Care Team RN

Care Team Registered Nurse

As a Care Team RN, this individual provides direct patient care in a care team through participating with the clinician in visits (especially acute co-visits, new patient exams and hospital follow-up visits), performing RN procedures, addressing needs of walk-in and call-in patients, providing patient education, integrating spiritual care, and coordinating care for complex patients on the care team.

Addresses Needs Of Walk-In And Call-In Patients

• Interviews patients to determine patient care needs
• Documents initial assessment and intervenes according to triage protocol and nursing standards of care
• Responds quickly and appropriately to urgent/emergent medical problems
• Prioritizes patient needs according to level of acuity
• Assists in the care and transfer of acutely ill patients to EMS services
• Demonstrates sound clinical judgment and decision-making, not working outside the level of training
• Documents all clinical interactions completely and efficiently in the patient's EHR chart
• Begins basic teaching relevant to current complaint as appropriate, i.e. reviews standard guidelines for the care of common illnesses such as fever, URI, diarrhea, vomiting, lice, etc
• Assists Clerical Assistants in managing providers' schedules throughout the day to improve work flow and decrease patient wait time
• Provides training and clinical oversight to Medical Assistants who are assisting in triage

Participates In Patient Health Education

• Provides patient education on topics such as diet and nutrition, self-administration of injectable medications, prevention and treatment of asthma, use of glucometer, etc
• Performs medication reconciliations with patients on complex medication regimens and reviews purpose, correct dosage and any special instructions or precautions for each medication
• Encourages and instructs patients to take the appropriate initiative in their own health, specifically encouraging them to understand and ask questions about their care, make their own appointments, follow-up with consultants and make initial contacts with insurances and vendors
• Provides patient education to sick patients regarding when to contact clinician or seek emergency care

Coordinates Follow-Up Care

• Contacts patients about critical lab results as requested by Clinicians; explains results and any needed follow-up
• Calls patients as requested by Clinicians to evaluate response to treatment and encourage compliance with treatment plan
• Communicates with other EHC teams such as Care Management, Social Services, BHC, etc regarding care of complex patients
• Communicates with outside agencies including consultants, mental health services, social service agencies, insurance companies, etc., to coordinate care of patients with multiple needs

Performs Direct Patient Care In RN-Led Visits And Other Care Team Visits

• Obtains thorough and accurate patient history
• Inserts and updates allergy, medication, and problem lists
• Performs physical assessment and initiates in house specimen collection/testing as appropriate; orders appropriate testing in the EHR
• Efficiently relays gathered history to the clinician in the patient room, in the patient's preferred language; scribes clinician's assessment in the EHR; documents patient instructions and reviews instructions with patient
• Identifies areas of concern and relays these to the clinician
• Performs suture and staple removal and basic wound care as needed
• Performs urinary straight catheterization as needed
• Performs and documents in-house lab procedures such as urine dip, urine HCG, finger stick Hgb, finger stick glucose, hemoccult test, etc., according to protocol and in compliance with OSHA standards
• Performs EKG and administer bronchodilators via nebulizer and as ordered by provider
• Administers oxygen as ordered by provider

Administers Injectable Medications And Vaccines

• Administers intravenous fluids, intramuscular and subcutaneous injectable medications, oral medications, and vaccines as ordered
• Receives deliveries of controlled medications; stores, records, and handles controlled medications appropriately

Maintains Emergency Clinical Supplies

• Responds to code blue and rapid response emergencies
• Assumes an RN-level role during a code blue and delegates other roles to staff as appropriate
• Able to correctly use all emergency clinical supplies
• Safely administers all emergency medications
• Performs monthly emergency equipment checks and inventory at home clinic site
• Promptly notifies supervisor and Director of Clinical Support Services of medications and equipment that are missing, expired, or need to be ordered

Performs Spiritual Care

• Provides effective spiritual intervention with patients, sharing hope and salvation through Jesus Christ, sharing helpful Biblical instruction and scriptures, praying for patients, and connecting/referring to Christian churches as appropriate and according to the leading of the Holy Spirit
• Does not force spiritual intervention, but gives spiritually uninterested pts respect and space, continuing to provide exemplary care in all other dimensions
• Participates in personal and community spiritual growth through active participation in daily prayer meetings and devotionals with EHC team
• Offers referral to chaplain or area clergy for follow-up as requested by patient

General Expectations

• Self-directed and motivated
• Exceptional organizational and interpersonal skills, with attention to detail required
• Exhibits self-motivation in undertaking new projects and assignments
• Independently identifies and resolves problems
• Pursues personal and professional development
• Able to effectively provide clinical care to socially and medically complex patients in a variety of non-traditional settings
• Able to work collaboratively in a team and manage multiple priorities, utilize effective time management skills, and exercise sound administrative and clinical judgment
• Able to analyze systems and to develop creative solutions to problems
• Able to work well with people of various ages, backgrounds, ethnicities, and life experience
• Adheres to policies and procedures of the health center and the regulations of governing agencies as they affect the department, recommending changes where appropriate
• Demonstrates habit of good attendance and punctuality by reporting for work whenever scheduled
• Participates in departmental meetings and general staff meetings
• Serves all patients in a Christ-like manner, with respect, humility, love, and self-control

Education, Knowledge, Skills, And Qualifications

• Registered Nurse license required; BSN preferred
• Good oral and written communication skills - Bilingual English/Spanish or willingness to learn required
• At least 1-2 years of experience providing clinical services preferred
• Maintains CPR certification
• Solid interpersonal skills, including the ability to deal with people politely, even when they are impolite; must communicate warmth and be able to put people at ease
• Remains calm under pressure
• Takes initiative in communication, being clear and direct, in order to effectively communicate with other staff
• Some computer experience - word processing and/or other
• Demonstrated ability to handle many details and multiple priorities; must show ability to organize, process, and verify details
• Must have a solid record of handling confidential information, as well as demonstrating trustworthiness and honesty in all transactions
• Solid character references, as well as no criminal record
• Solid record of timeliness and reliability in a work setting
• Experience in community/outpatient setting and case management preferred
• Experience in serving the poor, urban environments, familiarity with North Philadelphia is preferred.

Working Conditions

• Requires the ability to travel to multiple office locations within North Philadelphia
• Requires the ability to be on your feet working in a high paced environment for 4 hours at a time.
• Require