Registered Nurse Supervisor SNF, Full Time PM Shift

Nursing Supervisor

Pay Range: $52.00 to $55.00/hour, depending on experience

Responsible for planning, organizing, implementing, directing, and evaluating direct nursing care provided to residents. Responsible for preparation, delivery and documentation of medications and treatments to assigned residents. Document change of condition, unusual occurrences, weekly summaries, initial assessments, MDS assessments etc. in a thorough and legible manner. Assures notification to physician and responsible party with any change of condition with appropriate documentation. Responsible for knowing and following current federal, state and local standards and assuring compliance with standards functions.

Supervisory Responsibilities:

• Provide supervision to nursing personnel on assigned shift on assigned unit, ensure that all duties are appropriately delegated and tasks are completed by the end of the shift.
• If unable to complete all scheduled duties and responsibilities, relay information to next shift verbally and in writing on the 24 hour report log.
• Provide assistance to staff to assure that care is provided in a timely manner i.e. assist with ADLs, distribution of meals, maintenance of the dining program and other activities as needed.
• Observe staff performance during routine patient care and give guidance regarding resident's care plan, infection control techniques, dignity and privacy issues, and abuse prevention.
• Fill up and review daily assignments to assure fair and even distribution of workload and that appropriate trained staffs are assigned to care for individual residents.
• Adjust staffing during shift as required to meet resident care needs.
• Assist Director of Staff Development (DSD) with annual review of competencies for assigned C.N.A.s
• Participate in nursing orientation as assigned.
• Participate in performance evaluations of assigned staff.
• Review equipment and supplies on assigned unit and replenish as needed.
• Assure that all residents are treated with respect and dignity and confidentiality is maintained.
• Assure security of environment to prevent exit of wandering residents. Implement the facility procedure for elopement if any resident leaves the facility without permission.
• Check and record temperature of medication room, medication and food refrigerator. Make adjustments if necessary and/or notify maintenance if out of compliance (night shift only).
• Greet visitors, families, rights advocates and representatives of other agencies to the facility. If visitor is unknown, requests identification prior to allowing visitor to see resident. Provide information to family members concerning resident's care as necessary or requested per HIPAA compliance.

Clinical Responsibilities:

• Assessment / Reassessment: Complete an admission assessment for new residents on day of admission. Complete a daily reassessment for Medicare residents and a weekly reassessment for all residents. Complete required clinical assessments as required i.e. Braden's, Falls, Bowel and Bladder, etc. Complete a reassessment whenever indicated by change in resident's condition. Make rounds to assigned residents during shift and observe for any change of condition or any concerns. Problem solves and implements new treatment plans as needed. Make round with physicians and assists with any procedures, examinations etc. Reviews vital signs, weights etc. for any variance and necessity of reporting to physician and responsible party.
• Care Planning: Initiate admission care plan and update care plans with change of condition, new problem identified and problem resolution etc. Update care plan with any change of condition, skin tear, and bruise, fall etc. and at least quarterly.
• Interdisciplinary Team (IDT): Participate in IDT meetings and contributes information regarding resident's current status.
• Resident Assessment Instrument (RAI) Process: Participate in the RAI process as assigned.
• Documentation: Document in nursing notes on admission, daily when on Medicare, weekly summary and with any change of condition. Assure compliance with documentation requirements for: pain management, restraints, vital signs, parameters for medications (i.e. BP, pulse, FSBS etc.), intake and output, neuro checks, IV therapy, skin / treatment records etc. Document new information concerning residents on the 24-hour log for follow up by the next shift or the responsible person. Checks charts for new physician orders. Complete 24-hour check of chart including all orders (night shift only).
• Notification: Notifies physician regarding any change in resident's condition, diagnostic testing results etc. and documents in medical record. Assure that the physician responds within the facility guidelines for response. Notifies resident / family / surrogate / conservator regarding changes in condition and new orders. Notifies physician regarding any untoward response to the medication, resident refusal to take medication, and medications, which have been held due to parameter i.e. low blood pressure. Assure that resident / family / surrogate / conservator are notified of changes and new medications / treatments. Document all notifications. Report any change of condition to the supervisor/ physician / responsible party and assures that a response is received on shift if possible. If the physician has not responded during shift, communicate information to next shift for follow up. Document all notifications in the medical record.
• Communication: Communicates with health care team members through 24 hour log regarding changes in resident's condition and verbally informs health care workers who need to know (i.e. C.N.A.s, R.N.A.s etc.) Accept shift report at beginning of shift and reports any changes at end of shift to nurses coming on duty. Notify housekeeping of any spills or cleaning required. Notify maintenance of any required repairs or maintenance. If any equipment is broken remove immediately and labels equipment with specific information about what is broken per facility "lock out / tag out" procedure.
• Quality Improvement Programs: Participate in facility improvement programs i.e. dining program, wound / skin, bowel / bladder, nutrition / weight management, restraint management, behavior management, fall prevention etc.
• Preferred Intensity of Care. Review resident's desires for end of life decisions to respond appropriately to a sudden change of condition i.e. initiate CPR if resident is a code status. Review code status of all residents and responds appropriately to a sudden change of condition i.e. initiate CPR if resident is a code status. If resident has a do not resuscitate (DNR), assure that appropriate comfort measures are implemented.
• Physician orders: Assure that all physician orders are noted and implemented in a timely manner. Transcribe new physician orders per facility procedure. If the order is a telephone order, place copy of physician order in chart and a copy for Medical Records to obtain the physician signature. Night nurse to check chart for completion of all new MD orders. Assure that recaps are completed as assigned by DON.
• Medications / Treatments: Medications are stored appropriately, checked for out of dates and re-ordered as needed. Two licensed nurses count narcotics on each shift. Medication refrigerator is checked 2x daily for compliance with temperature requirement (36 46 degrees F). Prepare, administer and document medications administered to assigned residents following medication guidelines established for the facility. Document all observations related to the medication including vital signs, manifested behaviors, blood sugar etc. in the medical record. Review emergency medication supplies and notify pharmacy once opened. Check all enteral feedings and IV's for dates and accuracy of administration. Review all medication drug levels for medications requiring monitoring i.e. Clozaril, Tegretol, Lithium, Digoxin and Dilantin etc. Check potassium levels periodically if resident are on diuretics. Notify physician regarding laboratory results and document response in chart within time frame required by facility policy. Provide treatment to all assigned residents and document all skin conditions and treatments on the proper form. Complete a thorough skin assessment at least weekly and as needed for all residents and document in weekly skin sheet and nursing note/summary.
• Resident Teaching: Assure that resident / family teaching is conducted as necessary and documented in the medical record.
• Blood Glucose Meter: Complete check of blood glucose monitor daily (night shift only). Assures that equipment is properly calibrated / cleaned, physician is notified of any out of range blood sugars, and notification is provided to resident / surrogate of any change in treatment orders.
• Dietary: Review new or changed diet orders and transmit information to the Dietary Department. Assure that residents receive correct diets with correct consistency.
• Incident Reports: Complete an incident report for any unusual occurrence and follow up investigation. Notify Director of Nursing Service or Administrator as required by facility procedure.

General Responsibilities:

• Follows facility policies and procedures and federal / state regulation.
• Participates in facility quality management program.
• Follows oral and written instructions accurately.
• Keeps supervisor informed of work priorities and problems.
• Responds appropriately to emergency situations and disasters.
• Provides a safe environment for patients, visitors and staff.
• Assures security of environment to prevent exit of wandering residents. Implement the facility procedure for elopement if any resident leaves the facility without permission.
• Follows facility standards

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