RN - Home Health at CARLE

To provide professional nursing care to assigned clients in support of the client's physician and pursuant to the objectives and policies of the Home Health Services Department (HHSD).

• * Ensures quality care for clients of all ages and groups by providing appropriate documentation, communication and other follow-up and by using time, supplies and other resources productively. * Ensures quality and the safe delivery of home health care services. * Conducts a client assessment as appropriate and completes visit documentation according to MMCI HHSD policy/procedure and regulatory bodies' requirements. * Develops, implements, evaluates and amends a client's Plan of Care (POC) in cooperation with the physician, client/ caregiver and other health care members involved in the care. * Implements nursing interventions to meet the client's needs and changing conditions in accordance with HHSD policy/ procedures. * Communicates to the physician changes in the client's condition according to HHSD policy/procedure. * Communicates with the physician(s), client/caregiver and other health care professionals involved in the care of the client per HHSD policy/procedure. * Communicates the client/caregiver's needs to other staff members as appropriate when others are assigned to the client's care. * Participates in client case reports to team members. * Reports to the assigned Home Health Clinical Manager. * Gives routine primary client reports to the Clinical Manager which include, but are not limited to, problems encountered with the client's care, the client's progress toward goals, client admission to primary caseload. * Respects client confidentiality in all communications. * Reports and completes appropriate documentation regarding client occurrences following HHSD policy/procedure. * Uses time, supplies and other resources productively to promote responsive and cost-effective client care. * Observes, performs tests, procedures and initiates measures to prevent complications or minimize the effects of disease or injury. * Demonstrates skilled care on an intermittent basis in compliance with the care described in the Plan of Treatment (POT). * Demonstrates knowledge and skills necessary to provide care appropriate to the age of the individual client. * Recognizes the need for referral(s) to other disciplines or resources that might assist with client care. * Sets goals with the client/caregiver that are realistic, age-specific and accordance with the Plan of Treatment. * Provides thorough coordination of care for all clients by communicating and/or documenting appropriate follow-up with HHSD staff, physicians and other sources in accordance with HHSD policy/procedure. * Supervises and directs client care provided by HHSD Home Care Aides (HCA) as well as makes supervisory visits in the client's home. * Assesses progression of goals for all disciplines involved in care per HHSD Policy /Procedures. * Possesses knowledge and skills necessary to obtain adequate lab specimens for testing. * Performs patient bedside lab testing and associated quality control in compliance with medical provider's orders and hospital lab procedures/policies.
• * Ensures that clinical records are complete, legible, accurate and submitted in a timely manner. * Provides necessary and appropriate documentation for the following, including, but not limited to: * Client admission/assessment visit; * Home Health Certification/Recertification and Plan of Treatment (POT) * Client Care Plans; * Daily Visit Notes; * Change Orders; * Discharge Visit/Summaries; * OASIS; * Audit issues; * Occurrence Reports; * ON-call visit communications; * Follow up communications; * Provides clinical records that will comply with MMCI HHSD Policies and Procedures and State and Federal Rules and Regulations and adheres to the standards of Regulatory agencies. * Submits all clinical documentation per HHSD policy/procedure.
• * Demonstrates punctuality and flexibility in work schedule to meet the needs of the client/caregiver and the needs of the department. * Utilizes time so that client care is maximized.