Director of Nursing

DIRECTOR OF NURSING – AMBULATORY SURGERY CENTER

Position Title: Director of Nursing (DON) Department: Clinical Operations Reports To: Administrator Supervises: Registered Nurses, LVNs/LPNs, Surgical Technologists, and other assigned clinical personnel Employment Status: Exempt / Full-Time Facility: Ambulatory Surgery Center

POSITION SUMMARY

The Director of Nursing (DON) is responsible for the leadership, management, coordination, and oversight of nursing and clinical services within the Ambulatory Surgery Center (ASC). The DON ensures that safe, high-quality patient care is provided in accordance with facility policies, medical staff requirements, applicable federal and state regulations, accreditation standards, and accepted standards of professional nursing practice. The DON works collaboratively with the Administrator, Medical Director, medical staff, anesthesia providers, and facility personnel to maintain a safe, efficient, patient-centered surgical environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Clinical Operations and Patient Safety Direct and oversee day-to-day nursing and clinical operations of the ASC. Ensure appropriate nursing care throughout the perioperative process, including pre-operative, intra-operative, and post-anesthesia recovery services. Promote and maintain a culture of patient safety and regulatory compliance. Ensure appropriate implementation of physician orders and established clinical protocols. Monitor patient care practices and intervene when patient safety or quality concerns are identified. Ensure emergency equipment, medications, supplies, and clinical resources are available and maintained appropriately. Participate in emergency preparedness activities, drills, and staff education. Ensure appropriate infection prevention practices are consistently followed. Nursing Leadership and Staff Management Provide leadership, supervision, coaching, and direction to clinical staff. Participate in recruitment, interviewing, selection, orientation, and onboarding of clinical personnel. Develop clinical staffing schedules based on patient volume, procedure complexity, staff competency, and operational requirements. Verify that clinical staff maintain required licenses, certifications, competencies, and training. Conduct and document initial and ongoing staff competency assessments. Identify performance deficiencies and implement education, counseling, corrective action, or performance improvement measures as appropriate. Conduct or participate in employee performance evaluations. Promote teamwork, accountability, professionalism, effective communication, and a positive workplace culture. Ensure appropriate staffing and skill mix for scheduled procedures. Regulatory and Accreditation Compliance Assist the Administrator and Medical Director in maintaining compliance with applicable ASC requirements, including CMS Conditions for Coverage, state licensing requirements, OSHA requirements, infection prevention standards, and applicable accreditation standards. Maintain readiness for regulatory and accreditation surveys. Participate in survey preparation, surveys, plans of correction, and follow-up activities. Ensure required clinical policies and procedures are implemented and followed. Assist with review and periodic revision of nursing and clinical policies. Ensure required clinical documentation, logs, inspections, and records are properly maintained. Participate in Governing Board and Medical Executive Committee activities when requested or required. Quality Assessment and Performance Improvement Participate in the facility's Quality Assessment and Performance Improvement (QAPI) program. Identify opportunities for clinical performance improvement and patient safety initiatives. Assist with development, implementation, monitoring, and reporting of quality improvement projects. Monitor clinical quality indicators, patient outcomes, medication errors, adverse events, infections, transfers, incidents, and other quality measures. Participate in root-cause analysis and corrective-action activities when appropriate. Report significant clinical or patient safety concerns promptly to the Administrator and Medical Director. Infection Prevention Work collaboratively with the designated Infection Preventionist to maintain an effective infection prevention and control program. Ensure compliance with hand hygiene, sterilization, disinfection, environmental cleaning, safe injection practices, and other infection prevention requirements. Monitor staff compliance with infection prevention policies and provide education or corrective action when necessary. Participate in infection surveillance and reporting activities. Surgical Services and Clinical Readiness Coordinate clinical preparation for scheduled surgical procedures. Ensure appropriate supplies, medications, equipment, implants, and clinical resources are available for scheduled cases. Collaborate with surgeons, anesthesia providers, surgical technologists, materials management, and administrative staff regarding clinical needs. Ensure appropriate pre-operative assessment, medication reconciliation, surgical site verification, time-out procedures, recovery, and discharge processes are followed. Ensure safe medication management practices and appropriate medication storage, security, documentation, and reconciliation. Maintain appropriate standards for controlled substances in coordination with facility leadership and pharmacy services. Staff Education and Competency Develop and coordinate clinical orientation and continuing education programs. Maintain documentation of required clinical competencies and training. Ensure staff maintain required certifications such as BLS, ACLS, and other certifications appropriate to their assigned responsibilities. Coordinate competency validation for clinical equipment, emergency procedures, infection prevention, medication administration, and other required areas. Conduct or coordinate mock emergency drills and clinical training exercises. Administrative Responsibilities Collaborate with the Administrator regarding staffing, scheduling, budgeting, purchasing, and operational planning. Assist in controlling clinical labor, supply, and operational costs while maintaining patient safety and quality. Participate in evaluation and selection of clinical equipment and supplies. Assist with inventory management and appropriate utilization of supplies. Attend required leadership, staff, quality, and committee meetings. Communicate operational and clinical concerns promptly to the Administrator. Perform other duties reasonably related to the position as assigned by the Administrator or Governing Board.

