PPV Hospice RN (Registered Nurse, Visiting Nurse, Case Manager) – HomeCare

Provides skilled nursing care to hospice clients in their homes or community health settings ensuring the delivery of outcome based, high quality, cost-effective care. Reviews referrals, and initiates contact with client and family. Conducts a complete nursing assessment based on referral data, client/family interview, and clinical observation of patient health status. Demonstrates clinical expertise in symptom management and end of life issues. Develops a plan of care in collaboration with client and all disciplines based on assessment data which documents need for services, appropriate discharge planning, short- and long-term goals, and the utilizations of appropriate resources. Facilitates peaceful death and assures appropriate bereavement follow up through timely documentation of bereavement assessment. Modifies plan of care as conditions change. Demonstrates understanding of payer information in order to maximize care planning. Utilizes Hospice Levels of care appropriately. Follows IDT process of approving non-formulary medications, treatments, and DME. Initiates and maintains a client record utilizing the Agency's standard for documentation. Makes follow-up visits to provide skilled care to assess disease progress and evaluates response to treatment so as to promote peaceful death; provides support to client/family utilizing teaching principles to promote and restore health and prevent disease and disability, as possible; coordinates care with providers. Utilizes interdisciplinary team members to support patient/family needs. Teaches patients and reinforces client/caregiver teaching and education. Prepares/teaches/supports family regarding signs and symptoms of death, as appropriate. Refers, collaborates, and coordinates all client care services. Consults with physician regarding client needs and plan of care. Directs LPNs in carrying out the established plan of care. Directs Home Care Aides and supervises plan of care.