Clinic RN

About the role

Responsible for providing direct and indirect nursing care to assigned Senior Total Life Care (TLC) participants in a clinic, home or community-based model of care in the STLC service area. Works under the direct and indirect supervision of the Center Manager but is independent in the application of advanced nursing knowledge and skills. Manages complex clinical situations for which (s)he is responsible. Works within an Interdisciplinary Team (IDT) to help care for the holistic needs of Senior TLC participants. Takes an active part in the care planning process and provides nursing interventions as appropriate. Provides on-call phone triage on weekdays, weekends, holidays and emergency situations on a rotating basis and documents those calls/visits in the Electronic Medical Record (EMR). Completes in-home aid re-assessments and supervisory visits as requested by the Home Care Agency (HCA) Supervisor.

Responsibilities

• Collects participant data and completes required forms with appropriate responses according to unit standards; identifies participant’s overt problems/needs and sets priorities; identifies problems requiring further referral and/or follow-up; interprets and records latest diagnostic results; and performs advanced nursing assessments using critical thinking skills.
• Performs wound care, skin care and other treatments as ordered by the Primary Care Provider (PCP) and documents in the EMR and logs as appropriate.
• Documents participant care delivered as planned and any variation, with appropriate rationale; makes and records observations related to impending or associated problems; implements nursing measures related to impending or associated problems.
• Schedules participants to be seen in the clinic per the IDT.
• Works with Clinic Technician and PCP along with the IDT to assess participants with holistic needs in the clinic setting.
• May provide End of Life Care at home or other home and/or hospital visits as requested.
• Using nursing process, delegates nursing care to appropriate personnel; integrates cost effective measures into nursing practice; recognizes unit problems and takes responsibility for documenting; demonstrates active participation in QI processes; complies with policies addressing safe working conditions; monitors unsafe working conditions; recognizes inappropriate and/or ineffective participant care management, resolves issue/problem and completes written reports.
• Takes on-call as scheduled on a rotating basis and documents those calls promptly.
• Makes home visits to provide care in crisis situations, to perform assessments, and to provide nursing care as requested by the IDT.
• During emergency procedures, they make participant welfare checks and documents those calls.
• May be required to deliver medications to participants to ensure continuity of care.
• Completes in-home aid re-assessments and supervisory visits as requested by the HCA Supervisor.
• Provides feedback to the IDT and the HCA on the results of those visits to support participants’ plans