LPN

Director of Wound Care and Restorative Nursing

Facility: 120 bed skilled nursing facility Department: Nursing Reports To: Director of Nursing Supervises: Restorative Aides (direct); provides clinical direction to licensed nursing staff on wound and restorative practice (indirect) Status: Full time, salaried. Classification as exempt or nonexempt should be confirmed with your HR partner or employment counsel based on actual duties performed. Schedule: Primarily days, Monday through Friday, with availability for weekend and after hours consultation on new admissions, acute skin changes, and survey activity.

Position Summary

The Director of Wound Care and Restorative Nursing owns two clinical programs that share the same underlying goal: keeping residents intact and functional. On the wound side, this position leads prevention, assessment, treatment, and documentation for all skin and wound conditions in the building. On the restorative side, this position designs, staffs, and monitors the formal restorative nursing program that maintains or improves resident function after skilled therapy ends.

This is a program leadership role, not a treatment cart role. The person in this seat is accountable for outcomes, documentation defensibility, regulatory readiness, and staff competency, and they are expected to be visible at the bedside every single day.

Program Ownership and Protected Time

This position is designated as a program role. The incumbent is not counted in daily direct care staffing ratios and is not routinely assigned to a hall or med cart. Emergency staffing coverage requires approval from the Director of Nursing or Administrator, should be documented, and should be the exception rather than the operating plan. Both programs collapse quickly when program leadership is repeatedly pulled to fill floor gaps, and both programs carry regulatory and reimbursement consequences when they collapse.

Essential Functions: Wound Care Program

Assessment and Clinical Management

• Perform a complete skin assessment on every new admission and readmission within the facility required window, and document findings before the end of the shift on which the resident arrives.

• Conduct weekly assessment and measurement of all open wounds, including length, width, depth, undermining, tunneling, wound bed characteristics, exudate, periwound condition, odor, and pain.

• Stage pressure injuries in accordance with current National Pressure Injury Advisory Panel definitions, and correctly differentiate pressure injuries from moisture associated skin damage, skin tears, arterial and venous ulcers, diabetic foot ulcers, and other nonpressure lesions.

• Determine and document whether each pressure injury was present on admission or acquired in the facility, and initiate immediate review of every facility acquired pressure injury.

• Develop and revise individualized treatment orders in collaboration with the attending physician, nurse practitioner, or wound physician, and ensure orders are transcribed accurately into the electronic health record.

• Coordinate wound consults, vascular studies, debridement services, negative pressure wound therapy, and specialty referrals, and track that recommendations are implemented.

• Round with the visiting wound physician or consultant and translate consult recommendations into actionable, transcribed orders the same day.

• Serve as the clinical resource for complex or nonhealing wounds, including escalation to the Director of Nursing and Medical Director when a wound fails to progress within an expected timeframe.

Prevention

• Own the pressure injury prevention program, including risk assessment on admission, weekly during the first four weeks, quarterly, and with significant change in condition.

• Direct the support surface and pressure redistribution program, including mattress and cushion selection, inventory, and verification that the ordered surface is actually in place and functioning.

• Verify turning and repositioning compliance through direct observation, not chart review alone.

• Partner with the Registered Dietitian on nutritional risk, weight loss, hydration, protein needs, and supplementation for residents at risk of or with existing skin breakdown.

• Partner with Therapy on seating, positioning, contracture management, offloading devices, and safe mobility for residents with wounds.

Documentation, Coding, and Supply Management

• Ensure wound documentation is complete, consistent between the treatment record, nurses notes, care plan, and MDS, and defensible under survey and payer review.

• Collaborate with the MDS Director to ensure accurate coding of skin conditions in Section M and related sections, and to reconcile any discrepancy between clinical documentation and coded data before submission.

• Maintain accurate wound photography or measurement records consistent with facility policy and resident consent requirements.

• Manage wound care product formulary, standardize dressings where clinically appropriate, control supply cost, and reduce waste and expired inventory in partnership with Central Supply.

• Maintain a current, accurate weekly wound census reported to the Director of Nursing and to the Administrator.

Essential Functions: Restorative Nursing Program

Program Design and Delivery

• Design, implement, and supervise the formal restorative nursing program, including the categories of range of motion, splint or brace assistance, and training and skill practice in bed mobility, transfer, walking, dressing and grooming, eating and swallowing, amputation or prosthesis care, and communication.

• Receive discharge recommendations from Physical Therapy, Occupational Therapy, and Speech Therapy, and convert them into written restorative programs with measurable goals, specific interventions, frequency, duration, and defined outcomes.

• Screen residents for restorative appropriateness on admission, at therapy discharge, quarterly, and with any decline in function.

• Ensure each restorative program is individualized, has a documented measurable objective, is reflected in the comprehensive care plan, and is reviewed and revised at least quarterly.

