Nurse III - PNMT Nurse

About the role

The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state.

Responsibilities

• Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
• Serves in an on-call status on a rotating schedule as required to meet operational needs of the facility.
• Attends daily medical and/or other state center meetings to keep abreast of individuals' health status. Tracks criteria to ensure the individual is referred to the PNMT for specialized supports/services when criteria are met as defined in Physical Nutritional Management policy.
• Participates in the PNMT to intervene with individuals who have health-related concerns/conditions for whom the IDT requires specialized assistance/services as outlined in the Physical Nutritional Management policy. Leads and/or participates in the PNMT during discussions and IDT meetings. Performs specialized nursing assessment(s) as indicated to gain additional information regarding the need for interventions related to physical and nutritional management supports.
• Analyzes assessment data and develops PNMT recommendations with measurable goals and action plans. Develops or participates in the development of the individual health care plan (IHCP) for individuals on active PNMT caseload. Documents in the PNMT progress notes. Collaborates with the IDT throughout the PNMT process to optimize integration of PNMT recommendations and plans into the ISP.
• Reviews all return from hospital documentation and performs PNMT Post-Hospitalization Assessment/Review following hospitalization for conditions listed in PNMT referral criteria for PNMT. Communicates and collaborates with the hospital liaison nurse for individuals who are hospitalized. Reports the results of the post-hospitalization assessments/reviews to the PNMT as part of the determination of PNMT services.
• Collaborates with the Interdisciplinary Team (IDT) throughout the PNMT process to provide current assessments, test results, medical history, lab reports, and other information in order to optimize integration of PNMT recommendations and plans into the Individual Support Plan (ISP). Supports the analysis and synthesis of pertinent data and monitors IDT implementation of PNMT recommendations. Assists the IDT in goal and action step development to improve the individual’s health status for PNMT criteria conditions. Collaborates with members of the PNMT as well as medical staff and other nurses as needed. Reports results of ISPA meetings to PNMT.
• Makes recommendations on how to improve nursing, habilitation and direct care services and activities related to physical and nutritional management. Makes recommendations for additions or changes to standards of care to promote prevent illness and injuries.
• Collaborates with the Interdisciplinary Team (IDT) to instruct, counsel and assist with physical and nutritional management needs for individuals served by PNMT. Assists with treatment to individuals on active PNMT caseload, performs PNMT interventions, and monitors individuals’ progress. Monitors individuals for proper alignment during and after eating and during enteral feeding, medication administration, oral care, and other activities that may provoke swallowing difficulties. Participates in the evaluation of individuals receiving enteral nutrition to determine whether a tube is medically necessary, and plans are made to return to the least restrictive method of eating as appropriate.
• Collects and tracks activities of the PNMT and outcomes of specific individuals served and identifies, compiles, reviews, and analyzes data for general trends. Conducts PNMP and/or PNMT documentation audits as scheduled. Reports findings and recommendations for interventions in assigned meetings such as PNMT, skin integrity committee, or other designated oversight groups. As assigned, contributes to development, review and revision of PNM - related policies. As assigned, submits a monthly report on targeted areas such as causes of wounds, weight loss/gain, fractures.
• Reviews literature and research findings to keep abreast of physical and nutritional management specialized topics, nursing care standards, state and federal laws (ICF/IID rules and regulations) and serves as the resource person for physical and nutritional management from the nursing perspective. As assigned, collaborates with others to create and deliver specialized training/in-service material to prevent or decrease the opportunity for injury or illness for at-risk individuals on topics such as risk guidelines, aspiration pneumonia, PNMP philosophy content and procedures, positioning, lifting and transferring, dining/eating/oral intake and monitoring procedures.
• Provides direct care nursing services. Provides treatment to HHS employees injured in course and scope of employment.

Qualifications

Considerable knowledge of nursing techniques, standards, and procedures; of health care laws and regulations; of medical diagnoses and procedures; of accepted medical treatment patterns; of community health and nursing care principles, best practices, and procedures; of program regulations and procedures; and of utilization review and control measures.

Knowledge of nursing care standards, the Settlement Agreement, and the Healthcare Guidelines or ability to quickly gain the knowledge.

Knowledge of evidence-based practices applicable to treatment of individuals with developmental disabilities.

Knowledge of state and federal laws and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) rules, regulations, policies, and procedures related to SSLCs or ability to quickly gain that knowledge.

Knowledge of emergency procedures and emergency equipment, i.e., Cardiopulmonary Resuscitation (CPR), and ability to assess and care for residents and/or staff members in emergency situations.

Knowledge of wound and ostomy care and wound prevention.

Knowledge of Root Cause Analysis.

Skills in the use of computer/software and an electronic health record system, including the ability to create graphs for data collected.

Skill in writing policy, procedures and guidelines.

Excellent verbal and written communication skills and the ability to present ideas clearly and concisely in both written and oral communications.

Skill in the care and treatment of patients.

Skill in working with individuals with complex physical and nutritional management needs.

Ability to provide patient care; to prepare and maintain records; to organize, coordinate, and evaluate nursing activities and delivery of health services; to interpret policies and procedures; to interpret health care regulations; to recognize patterns of medical necessity treatment; and to provide technical assistance.