LPN/RN Night Shift

Job Description

Job Description

Position Purpose:

Be in charge of a CNA ensuring they are able to provide the highest quality of care for residents. Working with doctors, obtaining medications, and maintaining accurate records of treatment.

Essential Functions of Position:

• Coordinate effective use of personnel, supplies, equipment and facilities; obtain medications and medical records to provide safe, efficient and therapeutic care to residents

• Contact physicians as necessary and ensure physician interventions are timely and appropriate; ensure appropriate documentation of resident care

• Responsible during the shift for the total nursing care of residents in the assigned unit.

• Assumes responsibility for compliance with Federal, State, Local, and company regulations.

• Explains procedures and treatments and care plan to residents.

• Transcribes physician's orders to resident charts, medication*/*treatment cards and care plans as required.

• Charts progress notes in an informative, factual manner that reflects the care administered as well as the resident's response to care.

• Receives*/ gives report fro m*/to nurse he*/ she is relieving /*coming on and records sufficient information and implements appropriate follow-up action as necessary

• Follows established procedures for charting and reporting all reports of incident/accidents for residents and employee

• onducts frequent rounds to evaluate effectiveness of care delivery. Maintains awareness of comfort and safety need resident.

• Observes resident, records significant conditions and reactions, and notifies supervisor or Physician of resident's condition and reaction to drugs, treatments, and significant incidents.

• Takes temperature, pulse, blood pressure, and other vital signs to detect deviations from normal and assess condition of resident.

• Responds to emergency situations based upon nursing standards, policies, procedures, and protocol.

• Assists in completion of the care plans *(*acute and long term) and is involved in the care conference as deemed necessary.

• Participates, reports to DON I Administrator and conducts (as appropriate) investigations related to any alleged abuse.

• Ensures that the progress notes are reflective of the care plan and that the approaches on the care plan are being followed.

• Assures that team is aware of the resident care plan, and ensure personnel refer to the care plan prior to administering care.

• Monitors that documentation is completed daily. Takes report from nursing staff to facilitate accurate documentation in resident medical record.

• Perform additional duties as assigned.

EDUCATION / REQUIREMENTS:

Current State RN/LPN license with a minimum of 2 years related experience; or equivalent combination of education and experience. Good standing in the state registry is required.