• Verify that restorative minutes are delivered as ordered and documented daily, and that documentation supports the frequency and duration recorded in Section O of the MDS. Note that qualifying restorative programs for MDS and PDPM purposes carry specific minimum time and frequency requirements. Confirm current thresholds against the active RAI Manual version rather than relying on prior year practice.

• Monitor and report restorative program participation, adherence, and outcomes monthly.

Restorative Staff Leadership

• Supervise, schedule, and evaluate Restorative Aides, including hands on competency validation for each program category the aide delivers.

• Train restorative and floor staff on proper technique for range of motion, transfers, ambulation, positioning, splint and brace application, adaptive equipment, and dining and swallowing interventions.

• Ensure restorative aides are not routinely reassigned to general nursing assistant duties, and elevate to the Director of Nursing when restorative coverage is compromised.

• Coordinate directly with Therapy leadership to prevent duplication of services, ensure a clean handoff from skilled therapy to restorative, and confirm that no resident is billed for restorative and skilled therapy for the same intervention in the same period.

Essential Functions: Regulatory, Quality, and Education

• Maintain readiness for survey in both program areas, with attention to the requirements governing skin integrity and pressure injuries, quality of care, activities of daily living and functional decline, care planning, and nutrition. Be prepared to walk a surveyor through any wound or restorative record without preparation time.

• Participate as a standing member of the facility QAPI committee, presenting monthly data on pressure injury incidence and prevalence, healing rates, facility acquired wounds, restorative participation, and functional outcomes.

• Lead root cause analysis on every facility acquired pressure injury and on any resident with unexplained functional decline, and drive corrective action to closure with evidence of sustained improvement.

• Monitor and report on the publicly reported quality measures tied to these programs, including pressure ulcer measures and long stay activities of daily living decline, and connect program performance to the facility Five Star rating.

• Deliver ongoing education and skills validation for licensed nurses and certified nursing assistants on skin observation, early reporting, prevention, positioning, and restorative technique. Deliver education during orientation, annually, and in response to identified deficits.

• Support Admissions and Clinical Leadership in evaluating referrals with complex wound needs, including realistic assessment of whether the facility can safely meet the resident's needs and what the treatment cost will be against the expected reimbursement.

• Participate in daily clinical meeting, Medicare meeting, at risk meeting, and care plan conferences as assigned.

Qualifications

Required

• Current, unencumbered Registered Nurse license valid in the state of practice. Note: assign the assessment and staging functions in this description to an RN. Verify against your state Board of Nursing scope of practice rules before filling this role with an LPN or restructuring duties.

• Minimum of three years of nursing experience, with at least one year in skilled nursing, long term care, or post acute care.

• Demonstrated wound assessment and treatment experience.

• Working knowledge of the federal requirements of participation for long term care facilities and of the survey process.

• Proficiency with an electronic health record. Experience with PointClickCare strongly preferred.

• Ability to communicate clearly and professionally with residents, families, physicians, staff, surveyors, and payers.

Preferred

• Wound care certification such as WCC, CWCN, CWS, CWON, or equivalent preferred.

• Facility will consider supporting certification for a strong candidate who is not yet certified, with a written commitment to obtain certification within an agreed timeframe.

• Prior experience building or rebuilding a restorative nursing program from the ground up.

• Supervisory experience.

Performance Expectations

Performance in this role is measured, not assumed. The following are reviewed monthly and are part of the annual evaluation. Specific numeric targets are set annually with the Director of Nursing and Administrator based on facility baseline.

Wound Care

• Facility acquired pressure injury rate, trended monthly

• Percentage of new admissions with a documented complete skin assessment within the required window

• Percentage of wounds with complete weekly measurement and documentation

• Average healing time and percentage of wounds progressing toward closure

• Wound supply cost per resident day against budget

• Zero survey citations related to skin integrity and pressure injuries

Restorative Nursing

• Number and percentage of eligible residents enrolled in a formal restorative program

• Percentage of restorative programs with documented delivery meeting ordered frequency

• Percentage of restorative programs with a current, measurable care planned goal

• Long stay activities of daily living decline quality measure performance

• Percentage of therapy discharges with a restorative program initiated within the defined handoff window

Physical Requirements

Must be able to move about the facility for the majority of the shift, including standing, walking, bending, kneeling, and reaching. Must be able to assist with resident positioning and transfers, lift and carry supplies, and perform fine motor tasks required for dressing application. Must be able to see and accurate assess subtle changes in skin color, texture, and condition. Must be able to respond to emergencies. Reasonable accommodation will be considered in accordance with the Americans with Disabilities Act.

Working Conditions

Long term care environment with exposure to blood, body fluids, wound drainage, odors, infectious disease, and hazardous materials. Standard precautions and facility infection prevention protocols are required at all times. Occasional evening, weekend, or holiday availability required for clinical urgency, survey, or program need.