- Develops and initiates the plan of care and assumes responsibility for the ongoing interdisciplinary assessment and development of the individualized plan of care in partnership with the patient, representative (if any), and caregiver(s);
- Initiates proper preventative and rehabilitative nursing procedures and provides services that are ordered by the physician as indicated in the plan of care; Provides patient, caregiver, and family counseling;
- Provides patient and caregiver education;
- Prepares clinical notes;
- Communicates with the physician who is responsible for the home health plan of care and other health care practitioners (as appropriate) related to the current home health plan of care.
- Identifies discharge planning needs as part of the care plan development and implements prior to discharge of the patient.
- Prepares clinical notes and updates the primary physician when necessary and at least every sixty days.
- Communicates with the physician regarding the patient’s needs and reports any changes in the patient’s condition; obtains/receives physician’s orders as required.
- Communicates with community health related persons to coordinate the care plan.
- Participating in the HHA’s quality assessment and performance improvement program and HHA-sponsored in-service training.
- 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.
- Instructs, supervises and evaluates home health aide care provided every two (2) weeks.
- Supervises Licensed Practical Nurses (LPNs)/ Licensed Vocational Nurses (LVNs) and/or Home Health Aids (HHAs)/Certified Nursing Assistants (CNAs), as directed.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description.
JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)
- Must have graduated from an approved school of nursing and be licensed in the state where practicing.
- Minimum of two years of experience, at least one of which is in the area of public health or home care nursing is preferred.
- Maintains a current CPR certification.
- Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order.
- Self-directed and able to work with minimal supervision.
- Demonstrates excellent observation, problem solving, verbal and written communication skills; nursing skills per competency checklist.
- Shows ability to organize and prioritize workload independently.
- Management experience not required. Responsible for supervising home health aides.
- Prolonged or considerable walking or standing. Able to lift, position, or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping, bending, kneeling, or crouching. Visual acuity and hearing to perform required nursing skills.