Cornerstone Visiting Nurse Association. JOB TITLE: Hospice RN/LPN. Lap top, various medical equipment, instruments, machines and a vehicle

Transcription

1 Cornerstone Visiting Nurse Association JOB TITLE: Hospice RN/LPN The purpose of this position is to enhance and support our mission statement by providing high quality, compassionate, costeffective hospice care. JOB DESCRIPTION: Cornerstone Visiting Nurse Association adheres to the American Nurses Association Standards for Community Health and Home Health Nursing Practice and the Hospice Nursing Practice. The Job Description for hospice RN/LPN is an integration of these standards. The job role requires independence with skills, expertise, judgment and reporting in from the field or office. The LPN functions under the supervision of a RN and is responsible for assisting RN in implementing all Standards. ACCOUNTABILITY: EQUIPMENT: Hospice Director Lap top, various medical equipment, instruments, machines and a vehicle ENVIRONMENT: Inside 20% Outside 80% DUTIES AND RESPONSIBILITIES: Definition of hospice case manager is as follows: Case Manager will be responsible for coordination of patient care with all members of the interdisciplinary Group (IDG).On going spiritual, psychosocial, emotional support to patient and caregivers, as well as pain & symptom management as patients needs require. STANDARD I: Assessment The hospice nurse collects client health data. 1. Data collection involves the client, family, community and other health care practitioners, as appropriate. 2. The priority of data collection is determined by the client s immediate condition or needs. 3. Pertinent data is collected using appropriate assessment techniques and valid and reliable instruments. 4. Relevant data is documented in appropriate areas of chart. 5. Data Collection is timely, accurate and comprehensive. 6. Documentation will be done in the home during the home visit. 7. Reviews record and procures necessary supplies. 8. Comprehensive assessment must identify the physical, psychological, emotional, and spiritual needs of the patient in order to establish the plan of care. 9. Pain assessment on admission and ongoing. STANDARD II: Nursing Diagnosis/Disease Management The hospice nurse analyzes the assessment data in determining nursing diagnoses. 1. Hospice terminal diagnoses are determined with hospice medical director. 2. Patient, caregiver, IDG and PCP will determine patient plan of care (POC) upon admission to hospice services and within the 5 day window for Medicare & Medicaid patients. 3. Problems are initiated and modified to reflect diagnosis and treatment orders. 4. Ongoing assessment of pain and symptom management is performed at each routine visit. STANDARD III: Goal Identification The hospice nurse develops and identifies patient goals by working with the patient/primary caregiver in conjunction with the IDG 1. Goals are derived from the assessment, patient wishes and diagnoses. 2. Culturally appropriate goals are mutually formulated with the client, family, physician, and other health care practitioners, when possible and appropriate. 3. Goals are documented, measurable and attainable in relation to patient diagnosis and available resources. 4. Competent in Allscripts accuracy.

2 STANDARD IV: Planning The hospice nurse develops a plan of care that prescribes intervention to attain expected goals. 1. The plan of care is customized for the client to include spiritual, psychosocial, emotional and physical components in line with the client s wishes and prognosis. 2. The plan is developed in collaboration with the client, family, physician, hospice IDG and other health care practitioners, as appropriate. Appropriate interagency referrals are placed for specialties and other disciplines. 3. The plan reflects utilization of agency and community resources and acknowledges the cost factor of care within the benefit coverage or other resources. Covered medications Necessary durable medical equipment time per visit average pre/post attendance at team meetings supply management multidisciplinary utilization 4. The plan reflects evidenced-based nursing practice (i.e. appropriate problems, goals, & interventions are selected.) 5. The plan is sensitive to the changing nature of the client s needs as reflected by modifying the problems, goals, & interventions. Plan of care is modified as patient needs/goals change. STANDARD V: Implementation The hospice nurse implements the interventions identified in the plan of care. 1. Interventions are consistent with the established plan of care. 2. Interventions are contingent on the timely monitoring of client response and the progress made toward achieving the anticipated goals and the expected outcomes. 3. Interventions are coordinated and communicated with client, family, and other healthcare providers. 4. Intervention documentation each visit includes client-related instruction, direct interventions, all elements of client management, patient care conferences, and referrals to other professionals or resources. 5. Supervision of assistants and support personnel is performed consistently and in accordance with state licensing laws and agency policy. 6. Interventions performed in the home will be documented in the home. STANDARD VI: Evaluation The hospice nurse evaluates the client s progress toward attainment of outcomes. 1. Evaluation is systematic, ongoing, and outcome-based. 2. The client, family and other health care practitioners are involved in the evaluation process as appropriate. 3. Ongoing assessment data are used to revise diagnoses, expected goals, the plan of care, and interventions as needed. 4. The client s responses to interventions are evaluated and documented. 5. Evaluation activities measure efficiency, effectiveness, costs, and consistency with client needs and developing scientific evidence. 6. Documentation will be done in the home. STANDARD VII: Quality of Care The hospice nurse systematically evaluates the quality and effectiveness of nursing practice. 1. The nurse participates in quality improvement activities such as the following: Identifies and participates in opportunities for improvement of care. Participates in gathering necessary QAPI information Participates in chart audits Appropriately utilizes/follows QI recommendations in nursing practice. 2. The nurse demonstrates effective case management skills as evidenced by:

3 Appropriate utilization of services, timely referral to other disciplines and effective coordination and continuity of patient care services within the IDG. Understands, utilizes and documents disease management protocols and tools. 3. The nurse provides quality patient care as evidenced by positive patient outcomes documented through QAPI data collection. STANDARD VIII: Performance Appraisal The hospice nurse evaluates his or her own nursing practice in relation to professional practice standards. 1. The nurse engages in performance self-appraisal on a regular basis, identifying areas of strength as well as areas for professional development. 2. The nurse seeks constructive feedback from peers and management regarding his or her own practice. 3. The nurse takes action to achieve goals identified during performance appraisal. 4. The nurse s practice is compliant with agency policies and procedures as well as Medicare and state regulations. STANDARD I: Education The hospice nurse acquires and maintains current knowledge and competency in nursing practice. 1. The nurse participates in educational activities to maintain the sufficient number of CEU s to comply with licensing. 2. The nurse acquires knowledge, competencies, and skills appropriate to home health practice. 3. The nurse participates in preceptorship of students and new employees. 4. The nurse participates in research activities such as involvement on committees, utilizes nursing journals, participates in nursing organizations, or provides input in development of policies/procedures and practice guidelines. STANDARD : Ethics The hospice nurse s decisions and actions on behalf of clients are determined in an ethical manner. 1. The nurse s practice is guided by the Code for Nurses with Interpretive Statement. 2. The nurse maintains and protects client and agency confidentiality within legal and regulatory parameters. 3. The nurse acts as a client advocate assisting clients and families in developing skills so they can care for and advocate for themselves. 4. The nurse delivers care in a nonjudgmental and nondiscriminatory manner that is sensitive to client diversity. 5. The nurse delivers care in a manner that preserves client autonomy, dignity and rights. 6. The nurse uses available resources to formulate ethical decisions. 7. The nurse reports fraudulent and neglectful care provided by peers, family members, and other health care practitioner s care systems. 8. The nurse understands and adheres to agency code of ethics. 9. The nurse understands and follows the patient rights and responsibilities. STANDARD I: Resource Utilization The hospice nurse assists the client or family in becoming informed consumers about the risks, benefits, and cost of planning and delivering client care. 1. The nurse assesses and communicates to the client and family the factors related to safety, effectiveness, availability, and cost related to choices in care options. 2. The nurse assists the client and family in identifying and securing appropriate and available services to address health related needs. 3. The nurse assigns or delegates tasks as defined by the state nurse practice acts and according to the knowledge, skills, availability and willingness of the designated caregiver. 4. If the nurse assigns or delegates tasks, it is based on the needs and condition of the client, the potential for harm, the stability of the client s condition, the complexity of the task, the predictability of the outcome and the legal implications. 5. The nurse uses appropriate agency and community resources. STANDARD II: Other factors affecting performance: (e.g.) The staff is responsible for adhering to agency policy and guidelines concerning the following:

4 1. Productivity Agency expectation (will be waived for the first 90 days): o RN s are expected to have productively measures of visits in an 8-hour period. Admissions count as 1 visit Resumptions count as 1 visit o LPN 5-6 clients per 8 hr. day 2. Tact 3. Attitude 4. Appearance will adhere to agency dress code 5. Punctuality 6. Attendance 7. Discretion 8. Dependability 9. The nurse contributes to a supportive and healthy work environment.

5 JOB TITLE: RN/LPN PHYSICAL DEMANDS NEVER OCCASIONALLY FREQUENTLY CONTINUALLY Sit Stand Walk Bend/Stoop Squat Crawl Climb Reach Above Shoulder Level Kneel Balance Lift, Carry, Push, Pull Maximum 10 Lbs. Maximum 20 Lbs. Maximum 50 Lbs. Maximum Over 50 Lbs. Must Be Able To See Hear Speak Use One Hand Use Both Hands Environmental NEVER OCCASIONALLY FREQUENTLY CONTINUALLY Conditions Involves Being Inside Outside Exposed to Temperatures of 32 0 F and less 100 û F and more Wet & Humid Conditions Noise, Vibration Fumes, Dust Hazards, Exposure NEVER OCCASIONALLY FREQUENTLY CONTINUALLY Infectious Wastes Toxic Chemicals Needles/Body Fluids Radiation Chemotherapeutics Occasionally = 1% to 33% of the time Continually = 67% to 100% of the time Frequently = 34% to 66% of the time