MINIMUM QUALIFICATIONS

Current, unrestricted Registered Nurse (RN) license in the state in which the ASC operates. Graduate of an accredited professional nursing program. Current BLS certification. ACLS certification required or obtained within the timeframe established by facility policy. Minimum of three years of clinical nursing experience, preferably in perioperative, surgical, PACU, critical care, or ambulatory surgery. Previous nursing leadership or supervisory experience strongly preferred. Knowledge of perioperative nursing standards, infection prevention, patient safety, medication management, and emergency procedures. Knowledge of ASC regulatory and accreditation requirements preferred.

PREFERRED QUALIFICATIONS

Bachelor's degree in Nursing (BSN). Previous ASC or hospital surgical-services leadership experience. CNOR, CAPA, CPAN, CASC, or other applicable professional certification. Experience with CMS and ASC accreditation surveys. Experience with QAPI, infection prevention, staff competency programs, and regulatory compliance.

KNOWLEDGE, SKILLS, AND ABILITIES

The Director of Nursing must demonstrate: Strong clinical judgment and patient-safety awareness. Effective nursing leadership and personnel-management skills. Ability to appropriately supervise and hold clinical personnel accountable. Strong organizational and time-management abilities. Effective verbal and written communication. Ability to manage multiple priorities in a fast-paced surgical environment. Knowledge of clinical documentation and electronic medical records. Ability to identify clinical risks and implement corrective actions. Ability to work collaboratively with surgeons, anesthesia providers, staff, administration, and facility ownership. Professionalism, discretion, integrity, and appropriate handling of confidential information.

PHYSICAL REQUIREMENTS

The position may require prolonged standing and walking; bending, reaching, and assisting with patient positioning and transfers; and lifting or moving equipment and supplies consistent with facility policy. The employee must be capable of responding appropriately during emergency situations. Reasonable accommodations will be provided as required by applicable law.

ACCOUNTABILITY

The Director of Nursing is accountable to the Administrator for the effective operation of nursing services and is expected to immediately communicate significant patient safety, staffing, regulatory, quality, or clinical concerns. The DON has the authority and responsibility to intervene when necessary to protect patient safety, including escalating concerns regarding unsafe clinical practices or conditions through the facility's established chain of command.

ACKNOWLEDGMENT

This job description describes the general duties, responsibilities, and qualifications associated with the Director of Nursing position. It is not intended to constitute an exhaustive list of every responsibility or task. Duties may be modified based on facility needs, regulatory requirements, Governing Board direction, and applicable law. #J-18808-Ljbffr Kingsland Surgery Center, LLC