Field Nurses (RNs)

Qualifications

• Must be a graduate of an approved school of professional nursing
• Must have a current RN license in New York
• Home care experience preferred
• Excellent verbal and written communication skills
• Must be willing to drive

Responsibilities of the FT Field Nurses

Performs a home care assessment to determine patient’s eligibility for services. If not eligible/appropriate for home care services COC will indicate not admitted in the system and reason for the determination. If appropriate for home care services, the COC will complete a comprehensive assessment utilizing HCHB.

In conjunction with patient’s family and physician, develops and implements the Plan of Care based upon a comprehensive physical, psycho-social and environmental assessment. Provides skilled nursing care as described in the 485-Plan of Treatment, such as, but not limited to, wound care, injections, prepour/prefill of medications, disease management, medication management, etc.. Orients and supervises home health aide personnel in accordance with regulatory requirements and documents accordingly.

Evaluates the effectiveness of interventions in accordance with the plan of care. Identifies the need for evaluation by other disciplines such as physical therapy, occupational therapy, MSW, speech therapy and nutrition. Observes signs and symptoms and changes in patient’s clinical, psychological and functional status.

Consults with physician regarding changes in the treatment plan. Educates, counsels, supervises patients and caregiver relating to disease management and medical regime. Documents in HCHB Clinical Software all assessments, treatments and services provided and patient response to the treatment plan.

Case manages respective caseload which includes, but is not limited to, ongoing communication with MD, case conferencing with supervisor, obtaining updates from interdisciplinary team, completion of interim orders, updating of patient profile, conducting recertification assessments, etc. Contacts physician to report, clarify and/or obtain orders for; medication changes/additions, precautions, treatment, changes in visit frequencies, additional services needed, requests for supplies and equipment, plans for discharge from a service or the agency.

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