APRN (Per Diem)

Hospice Nurse Practitioner

North Country Healthcare is a non-profit affiliation of four medical facilities, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve. As a valued team member this role emphasizes advancing High-Reliability Organization (HRO) principles, embedding a culture of safety, accountability, and consistent high performance.

Adhering to System Values, Service Excellence and Standards of behavior, the Hospice Nurse Practitioner (Advanced Practice Registered Nurse) is an advanced practice registered nurse responsible for providing comprehensive palliative and hospice care to patients with terminal illnesses. Working collaboratively with the Hospice Medical Director, attending physicians, and the interdisciplinary team, the APRN evaluates patients, manages symptoms, develops and revises treatment plans, and provides education and support to patients and families.

The Hospice Advanced Practice Registered Nurse promotes quality end-of-life care that aligns with the patient's goals, values, and preferences while ensuring compliance with CMS Hospice Conditions of Participation and applicable state and federal regulations.

Essential Qualifications

Education:

• Master's or Doctoral Degree in Nursing from an accredited program.

Certification:

• National Nurse Practitioner Certification.
• Hospice and Palliative Care Certification (ACHPN or equivalent) preferred.
• All employees and contracted staff will have either successful completion of an American Heart Association* accredited course in Basic Life Support (BLS), or ACLS and PALS combined. (for clinical staff), Heartsaver CPR AED (for nonclinical staff), and renewal on a regular basis.

Licensure:

• Licensed as an APRN in New Hampshire.
• DEA License.
• Valid driver's license and reliable transportation.

Skills:

• Strong understanding of hospice philosophy, palliative care principles, and end-of-life care practices.
• Advanced clinical assessment and symptom management skills.
• Proficiency in pain management and medication management for complex hospice patients.
• Effective communication, active listening, and conflict resolution skills.
• Ability to facilitate advance care planning and goals-of-care discussions.
• Sound clinical judgment, critical thinking, and decision-making skills.
• Ability to collaborate effectively with interdisciplinary teams, patients, and families.
• Working knowledge of hospice regulations, CMS Conditions of Participation, documentation standards, and applicable state and federal requirements.
• Strong time management, organization, and prioritization skills.

Work Experience:

• Two years of hospice or palliative care experience preferred.
• Experience in home health or community-based care preferred.
• Experience with electronic medical records preferred.

Physical Requirements:

• Ability to travel throughout the agency service area.
• Ability to lift up to 25 pounds.
• Ability to perform patient assessments in home environments.
• Ability to sit, stand, bend, and kneel for extended periods.

Work Environment:

• Patient homes.
• Assisted living facilities.
• Skilled nursing facilities.
• Hospitals.
• Agency offices.
• Travel throughout the service area is required.

Essential Functions

Patient Care:

• Provide compassionate, patient-centered hospice and palliative care to patients with terminal illnesses.
• Assist with complex symptom management, including pain and other distressing symptoms.
• Educate patients and caregivers regarding disease progression, symptom management, medication use, goals of care, hospice philosophy, advance directives, and end-of-life expectations.

Scope of Clinical Practice:

• Perform comprehensive hospice and palliative care assessments.
• Conduct face-to-face encounters for hospice recertification as permitted under CMS regulations.
• Evaluate disease progression and prognosis.
• Develop and revise individualized care plans.
• Order and interpret diagnostic testing as appropriate.
• Prescribe medications, treatments, and durable medical equipment in accordance with state licensure and collaborative practice requirements.
• Complete medication reconciliation and deprescribing when appropriate.
• Participate in goals-of-care discussions and advance care planning.
• Support patients receiving care in homes, assisted living facilities, nursing facilities, and inpatient settings.

Coordination & Collaboration:

• Participate in Hospice Interdisciplinary Group meetings.
• Collaborate with physicians, nurses, social workers, chaplains, hospice aides, volunteers, therapists, and other members of the interdisciplinary team to support coordinated, goal-concordant care.
• Provide clinical consultation to hospice staff.
• Coordinate transitions of care.
• Participate in clinical reviews and debriefings as appropriate.

Compliance, Documentation & Safety:

• Complete timely and accurate documentation in the Electronic Medical Record.
• Document all patient encounters according to agency standards.
• Complete hospice recertification documentation and required face-to-face documentation.
• Ensure documentation supports patient eligibility for hospice services.
• Meet documentation and regulatory requirements within agency timelines.
• Maintain compliance with CMS Conditions of Participation, the State Nurse Practice Act, DEA regulations, agency policies and procedures, documentation standards, and HIPAA regulations.
• Support regulatory compliance initiatives and survey readiness.
• Support a culture of safety, quality improvement, and continuous improvement.

Core Competencies:

• Compassion and empathy.
• Clinical excellence and critical thinking.
• Communication and collaboration.
• Leadership and accountability.
• Ethical decision-making.
• Cultural sensitivity.
• Quality improvement.

Physical Demands:

• Participate in Quality Assurance and Performance Improvement (QAPI) activities.
• Support quality improvement initiatives and identify opportunities for clinical improvement.
• Maintain high patient and family satisfaction.
• Demonstrate excellent clinical judgment in hospice care delivery.

Other Responsibilities:

• Performs additional duties as assigned.