Specialty experience in phone based/telephonic triage experience or Home Care experience (preferred). You will need to have specialty Oncology experience.
In this position, the RN will virtually monitor, assess, engage, and intervene with a cohort of high risk home health patients between scheduled visits. In close collaboration with the home health interdisciplinary team, patient, and physicians, the nurse will use the case management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care/long term care outcomes, and the transition to stabilization or independent status. The nurse will partner with the home health team to coordinate and facilitate the delivery of care.
Using various modalities such as video chat, calls, and home care visits the nurse will:
•Along with other members of the home health team, conduct comprehensive screenings and assessments that include the medical, behavioral, pharmaceutical and social needs of the patient.
•Identify gaps in care and barriers to attaining improved health by continually assessing the patient’s knowledge of their clinical condition(s) and provide education and self-management support based on the patient’s unique learning style.
•Collaborate on the creation and implementation a care plan that will address the identified needs, remove the barriers and improve the health of the patient.
•Serve as the contact point, advocate and resource for the patient, their family and their physician.
•Measure, improve and maintain quality outcomes (clinical, financial, and functional) for individual patients and the population served.
The RN functions collaboratively within the team by observing the patient/family needs and facilitating care. The RN provides direct nursing care to home care patients within the scope of practice for RNs. The individual will follow the Plan of Care (POC) established by the RN and the Interdisciplinary Team for patients.
• Follows established Plan of Care (POC) developed by the RN and understand the process for changing the POC according to the patient and family needs.
• Performs approved nursing procedures and treatments within the RN scope of practice. Follows appropriate preventative and palliative nursing procedures according to the Nurse Practice Act for RNs.
• Documents all interventions, patient/family response, and medication administered in the medical record. Maintains patient records so that problems, plans, actions, and goals are accurately and clearly stated. Completes patient notes the same day that patient is seen or shift care provided.
• Assists in the planning and evaluation of the nursing care for patients and their families.
• Reviews POC with the RN and RN Team Manager. Updates and revises the POC under the direction of the RN to address current patient and family needs.
• Participates in performance improvement activities as requested.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department, entity, and health system organization
The Clinical Nurse II is an RN that practices as a full partner on the health care team and consistently demonstrates safe practice within the organizational professional practice model.
The Clinical Nurse II possesses the knowledge, skills and the attitude to effectively meet standards for competent professional nursing practice. The Clinical Nurse II exhibits UPHS organizational behavioral competencies which reflect its mission and are embedded in the professional practice competency domains. The Clinical Nurse II independently provides patient care through the application of the nursing process and accepts accountability for the nursing care of assigned patients ranging in age from infancy to the elderly. Additional competencies include Continuous Quality Improvement, Evidence Based Practice and Research, Leadership, Person and Family Centered Care, Professionalism, Safety, Technology/Informatics, and Teamwork.
The Clinical Nurse II works closely with the interprofessional health care team to facilitate the coordination of care across the continuum. The nurse focuses on expanding the knowledge and skills necessary to provide individualized care based on physical, psychosocial, cultural, educational, safety, and age appropriate considerations of patients.
The Clinical Nurse II will seek feedback in assuming leadership roles and provides feedback for improved clinical practice, demonstrates how nursing practice impacts the organizational vision, mission, and goals and the care delivery system, and will comply with all regulations and standards of regulatory and accrediting bodies.
• Must have Bachelor's Degree in Nursing (BSN) from an accredited school of nursing, at time of hire.
• Must have more than 15 months relevant professional nursing experience and completion of the Nurse Residency Program, if applicable, at time of hire.
• Must possess active Pennsylvania RN License, at time of hire.
• Must possess active BLS/CPR, as a healthcare provider as per the American Heart Association at time of hire.
• Must have a valid driver’s license, a car and car insurance.