Registered Nurse

Hospice of San Joaquin is the oldest not-for-profit hospice of 40 years. We serve all of San Joaquin and Stanislaus Counties. We are committed to continue to be the leader in ensuring quality of the journey, from serious illness through end of life and to honor our mission by honoring life by ensuring patients and their Caregivers are the focus of everything we do. We are seeking a Dynamic skilled, self-motivated Registered Nurse who thrives in a fast paced environment and to support our mission. This is a Full-Time position.

Sign-On Bonus:

***$8,000.00 for Registered Nurse with 2 or more years of Hospice Experience - paid out in 4 equal payments over 12 months***

***$4,000.00 for Registered Nurse with no Hospice Experience - paid out in 4 equal payments over 12 months***

POSITION PURPOSE/SUMMARY:

Provide total management of patient care for high acuity/complicated patients identified at time of admission.
1. Provide skilled nursing assessments/delivery of direct care.
2. Works with IDT to develop individualized plan of care.
3. Provides direction for social services, home health aides, LVNs, and all contracted clinical care providers.
4. Coordinate/Communicates with the RRT Case Manager 2 to ensure continuity of care for a shared caseload.

CLINICAL SERVICES:
Ensures that patients/families receive quality palliative and supportive care in the home setting, 7 days per week.
1. Using clinical assessment skills, completes the initial nursing assessment; identifies the physical, practical, physiological needs of the patient. Assess patients within regulatory requirements. Perform admission visits and follow up assessments in a thorough and complete manner.

2. Works with social services to identify the emotional, psychological, and spiritual needs of the patient.

3. Develops Plan of Care based on identified needs, plans reflect a problem-solving approach; defined outcomes are measurable. Ensure quality, continuity of care and achievement of patient goals. Plan of Care is updated with outcomes, changes with new interventions at the time of specific changes in patient’s condition. Care Plan will be current and up to date, and will reflect the individualized needs of the high acuity patients. Updates provided at IDT meeting every 14 days.

4. Makes recommendations to IDT for action/follow-up as needed for patients.

5. Maintains up-to-date patient records so that problems, plans, actions and goals are accurately and clearly stated and kept in accordance with Medicare, Medi-Cal, State home health agency and JCAHO standards.

6. Collaborates with physicians to determine appropriate frequency of nursing visits and the need for a change of level of care (continuous home care, respite, General Inpatient Care, discharge, from the Hospice Program). Visit Frequency and Level of Care should reflect the high acuity needs of the patient group, as appropriate.

7. On an ongoing basis, uses clinical assessment skills specific to the Hospice patient population to update the plan of care and to give suggestions to the IDT for action and follow-up by various team members.

8. Interventions reflect an advanced level of nursing practice and commitment to execution of IDT plan of care.

9. Follows universal precautions in delivering patient care.

10. Provides support to families at time of patient's death with coordination of services with physician, mortuary, DME, supplier.

11. Assists family in making transition from care giving to bereavement, in coordination with IDT members.

12. Functions as an on-call nurse, utilizes expert knowledge of Hospice nursing, home health care, crisis intervention, and family dynamics to determine necessity for home visits.

13. Demonstrates creativity in meeting patient/family needs in the home environment.

14. Uses expert nursing judgment and functions as patient advocate, in collaboration with IDT and primary physician, when seeking a change in optimal care setting for the patient, incorporating patient safety and family care giving ability.

INTERDISCIPLINARY COLLABORATION/COMMUNICATION:
Ensure continuity of care to patient/families by effectively collaborating and communicating with Social Services and other members of the IDT and the patient/family/caregivers.
1. Attend all meetings; verbal presentations are concise, accurate and pertinent.

2. Communicates the need to discuss "crisis" patients/families to the Chief Clinical Officer/Designee in order to facilitate team discussion and necessary changes in patient's plan of care.

3. Works with social workers, home health aides, homemakers, pharmacy, therapists, DME suppliers, and other health care providers as case manager for patient's care.

4. Makes appropriate referrals for additional services when indicated by change in patient condition.

5. Sensitive to CG ability to provide care & offers additional services when need arise.

6. Give support/instruction to patient/caregiver to facilitate the IDT Plan of Care.

7. Recognizes the knowledge, skills and input of each discipline representative on the team and advocates for the most appropriate team member(s) intervention(s) with the patient/family.

8. Coordinates with the RRT Case Manager 2 to ensure supervisions and clinical direction of LVN’s, and HHA’s. Team documents the supervision of HHA as required no less than once every 14 days, submit summary of patient care to attending physician every 62 days.

9. Ensures the patient's family's right to confidentiality in communications.

10. Contributes to the annual volunteer evaluation for individuals with whom she/he has interacted.

11. Minimum productivity requirements, based on current number of patient referrals received, productivity levels are maintained; promotes agency philosophy, mission statement and administrative policies to ensure quality of care. Manages time efficiently utilizing ancillary staff to their fullest capacity to ensure that patients are provided the optimum level of care and service available.

EDUCATION OF PATIENTS FAMILIES AND CAREGIVERS:
Ensures that patients/families/caregivers receive the education they need to understand the philosophy of Hospice care and the knowledge required to provide for the comfort and physical care needs of the patient. Helps Hospice of San Joaquin educate the community.
1. Responsible for coordinating physical care of patients by teaching primary caregivers, employed caregivers, and volunteer caregivers as appropriate.

2. Educates patients/families/physicians/referral sources and the community about the Hospice philosophy and Hospice's services as needed.

Pre-Employment Requirements:

1. Health Screening
2. TB Screening
3. Hepatitis B Series offered
4. Background Check
5. Reference Check
6. Immunizations
7. Drug Screening

Job Qualifications:

1. A current license in the State of California as a Registered Nurse.
2. Minimum of one year clinical experience as an RN required. One year recent clinical experience dealing with acute care patients in a critical care or emergency room setting preferred. Six months or more of home care or Hospice experience ideal.
3. Ability to set priorities, organize work independently.
4. Ability to make independent clinical decisions.
5. Knowledge of medications, indications, dosage ranges, side effects and potential toxicity.
6. Skill in nursing practices with understanding and knowledge of Hospice care and committed to the philosophy and goals of the program.
7. Ability to communicate effectively verbally and in writing.
8. Ability to learn and assimilate the Netsmart computer software program.
9. CPR Certification

OTHER QUALIFICATIONS
1. Ability and willingness to drive own vehicle, have a valid California driver's license and have automobile insurance that meets State standards. All employees, volunteers, consultants and consultant volunteers who drive need to provide Hospice of San Joaquin with evidence of insurance. This is necessary to be covered on the agencies non-owned auto policy.
2. Ability to safely maneuver equipment (wheelchairs etc.) and assist family/caregivers with transferring and ambulating patients when necessary.
3. Implements personnel policies as they relate to nursing staff.
4. Physically able to walk, stand, stoop, sit and lift.
5. Good manual dexterity
6. Visual/hearing ability sufficient to comprehend written/verbal information.
7. Able to tolerate driving in a car for long periods of time.
8. Able to negotiate steps and non-paved surfaces to reach patients.
9. Able to move patients and/or bend over bed or wheelchair bound patients while providing care.