Responsible for direct patient care for assigned patients
Evaluates the clinical needs of the patient; initiates, develops, implements and makes necessary revisions to the patient's plan of care; addresses all problems in the plan of care and documents accordingly.
Utilizes clinical grouping guidelines including guidelines for appropriate interdisciplinary utilization to capture and data enter the initial visit frequency
Ensures OASIS assessment accurately reflects documentation and vice-versa.
Updates the Clinical Manager regarding referrals to community resources as appropriate.
Participates in inter-disciplinary patient case conferences; assists in evaluating effectiveness of established plan of care.
Instructs and provides documented supervision of the Home Health Aide plan of care every 14 days.
Notifies MD/other involved care providers and Clinical Team Manager of significant changes in the patient's condition.
Completes admission and other paperwork on a timely basis.
Records narrative documentation to reflect skilled care. Documentation is clear, concise, complete and captures and addresses the specifics of teaching, direct care and response of patient / caregiver.
Obtains and clarifies valid MD orders for all care delivered.
In collaboration with Clinical manager and interdisciplinary team, plans and coordinates discharges appropriately and informs patient/MD and records disposition of patient in the discharge summary. Completes all appropriate discharge paperwork.
All other duties as assigned.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects VNA's commitment to CARES: compassion, accountability, respect, excellence and service.
Current RN license in Mass. and other related credentials to meet specialty.
Minimum one (1) year of nursing experience required or 6 months of nursing experience with a BSN.
CPR certification required.
Home care and IV experience, computer skills and BSN preferred.
Cape Cod Healthcare Inc.