o Coordinate transitions of care, including admissions, discharges, and transfers, to ensure seamless
transitions and optimal patient outcomes.
o Conduct regular case conferences, team meetings, and interdisciplinary rounds to review patient
status, discuss care plans, and address complex clinical issues.
o Participate in interdisciplinary team meetings, care conferences, and care planning sessions to review
patients’ progress, discuss care goals, update patient care plans and address any other patient care
concerns.
- Clinical Oversight and Support:
o Provide clinical oversight, support, and training to other nursing and hospice aide staff, guiding them in
the delivery of high-quality, compassionate care to hospice patients.
o Responsible for completing Hospice Aide supervisory visits; as required.
- Patient and Family Education:
o Provide education and support to patients, families, and caregivers about hospice services, goals of
care, symptom management, and end-of-life care options.
o Offer guidance and resources to help patients and families navigate the hospice experience, including
advance care planning, community resources, and psychosocial support services.
o Empower patients and families to actively participate in their care journey, advocating for their
preferences, values, and goals throughout the hospice experience.
- Patient and Family Advocacy:
o Advocate for the needs and preferences of patients and families, ensuring that their voices are heard
and respected throughout the care process.
o Provide emotional support and education to patients and families, addressing concerns, fears, and
questions related to end-of-life care.
o Collaborate with social workers, chaplains, and other support services to provide comprehensive
psychosocial and spiritual support to patients and families.
- Documentation and Regulatory Compliance:
o Maintain accurate and timely documentation of assessments, interventions, and patient/family
interactions in patients' electronic medical record and other required documentation systems, within 24
hours of contact.
o Ensure compliance with Medicare Hospice regulatory standards and MN Standards of Practice.
o Provide care consistent with National Hospice and Palliative Care Organization Standards of Practice
for Hospice Programs.
- Professional Development and Training:
o Participate in ongoing professional development activities, including continuing education and training
to enhance skills and knowledge.
o Stay informed about best practices and emerging trends in clinical hospice care.
o Participates in on-call/holiday rotation.
o Participate in coverage for PTO taken by the On Call RN position.
o Serve in the role of back up Admission RN; as needed.
