Trinity Health (HQ Michigan)
This position involves nursing in the LIFE clinic primarily, but also may include making home visits and nursing home visits. As part of an interdisciplinary team (IDT), assesses and monitors participants’ health status, provides nursing care, administers prescribed medications, educates and counsels participants and families in collaboration with primary care physician, home care nurse, and other team members. Conducts initial assessments and periodic reassessments, develops a plan of care, coordinates 24 hour care delivery, regularly informing the IDT of the medical, functional, and psychosocial condition of each participant, remaining alert to pertinent input from other team members, participants caregivers, as well as documenting changes in a participant’s medical record consistent with established documentation policies. Rotates answering evening and weekend call.
Conducts initial nursing assessment and scheduled and episodic re-evaluations of all participants; provides ongoing assessment, monitors health problems and health status as needed.
Develops a nursing care plan, setting long and short-term goals to meet preventive, restorative, maintenance, and palliative care needs. Also assesses functional status and personal care needs, and develops personal care plan.
Serves as a member of the IDT and participates in initial assessments, care planning, and ongoing re-evaluations of participant care, changing the plan of care as the participant’s needs change.
Assesses and triages participants in person and on the phone for care in the clinic, and assists with facilitating efficient, effective patient care in the LIFE center clinic on a daily basis.
Responds to emergencies, assisting the participant, primary care provider, staff and family. Assists with coordination of care across settings, i.e., hospital, nursing home, LIFE center and home.
Indicates need for dietary assessment and refers to dietitian as needed.
Administers medications and treatments ordered by the primary care physician (or nurse practitioner). Develops and implements an individualized “medications administration plan” and education program for participants. Maintains appropriate medication records.
Assists with management of the pharmacy dispensary, following all policy and procedures relating to control and storage of narcotics, and emergency medicines and equipment.
Assists participants in maintaining optimum health, coordinating and supervising health screening programs, and administering emergency care according to established policy and procedures.
Provides health education to participants and family members, staff, and volunteers as necessary.
Consults with aides concerning personal care duties and oversees staff participation in personal care giving. Participates as a personal caregiver.
Participates in the daily activities of the Center including conducting classes, as needed.
Make home visits to conduct nursing assessments, treatments, education, supervision of personal and respite care, as needed.
Provides evening and weekend on-call phone coverage on a rotating basis to triage, troubleshoot, and coordinate participant care with the physician on call.
Maintains a clean, safe, clinic environment, promotes infection control, accident prevention, and reports potential hazards.
Demonstrates professional practice in patient care by use of established standards in planning, organizing, implementing, and evaluating.
Maintains current, written and electronic records in compliance with regulatory standards; prepares reports and correspondence.
Develops and implements participant bowel and bladder training programs.
Demonstrates understanding of participants as unique individuals in need of loving, supportive, emotional, physical and spiritual care.
Demonstrates positive interpersonal relations in dealing with fellow employees, supervisors, and other department employees to maximize positive employee relations and productivity.
Supervises, coordinates, and evaluates students as appropriate.
Performs duties in accordance with ANA Code for Professional Nurses.
Administers competency testing to appropriate PACE staff.
Other duties as assigned.
Education
Minimum Qualifications:
Graduate of a NLN Accredited RN Program.
Current CPR certification.
Licensure: Current RN licensure in the Commonwealth of Pennsylvania.
Experience
One year acute care experience with an adult population and
One year experience as a community health or long term care nurse or equivalent experience.
Minimum of one year experience in working with the frail or elderly population
