We are seeking an experienced, reliable and highly knowledgeable Maryland Registered Nurse Delegating Nurse to provide clinical oversight, resident assessments, nurse delegation, medication-management oversight and regulatory support.
This is an excellent opportunity for an experienced RN who values professional autonomy, flexible scheduling and the ability to make a meaningful difference within a small assisted-living setting.
The Registered Nurse Delegating Nurse will provide ongoing clinical oversight for Serene Meadows Assisted Living in accordance with applicable Maryland assisted-living regulations, Maryland Board of Nursing requirements, the Maryland Nurse Practice Act and the facility’s policies and procedures.
The nurse will collaborate with the assisted-living manager to evaluate prospective residents before admission, review resident assessments, determine whether the facility can safely meet each resident’s needs, develop and issue appropriate nursing or clinical orders, delegate nursing tasks when appropriate, evaluate medication technicians and other delegated staff, monitor resident health status and assist with safe transitions into and out of the facility.
The role is designed for an experienced RN seeking a flexible, ongoing consulting or part-time relationship with a high-quality residential assisted-living program.
Essential Regulatory Responsibilities
The Registered Nurse Delegating Nurse will:
1. Maintain an ongoing clinical-oversight relationship
- Enter into and maintain a current written agreement with Assisted Living for delegating-nurse services.
- Serve as the facility’s designated Registered Nurse Delegating Nurse.
- Maintain professional availability for required consultation, assessment and nursing oversight.
- Remain available on call as required or ensure that a qualified alternate Registered Nurse Delegating Nurse is available.
- Assist in maintaining continuous qualified delegating-nurse coverage.
2. Conduct mandatory resident observations
- Vary the timing of visits when reasonably necessary to observe and evaluate medication technicians or caregivers working different shifts.
- Document each required on-site observation completely, accurately and promptly.
- Perform additional visits whenever a resident’s condition, delegated task, staff competency or clinical risk requires more frequent nursing oversight.
3. Complete and review preadmission assessments
Before a prospective resident is admitted, the nurse will collaborate with the assisted-living manager or designee to determine whether:
- The prospective resident is eligible for admission under the facility’s licensure category.
- The resident requires a level of care that the assisted living is approved to provide.
- The resident’s clinical, functional, behavioral and psychosocial needs can be safely and appropriately met.
- The facility has sufficient staffing, equipment, training and resources to provide the required care.
- The resident presents a need that exceeds the facility’s licensed scope or available capabilities.
- If additional professional services, equipment or third-party care arrangements are necessary before admission.
The nurse will communicate whether the applicant is clinically appropriate for admission and identify any conditions that must be resolved before acceptance.
4. Perform admission and transition assessments
For each incoming resident, the nurse will:
- Review the completed Resident Assessment document and related medical records.
- Compare hospital, rehabilitation, physician and pharmacy information for consistency.
- Reconcile medication orders.
- Identify missing, conflicting or unclear orders.
- Confirm allergies and adverse drug reactions.
- Determine whether specific nursing tasks may lawfully and safely be delegated.
- Establish initial nursing or clinical orders.
- Identify staff competency requirements.
- Collaborate with the assisted-living manager regarding the resident’s initial service plan.
- Document the resident’s baseline clinical status.
- Identify signs and symptoms that require immediate notification of health care practitioner.
- Confirm that the facility has the equipment, supplies and staffing necessary for admission.
- Review cognition, behavior, mobility, falls, nutrition, hydration, skin integrity, continence, medication use, hospitalizations and activities of daily living.
- Recommend against admission when the resident’s needs cannot safely be met.
- Collaborate in updating the resident’s service plan.
5. Provide medication-management oversight
The nurse will:
- Review medication administration records during required nursing visits.
- Confirm that medication entries are complete and consistent with current health care practitioner orders.
- Review missing medication signatures and ensure explanations and corrective action are documented.
- Identify possible adverse reactions, contraindications, duplication or clinically significant concerns.
