Outpatient registered Nurse- RN - Dialysis - Fresenius Medical Care Holdings, Inc.

PURPOSE AND SCOPE:

Functions as part of the hemodialysis health care team as a Staff Registered Nurse to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA’s mission, vision, values, and customer service philosophy. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities,  including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMCNA Quality Enhancement Goals (QEP). Adheres to all requirements of the FMCNA Compliance Program, and FMS patient care and administrative policies.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Directs Patient Care Technician’s provision of safe and effective delivery of chronic hemodialysis therapy to patients in compliance with standards outlined in the facility policy procedure manuals, as well as regulations set forth by the corporation, state, and federal agencies.
• Delegates tasks to all direct patient care staff including but not limited to LVN/LPNs, Patient Care Technicians, and Dialysis Assistants.
• Assesses daily patient care needs and develops appropriate patient care assignments.
• Routinely monitors patient care staff for appropriate techniques and adherence to facility policy and procedures.
• Participates in staff training and orientation of new staff as assigned
• Participates in all required staff meetings as scheduled.
• Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).
• Provides ongoing education to patients regarding their renal disease, vascular access and dialysis therapy, and other related health conditions.
• Discusses with patient, and records education related to diet/fluid and medication compliance.
• Provides patient specific detailed education regarding adequacy measures where applicable - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM).
• Ensures transplant awareness, modality awareness, and drive catheter reduction.
• Educates patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid.
• Provides safe and effective delivery of care to patients with ESRD.
• Accurately implements treatment prescriptions including Sodium (Na) modeling prescription, and Ultrafiltration modeling (where appropriate) to ensure stable treatment therapy as indicated.
• Assesses patients’ response to hemodialysis treatment therapy, making appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician. Communicates problems or concerns to the Team Leader or physician.
• Identifies and communicates patient related issues to Team Leader or physician.
• Initiates Initial and Annual Nursing Assessment, and ongoing evaluation and documentation of patient care needs according to FMC Policies and Procedures.
• Actively participates in the pre-evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy according to established FMC procedures.
• Takes appropriate intervention for changes in patient adequacy status and troubleshooting access flow issues as identified by OLC/AMP yellow lights.
• Provides, supervises (if applicable), and monitors hemodialysis access care according to established procedures.
• Implements, administers, monitors, and documents patient's response to prescribed interdialytic transfusions, including appropriate notification of adverse reactions to physician and appropriate blood supplier.
• Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet.
• Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System.
• Ensures appropriate preparation of lab requisitions for Spectra or alternate lab.
• Ensures correct labs tubes are utilized for prescribed lab specimens and that lab draw and processing procedures are performed appropriately for all lab samples.
• Identifies and ensures appropriate follow-through regarding missed labs and specimens reported to be insufficient according to company policies and procedures.
• Ensures all specimens are appropriately packaged according to Department of Transportation (DOT) policies and procedures relating to shipment of blood or body fluid specimens and potentially hazardous material.
• Ensures that all labs are directed and delivered to appropriate labs.
• Reports alert/panic and abnormal labs results to appropriate physician.
• Ensures lab results are forwarded to physicians as requested.
• Enforces all company approved policies and procedures, as well as regulations set forth by state and federal agencies and departments.
• Maintains overall shift operation in a safe, efficient, and effective manner.
• Act as a resource for other staff members.
• Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information.
• Collaborate and communicate with physicians and other members of the healthcare team to interpret, adjust, and coordinate care provided to the patient.
• Provides assistance as needed to patients regarding prescription refills according to FMCNA Policies.
• Ensures all physician orders are transcribed and entered into the Medical Information system in a timely manner.
• Oversees all documentation of patient information.
• Maintains facility drug list for all required stock medications.
• Maintains competency with all emergency operational procedures, and initiates CPR and emergency measures in the event of a cardiac and/or respiratory arrest.
• Ensures verification and availability of adequate emergency equipment.
• Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.
• Administers medications as prescribed or in accordance with approved algorithm(s), and documents appropriate medical justification if indicated.
• Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.
• Maintains appropriate recording of controlled substances as required by law.
• Assists with the coordination of patient transportation if necessary.
• Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area.
• Ensures competency in the operation of all dialysis-related equipment safely and effectively.
• Ensures all patient stations, including machines and chairs, are clean and free of blood and placed appropriately.
• Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.
• Ensures all relevant data including physician orders, lab results, vital signs and treatment parameters, and patient status are documented appropriately and entered into Medical Information System.
• Ensures all appropriate patient related treatment data is entered into the Medical Information System.
• Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.
• Ensures and verify accuracy of Patient Care Technician documentation.
• Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
• Ensures that all appropriate procedures are followed regarding opening and closing procedures, inclusive of monitoring that all staff and patients have safely left the premises.
• Initiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports.
• Completes monthly nurses' progress note.
• Ensures patient medical records are complete with appropriate information, documentation, and identification on each page (Addressograph label is on all chart forms).
• Reviews transplant status and follows established procedure regarding appropriate action to be taken.
• Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.
• Completes any long-term programs that are due.
• Completes initial and annual Nursing History and Assessment physical.
• Ensures completion of Annual Standing Order Review with each physician as required.
• Performs additional duties as assigned.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The position provides direct patient care that regularly involves heavy lifting and moving of patients, and assisting with ambulation. Equipment aids and/or coworkers may provide assistance. This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet.
• The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.
• Employees are required to take the Ishihara's Color Blindness test as a condition of employment. Note that: Failing the

