Oversee primary caseload of hospice patients and provide skilled professional nursing care to them, their families, and caregivers as prescribed by the physician and in compliance with the Hospice Medicare Conditions of Participation, PA hospice licensure laws, and agency policies and procedures. Provide the initial assessment and comprehensive nursing assessment of patient needs and collaborate to develop the Interdisciplinary Group plan of care. Implement the plan of care and reevaluate and revise the Plan of Care relative to the patient’s nursing needs to provide appropriate, comprehensive, and responsive goals and interventions. Work closely with other members of the interdisciplinary team to ensure all patient and family care needs are being met.
Primary Duties:
As a member of the interdisciplinary team, the Registered Nurse utilizes the nursing process to contribute to each patient’s total plan of care.
Assessing and Planning:
- Seek and obtain sufficient information necessary to function effectively in the Hospice setting where the patient/family/caregiver is receiving care.
- Conduct initial assessment, including physical, emotional and psychosocial aspects, of patient/family/caregiver in a thorough, accurate, compassionate and timely fashion.
- Utilize the nursing body of knowledge to provide leadership and guidance to the Interdisciplinary Team in formulating and individualizing the interdisciplinary plan of care to include problem identification, interventions and goals to address palliative comfort measures for the terminally ill patient, family and caregiver.
- Contribute to identifying both active and potential needs of the patient and his/her family, which may affect the plan of care.
- Consistently collaborate with the physician to plan and implement the medical and nursing plan of care.
- Review the comprehensive interdisciplinary plan of care with the Interdisciplinary Team (IDT). Communicate in writing in the clinical record and verbally with the IDT to coordinate interventions and ensure continuity of care.
- Facilitate and participate in the IDT care conference and contribute to patient care planning.
Implementing and Evaluating:
- Provide nursing interventions and appropriate preventative and therapeutic nursing procedures.
- Collaborate with interdisciplinary team members to provide continuous assessment of assigned patients, interpret findings, initiate appropriate therapeutic actions, and evaluate the results of these actions.
- Accept responsibility of assignment to perform a specialized procedure only when qualified with specialty training, proven competency, clinical background, and expertise in the specialty area.
- Work in cooperation with family/caregiver and interdisciplinary team members to meet the physical and emotional needs of the patient/family/caregiver.
- Provide appropriate information and explanations to the patient and the patient’s family.
- Facilitate patient and family education to promote continuity of care and optimal patient/family outcomes for quality of life as defined by the patient/family/caregiver.
- Demonstrate expertise in the utilization of all interdisciplinary team members, including volunteers and community resources.
- Fulfill productivity requirements on an average daily census basis as determined by acuity level and Hospice RN Clinical Manager.
- Document accurate, complete, and relevant clinical notes regarding the patient’s condition and care given. Maintain documentation on a timely basis.
- Assess the dietary/nutritional needs of hospice patients and provide appropriate interventions relative to nutritional intake as the patient’s condition progresses.
Education
The Registered Nurse is a mentor who is able to provide educational experiences and communicate knowledge of patient care to members of the Interdisciplinary Team including, but not limited to: volunteers, hospice aides and family/caregivers, health care professionals, and the general community.
- Act as a mentor to other personnel by participating in orientation and assisting with field training and in-service education to contractors and referral sources, as needed.
- Participate in formal and informal in-services, and patient care conferences to promote the professional growth of all interdisciplinary team members.
- Teach the patient, family and/or caregiver regarding the progression of the disease process and self-care techniques as appropriate, which includes providing medication, addressing dietary and nutritional issues, and other instructions as ordered by physician, as well as recognizing and utilizing opportunities for health counseling.
- Supervise hospice aides/homemakers every 14 days per Medicare Conditions of Participation.
- Evaluate the effectiveness of educational experiences and teaching methods in order to promote the ongoing professional development of hospice staff and quality patient outcomes for patients, families, and caregivers.
Qualifications:
- Graduate of an accredited registered nursing program.
- Bachelor’s degree in nursing.
- C.H.P.N. (Certified Hospice and Palliative Nurse) certification is preferred.
- Has minimum of one-year general nursing experience is preferred with current hospice, home health, medical, surgical, or critical care experience.
- Experience with pain and symptom management interventions are preferred.
- Ability to work in an interdisciplinary setting.
- Understanding of Hospice philosophy, principles of death/dying.
- CPR certified.