the Nurse Manager and with anesthesia staff to ensure that any problems during the immediate postoperative period are promptly communicated. Ensures that required patient assessments and reassessments are completed in a timely manner with use of assessment data in the formulation of individualized nursing diagnoses or patient needs/ problems to include an assessment of patients immediately upon admission, maintenance of a patent airway, observation for cardiopulmonary complications, identification of bleeding or other potential complications related to the surgical site, assessment of patients level of fear or pain with corresponding provision of comfort and support.

• Maintains environmental control through constant surveillance of patient temperature and physiological responses. Utilizes special precautions in the direct care to sedated patients to minimize potential for injury. Assesses patients appropriately for discharge based on approved discharge criteria. Ensures implementation of operational standards which promote the maintenance of patient rights, including maintenance of confidentiality of patient information, prevention of unnecessary exposure of the patient, explanation of treatment processes and the like.

• Applies principles of body mechanics in the provision of direct patient care activities and in the supervision of other personnel in the PACU, including during transport of patient to other patient care units. Provides appropriate information to nursing personnel regarding the patient's status on transfer of patients from the PACU to other patient care units.

• Current licensure in California as a Registered Nurse.
• Previous clinical nursing experience preferred: provision of medical-surgical nursing care desired. Previous clinical nursing experience in Peri-operative services or endoscopy environment desired.
• Current B.L.S. certification and Advanced Cardiac Life Support required