Under the direction of the Communicable Disease Program Manager and the guidance of the TB Nurse Lead, performs professional and advanced level public health work. In collaboration with the TB Nurse Lead, develop treatment plans for persons with TB disease, suspects, and individuals with TB infection (TBI). Perform nursing assessments to determine if a patient has TB.
Provide case management of persons with TB and suspects. With guidance and support from the lead public health nurse, participates in coordinating treatment plans to include directly observed therapy (DOT). Provide directly observed therapy (DOT) and directly observed preventive therapy (DOPT) to persons with TB disease, suspects, and persons with TB infection. Conducts surveillance to identify persons with TBI or disease.
Educates tuberculosis suspects, persons with TB disease and contacts on TB transmission, pathogenesis and treatment process. Using judgement and tact, elicits contacts and expands the concentric circle when appropriate. Participates in case reviews to ensure treatment guidelines are met.
Prepares monthly performance measures report. Performs other communicable disease related activities as required. Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.(35%) TB Case Management: Educates tuberculosis suspects, contacts and cases on tuberculosis transmission, infection, disease, and treatment within three (3) days of initial report.
In coordination with the lead public health nurse, actively case manages tuberculosis (TB) suspects, cases and persons with TB infection (TBI). Prepares patient summary reports and participates in case reviews to ensure treatment guidelines are met. Reviews TB reporting forms (TB 400s) for accuracy and completeness with timely submission. Ensures all medical case management forms are complete and appropriately placed in medical charts.
Obtains sputum specimen for acid-fast bacteria (AFB) testing and packaged for mail to DSHS lab. Provide education to patients and contacts of patients on TB, the transmission of TB, exposure risk, rationale for testing, meaning of test results, and, if positive for TBI, actively encourages treatment regimens. Assist lead TB nurse in managing patient care of patients diagnosed with TB, suspected TB, TBI, patients who are contacts to cases or referred for an evaluation by other jurisdictions, and patients referred through the EDN system.
This includes: drawing labs; providing directly observed therapy (DOT); collecting sputum specimens; performing monthly toxicity screenings, documenting appropriately in patient's charts, carrying out data entry, following through on lead TB nurse and medical director instruction, educating clients and family and performing other patient management tasks as needed. Abides by standing delegation orders and program procedures. (20%) Directly Observed Treatment (DOT): Provides DOT to TB cases/suspects and DOPT to TB contacts or TBI clients as ordered by TB physician. Reviews adverse reactions with client or parent at every visit.
Documents each visit on the DOT check list. Meets patient at assigned time and place and documents and notifies TB nurses if patient does not show or cannot attend DOT. Assures treatment compliance by providing DOT/DOPT services.
Assesses patient environment to reduce risk of transmission and minimize delinquency. Performs DOT/DOPT toxicity check and documents on appropriate forms. Track DOT mileage.
Abides by standing delegation orders and program procedures. (15%) Contact Investigation: With advanced interviewing techniques, elicits, and verifies contact information within seven (7) days of suspect/case identification. Using the concentric circle approach, conducts investigation to locate all appropriate contacts.
Educate contacts on TB infection, disease, and treatment. Evaluates contacts for infection or disease based on window and post window tuberculin skin testing or blood tests. Assures appropriate follow-up to complete evaluation.
Accurately completes contact evaluation and investigation forms with timely submission to the lead contact investigator. Reviews contact information forms for completeness. Using the concentric circle map assesses investigation results to determine contact expansion.
Actively case manages contacts to a known source case. Interviews patient with confirmed TB or suspected to have TB within 7 days of notification to DSHS TB staff. Collaborates with contact investigation coordinator to: determine the scope of the contact investigation, provide a summary of contacts listed and whether the contacts are low, medium, or high priority, update current results from contacts tested, obtain CXR referrals for patients as needed and data enter patient information.
Completes 340/341 reporting form and sends completed form to contact investigation coordinator for audit and reporting. Ensures all documentation is provided to contact investigation coordinator in order to obtain orders for treatment of contacts to index case. Abides by standing delegation orders and program procedures. (15%) Education and Training:
Provide technical assistance to private physicians, local health departments, regional staff, correctional facilities, and the general public. Develop and conduct in-service training and continuing education for healthcare providers, hospitals, correctional facilities, workplaces, and the public. Coordinates, educates, and counsels on the implementation of DOT and treatment of TB infection for the prevention of tuberculosis disease to include health care providers, school nurses, high risk nursing homes, and other community providers as needed.
Provides education to facilities undergoing large contact investigations. These include, but are not limited to: nursing homes, adult day cares, correctional facilities, schools, and community medical providers. Develops educational material on TB for patients and families in English or Spanish.
Provides education to patients and patient contacts about TB, LTBI, spread of TB disease, and rationale for testing and treating LTBI. Develops and provides training to contractors who provide DOT. Acts as a liaison/resource to health delivery service centers in the community to assure appropriate management of suspects, cases, and persons with latent TB infection.(10%) Reporting/Quality Assurance:
Participates in compiling data for performance measures report with timely submission to the communicable disease manager and lead TB nurse. Completes reports as requested by the communicable disease manager and lead TB nurse. Assists in compiling documents required to perform chart audits.
Ensures medical supplies and needed medications are available and current. Carries out quality assurance audits to contractors who provide DOT. (5%) Other Duties: Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency's obligations for disaster response and/or recovery or Continuity of Operations activation.
Such participation may require an alternate shift pattern assignment and/or location. Safe operation of either a state-owned vehicle or personal vehicle is required to conduct state business and an acceptable driving record must be maintained in accordance with DSHS Policy 06-3901, Fleet Operations and Management & Procedures and standards developed by the Texas Department of Public Safety. Complies with the Department of State Health Services Immunization Policy.
Support other PHR 8 programs (Border Health, Epidemiology, HIV/STD, Immunizations, and Zoonosis Control) as needed, including providing immunizations, testing and treating STD patients, and assisting with disease outbreak investigations. Provide general nursing or other support services in the event of a natural or man-made disaster. Knowledge Skills Abilities:
Knowledge of public health law (tuberculosis), public health nursing and public health principles/practice including epidemiology, disease prevention, health promotion, health and community assessment, and community collaboration.Knowledge of CDC's and regional treatment protocols and guidelines including directly observed therapy, targeted screening for latent TB infection and contact investigation.Knowledge of case management techniques.Knowledge of local, state, and federal laws and procedures pertaining to tuberculosis and disease surveillance.Knowledge of community resources.Knowledge of medical terminology.Knowledge of teaching/learning theories and curriculum development principles.Knowledge of principles of quality assurance, evaluation methods and data analysis.Skill in administering medication and vaccines.Skill in phlebotomy.Skill in developing and conducting individual and group training, continuing education workshops.Skill in conducting patient assessments, administering and reading TB skin tests, performing screening procedures, conducting case management and investigational interviews with patients, contacts and health care providers.Skill in case analysis for case management purposes.Skill in interpreting and evaluating of treatment, radiographic and bacteriological data.Skill in developing guidelines/protocols.Skill in the use of a personal computer
Current Texas Class C drivers license or equivalent from another state
Current license to practice as a Licensed Vocational Nurse (LVN) by the State of Texas or a state with recognized reciprocity through the Nurse Licensure Compact.Initial Selection Criteria:
One year's experience in public health or community service. Current license to practice as a Licensed Vocational Nurse (LVN) by the State of Texas or a state with recognized reciprocity through the Nurse Licensure Compact.Additional Information:
Requisition # 402723MOS Code:
68C, 290X, 46FX, 46NX, 46SX, 46YX
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Texas Health & Human Services Commission