Ishihara Test for Color Blindness does not preclude employment. The Company will consider whether reasonable accommodation can be made.

SUPERVISION:

• None

EDUCATION AND REQUIRED CREDENTIALS:

• Graduate of an accredited School of Nursing.
• Current appropriate state licensure.
• Must meet the practice requirements in the state in which he or she is employed.

EXPERIENCE AND SKILLS:

• Minimum of one-year medical-surgical nursing experience preferred.
• Hemodialysis experience preferred.
• ICU experience preferred.
• Successfully complete a training course in the theory and practice of hemodialysis.
• Successfully complete CPR Certification.
• Employees have to meet the necessary requirements of Ishihara's Color Blindness test as a condition of employment.
• Provide coverage at any or all area facilities as required by management.
• Icd-9 coding Training.
• Nurses Technical Training.

ACKNOWLEDGEMENT:

I acknowledge that I have read and accepted this job description. I understand what is expected of me in this position, and I am able to perform the essential functions as outlined with or without reasonable accommodation. Furthermore, I understand that the duties and responsibilities listed in this job description are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. If I have any questions about duties and responsibilities not specified in this job description that I am asked to perform, I should discuss them with my immediate supervisor or my Human Resources representative.

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ADDENDUM:

Infusion Nurse Coordinator

Coordinates and provides the delivery of patient services and the management of the POIC by performing the following duties personally or through subordinates.

• Standards of Practice

Understands and conforms to the rules and regulations affecting the RN’s current area of practice including federal, state and local laws.

Know the rationale for and the effects of medications and treatments and shall correctly administer the same. Accurately and completely report and document.

The client’s status including signs, symptoms and responses.

Care rendered.

Physician orders.

Administration of medications and treatments.

Client response(s).

Contacts other health care team members concerning significant events regarding client’s status.

Respect the client’s right to privacy by protecting confidential information unless obligated or allowed by law to disclose the information. Obtain instruction and supervision as necessary when implementing procedures or practices. Notify the appropriate supervisor when leaving an assignment. Know, recognize and maintain professional boundaries of the clinician-client relationship. Report unsafe nursing practice which a clinician has reasonable cause to suspect has exposed or is likely to expose a client unnecessarily to risk of harm as a result of failing to provide client care that conforms to the minimum standards of acceptable and prevailing professional practice. Be responsible for one’s own continuing competence in clinical practice and individual professional growth.