- Ensure that medication changes are implemented promptly.
- Assess medication storage, security, disposal and documentation practices.
- Review controlled-medication processes when applicable.
- Provide instruction, remediation and follow-up for medication technicians.
- Communicate significant medication concerns to the resident’s health care practitioner and assisted-living manager.
- Document review and sign applicable records as required.
6. Conduct hospital-return assessments
When a resident is hospitalized and questions arise regarding the resident’s ability to return safely, the nurse will:
- Obtain and review available hospital information.
- Perform and document a nursing assessment of the resident’s current condition.
- Determine whether the resident can safely return to assisted living.
- Determine whether the facility has the staffing, equipment, competency and resources required to meet the resident’s updated needs.
- Identify new diagnoses, medication changes, treatments, equipment, monitoring and follow-up appointments.
- Communicate findings to the assisted-living manager, resident, resident representative and authorized health care professionals.
- Recommend a different level of care when the assisted living cannot safely meet the resident’s needs.
7. Assist with discharge and transfer processes
The nurse will support clinically appropriate discharges and transitions by:
- Assessing the resident before a planned discharge or transfer when clinically indicated.
- Documenting current condition and relevant nursing needs.
- Reviewing medication and treatment information.
- Identifying immediate health and safety concerns.
- Communicating authorized clinical information to the receiving provider.
- Collaborating with the resident, resident representative, assisted-living manager and health care practitioner.
- Assisting in determining whether a proposed receiving setting can address the resident’s care needs.
- Supporting continuity of medications, treatments, equipment and follow-up care.
- Documenting clinical recommendations and communications.
- Participating in emergency-transfer procedures when needed.
8. Required Qualifications
Applicants must have:
- Current, active and unrestricted Registered Nurse license authorizing practice in Maryland.
- Completion of the mandatory Maryland Board of Nursing delegating-nurse training course.
- Documentation verifying completion of the required delegating-nurse training.
- Knowledge of Maryland nursing delegation requirements.
- Knowledge of medication-technician practice and oversight.
- Ability to perform comprehensive geriatric nursing assessments.
- Ability to determine whether nursing tasks may be safely delegated.
- Ability to issue clear nursing and clinical orders.
- Ability to respond to clinical questions within agreed response periods.
- Ability to travel to Randallstown, Maryland for required on-site visits and assessments.
- Strong communication, judgment and organizational skills.
Preferred Qualifications
Strong preference will be given to candidates with:
- Three or more years of registered-nursing experience.
- Experience reviewing medication administration records.
- Experience with Maryland Office of Health Care Quality surveys.
- Experience with Medicaid Home and Community-Based Services or assisted-living waiver programs.
- Willing to conducting hospital-return and significant-change assessments.
- Current CPR/BLS certification.
- Professional liability insurance appropriate to the contractual role.
- Access to a qualified alternate delegating nurse or willingness to coordinate alternate coverage.
Schedule and Availability
This is an ongoing contractual role.
The selected nurse must be available for:
- Required on-site visits at least every 45 calendar days.
- Preadmission and admission assessments.
- Significant-change assessments.
- Annual and six-month assessment reviews.
- Hospital-return assessments.
- Medication and delegation oversight.
- Scheduled staff training or remediation.
- Reasonable on-call clinical consultation.
- Urgent assessments when a resident’s health or safety requires timely intervention.
Most routine visits can be scheduled in advance. Additional assessments will be arranged based on admissions, hospitalizations, changes in condition and facility needs.
Other Compensation
Additional compensation may be available for:
- Urgent evening or weekend visits
- Hospital assessments
- Significant-change assessments
- Staff training
- Survey support
- Extensive record audits
- Travel beyond the agreed service area
Application Requirements
Qualified applicants should submit:
- Current résumé
- Maryland RN license verification
- Proof of Maryland delegating-nurse training
Pay: $100.00 per hour
Work Location: In person
