22/03/2019
Job Description Summary
Responsible for coordinating hospice services for patients which includes establishing and maintaining the patient’s plan of care.
Essential Job Functions/Responsibilities
Coordinates hospice services for patients, assists with the establishment of the plan of care in coordination with the physician and ensures a seamless transition to hospice.
Works with Clinical Supervisors and staff clinicians to gather, collate, and report patient care summary information to IDT.
Initiates appropriate preventive and rehabilitative nursing procedures.
Counsels the patient and family in meeting nursing and related needs.
Provides health care instructions to the patient as appropriate per assessment and plan.
Assists the patient with the activities of daily living and facilitates the patient’s efforts toward self-sufficiency and optional comfort care.
Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload.
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Communication
Completes, maintains and submits accurate and relevant clinical notes regarding patient’s condition and care given. Records pain/symptom management changes/outcomes as appropriate.
Communicates with the physician regarding the patient’s needs and reports changes in the patient’s condition; obtains/receives physicians’ orders as required.
Communicates with community health related persons to coordinate the care plan.
Teaches the patient and family/caregiver self-care techniques as appropriate. Provides medication, diet and other instructions as ordered by the physician and recognizes and utilizes opportunities for health counseling with patients and families/caregivers. Works in concert with the interdisciplinary group.
Provides and maintains a safe environment for the patient.
Assists the patient and family/caregiver and other team members in providing continuity of care.
Works in cooperation with the family/caregiver and hospice Interdisciplinary Group Members to meet the emotional needs of the patient and family/caregiver.
Attends interdisciplinary group meetings.
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Additional Duties
Participates in on-call duties as defined by the on-call policy.
Ensures that arrangements for equipment and other necessary items and services are available.
Supervises ancillary personnel and delegates responsibilities when required.
Assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and inservice classes.
Fulfills the obligation of requested and/or accepted case assignments.
Actively participates in quality assessment performance improvement teams and activities.
The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
Position Qualifications
Registered nurse with current licensure to practice professional nursing in the state.
Licensed vocational nurse with current licensure to practice professional nursing in the state.
Minimum of two years experience, at lease one of which is in the area of public health, home care, or hospice nursing is preferred.
Self directed and able to work with minimal supervision.
Complies with acceptable professional standards and practice.
Demonstrates excellent observation, problem solving, verbal and written communications; nursing skills per competency checklist.
Shows ability to organize and prioritize workload independently.
Demonstrates good communications, negotiation, and public relations skills.
Demonstrates autonomy, organization, assertiveness, flexibility and cooperation in performing job responsibilities.