• Ensures quality and safe delivery of OIC care service.
  • Practice is guided by policies, procedures and standards of clinical practice.
  • Understands and implements current standards of practice for infusion therapy.
  • Adheres to policies related to medication safety, including documentation of orders, correct administration, double check procedures and other established policies and practices.
  • Understands use of products and equipment.
  • Observes and monitors OSHA, infection control and safety policies.
  • Adopts practices to improve work processes, enhance customer/patient satisfaction and ensure excellence.
  • Contributes to a safe and secure environment for patients, visitors and staff by following established procedures and protocols.
  • Accurately documents, implements and evaluates Physician orders in a timely manner.
  • Initiates teaching using patient teaching protocols and patient care standards.
  • Identifies expected outcomes and nursing interventions to meet identified diagnosis.
  • Implements nursing interventions to meet patient needs and changing conditions. Monitors patients for compliance with therapy.
  • Completes all documentation accurately and timely.
  • Maintains client/family rights and maintains confidentiality.
  • Recognizes the nurse/patient/family relationship impacts the patient experience. Understands and respects nursing boundaries.
  • Shows kindness and care with patient/family. Displays sensitivity to the needs and concerns of others.
• Drug Preparation and Management
  • Ensures that drugs are ordered, received and stored properly.
  • Maintains optimal drug and supply inventory and reports are submitted in a timely manner.
  • Ensures that proper technique is used in the preparation of sterile products.
  • Ensures that the mixing area is clean, neat and orderly at all times.
  • Responsible for the accuracy of information recorded for proper patient billing.
  • Ensures that all purchasing invoices and inventory records are completed and submitted in a timely manner.
  • Participates in ongoing training and education.
• Referral Management
  • Submits referral timely and accurately.
  • Notifies appropriate person of referral concerns.
  • Roster is reviewed, updated and current.
• General Site Management
  • Communicates recommendations and requirements for additional services to appropriate individuals in a timely manner.
  • Consistently addresses and communicates patient concerns to the Physician and OIC staff.
  • Completes job tasks on time by planning and organizing the schedule of activities.
  • Effectively communicates with Pharmacy for collaboration of protocols, patient care and Physician communication.
  • Communicates with OIC staff, Division Managers, Physicians and Corporate clinical as necessary.
  • Nursing calendar/ patient schedules reflects planned visits 2 weeks in advance.
  • Delegates responsibilities appropriately.
  • Performs nursing functions in staffing situations.
  • Uses equipment and supplies effectively and efficiently. Monitors supplies to maintain appropriate inventory.
  • Accurately performs drug and supply inventory.
  • Nursing billing is accurate and timely.
  • Ensures a RN is available at all times during OIC office hours.
  • Ensures a RN is on call for emergencies involving patients 24 hours, if site not utilizing Healix Call Center
• Professional Growth
  • Monitors and maintains professional licensure and qualification of staff nursing.
  • Participates in case conferences and staff meetings.
  • Promotes importance of team collaboration and communications.
  • Maintains professional competence, particularly in the areas of clinical knowledge.
• Leadership
  • Presents a positive image of the OIC at all times, and at professional functions, with patients, physicians, OIC staff, etc.
  • Recognizes the impact of one’s behavior of others.
  • Deals with others in a pleasant and respectful manner.
  • Assumes responsibility for improving care/services.
  • Performs as a preceptor to other nurses.
  • Monitors staff completion of assignments.
  • Clearly defines work assignments.
  • Resourceful in handling assignments and solving problems; flexible in adjusting to a new or changing work environment/requirement.
  • Communicates with staff regarding assignments, as necessary.
• Performs Additional Assigned Responsibilities as necessary
  • Fulfills additional responsibilities accurately and completely in a timely manner.
  • Submits written reports in a timely manner.
  • Cooperates with staff members according to OIC philosophy and objectives.
  • Maintains consistent and concise lines of authority and responsibility.
  • Participates in the development of patient education programs.
  • Participates in establishing (written and instructing other staff) protocols for the initiation of new therapies or new care related programs.
  • Participates in committee meetings.
  • Actively participates in the CQI program through meetings and gathering of information.

CORE DUTIES AND RESPONBILITIES

• Include the following basic performance factors all Healix, Inc. employees are expected to meet.
  • Communicates with clients and fellow employees through written and verbal forms, clearly and timely.
  • Interacts professionally with clients and fellow employees.
  • Cooperates with team members to accomplish departmental goals.
  • Accepts and incorporates changes or new ideas into daily work.
  • Provides service in a responsive, timely and accurate manner to both clients and fellow employees.
  • Understands and adheres to policies and procedures.
  • Arrives at work as scheduled and notifies supervisors in a timely manner of any absences.
  • Recognizes priorities and takes action; makes productive use of time.
  • Strives to resolve problems and conflicts on his/her own initiative.
  • Attempts to create new ideas or new procedures working as part of a group or individually.
  • As a part of your job, you will receive protected health information. It is your responsibility to comply with HIPAA in using and disclosing health information.

QUALIFICATIONS

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND REQUIRED CREDENTIALS:

• BSN or AND or
• College or university program certificate; 2 – 4 years related experience and/or training; or equivalent combination of education and experience
• Applicable State License
• CPR certification

OTHER SKILLS AND ABILITIES

• To perform this job successfully, an individual must have a minimum of two years recent clinical experience to include excellent IV skills
• One-year experience in Home Health Care or Home IV Therapy
• Management experience

PHYSICAL DEMANDS AND WORKING CONDITIONS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is required to:
  • Regularly use hands to finger, handle, or feel and talk or hear
  • Frequently stand, walk, sit, reach with hands and arms, and stoop, kneel, crouch, or crawl
  • Frequently lift and/or move up to 25 pound and occasionally lift and/or move up to 50 pounds
• Specific vision abilities required by this job include close vision

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is:
  • Frequently exposed to blood borne pathogens
  • Occasionally exposed to outside weather conditions
• The noise level in the work environment is usually moderate

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EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.