Northern Light Home Care and Hospice

Department: Hospice - Aroostook County

Position is located: Northern Light Home Care and Hospice Presque Isle

Work Type: Full Time

FTE: 1.0 (40 hours)

Work Schedule: 8:00 AM to 5:00 PM

Summary :

The Hospice Outreach Visiting Nurse is responsible for exercising independent judgment in directing and supervising the provision of professional nursing care to a designated group of clients and families in a variety of care settings, with accountability if such care is not rendered correctly or appropriately by the nurse or by those whom he/she directs and supervises. The Hospice Outreach Visiting Nurse assesses, plans, implements, evaluates the initial plan of care for clients referred for Hospice care and exercises independent judgment in coordinating the hospice course of treatment and assigning significant overall duties to subordinate personnel. The Hospice Outreach Visiting Nurse acts as a leader for client care team members in coordinating a holistic plan of care. The Hospice Outreach Visiting Nurse confers and collaborates with physicians and members of the IDT in implementation of the hospice plan of care. The Hospice Outreach Visiting Nurse provides direct care to clients with medical surgical needs, and end stage terminal illness. The Hospice Outreach Visiting Nurse functions as a liaison for community education, and at the system level for the coordination of hospice and ongoing services. The Hospice Outreach Visiting Nurse uses current nursing research to implement and modify their personal clinical practice and advocates within the agency to recommend changes to policies and procedures. In addition to acting as an educator trainer and consultant to other members of the client care team, the Hospice Outreach Visiting Nurse collaborates with, and responsibly directs, supervises, and independently evaluates other members of the client care team. Performance reflects the mission and values of VNA Home Health Hospice.

Responsibilities:

Clinical Practice- Uses evidence based research to develop best practices for client care. Collaborates with members of the healthcare team to provide integrative care for all clients through assessment, care plan development, and evaluation of client outcomes as supported by completed documentation. • Initiates a systematic, accurate and ongoing comprehensive assessment of needs of the client, family, and/or significant other. • Demonstrates competency in the fundamentals of case management. • Demonstrates competency in OASIS assessments. • Demonstrates knowledge and use of the Lifestream application. • Demonstrates basic knowledge of telehealth-its use and purpose. • Exhibits ability to phone and triage telehealth clients. • Develops and implement a POC based on identified needs and Agency protocol. • Receives timely authorization for any deviation from Agency protocols prior to initiating POC. • Initiates actions directed toward achieving expected outcomes. • Collaborates with others to evaluate and modify the POC based on client outcomes. • Exercises independent judgment in supervising and directing client care provided by other members of the client care team, with accountability if such care is not rendered accurately or appropriately. • Adheres to discipline specific clinical practice standards. • Utilizes critical thinking process to analyze, utilize and incorporate evidence based practice research into clinical practice. • Identifies credible sources of health care information that can be provided to clients. • Shares evidence based nursing practice with other members of the client care team. • Acknowledges the value of and participates in the interdisciplinary team meetings and utilizes services according to standards of care. • Provides service and produces work at or above expected levels of quality and consistent with agency defined quantitative standards. • Documents accurately, completely and in accordance with Agency policy. • Demonstrates knowledge, skills, and abilities necessary to provide care to the age groups served. Leadership- Demonstrates the ability to create a shared mission and vision as it relates to client care. • Acts as a resource to non-BSN prepared nurses in coordinating, designing and implementing a coordinated and holistic plan of care • Utilizes community assessment strategies to provide preventive services for the community population. • Implements interdisciplinary care strategies within the changing economics of health care systems. • Establishes goals and objectives to inspire others to achieve the mission and vision. • Engenders support from subordinates, peers, and superiors. • Trains, reviews and evaluates the clinical practices of hospice nurses and other members of the client care team. • Facilitates involvement and participation on the part of key stakeholders. • Contributes to the development of professional nursing practice at VNA through research and personal self-development • Seeks advanced certification and training opportunities. Hospice Outreach- Collaborates with the Supervisor of Clinical Hospice & Palliative Care Services to ensure clients referred to Hospice care are evaluated and brought under care in an organized and timely basis. • Collaborates with Central Intake in the collection of referral information to substantiate Hospice admission criteria, and prioritizes referrals clinically with goal of setting same day to next day visits for evaluation and admission to services. • Completes critical aspects of admission processes at time of admission, such as DME vendor changes, HP profiling, Comfort Pac and DNR follow up, as well as Medical Director authorizations. • Tracks and follows up on all NTUCS for ongoing needs and community referrals. • Provides hospice informative visits as requested for Home Health program clients as well as those in the community. • Coordinates and presents Hospice specific in-services to contracted facilities. • Presents initial Hospice orientation for new VNA employees as required by regulatory bodies. • Attends IDT to report on admissions and collaborate on HIPOC. • Attends regional Oncology and Palliative Care meetings (ie Mercy Oncology Comfort Care) to collaborate with Oncology and Palliative Care staff on potential referrals and informative visits. • Assists with routine nursing visits as requested. • Collaborates with VNA Provider Relations Liaisons on informational meetings and presentations to hospice referral sources. Performs additional duties as required or assigned.

Other Information :

Current license to drive in the state of Maine, with reliable transportation and agency required auto liability insurance. Must be able to travel within assigned region, or statewide, depending on the position.

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Credentials

• Required Registered Nurse

Education

• Required Bachelor's Degree

Working Conditions

• Potential exposure to abusive and/or aggressive people.
• Potential exposure to diseases or infections.
• Need to drive to perform responsible duties.
• Potential exposure to hazardous materials.
• Potential exposure to noise levels being uncomfortable.
• Potential exposure to noxious odors.
• Potential exposure to very hot or cold temperatures.
• Work with computers, typing, reading or writing.
• Lifting, moving and loading 20 to 30 pounds.
• Prolonged periods of sitting.
• Prolonged periods of standing.
• Prolonged periods of walking.