Redwood Coast PACE with Humboldt Senior Resource Center is looking for a full-time Registered Nurse (RN) to provide care for our participants. Redwood Coast PACE — a Program of All-inclusive Care for the Elderly — is a comprehensive health plan for older adults who wish to remain living in their home and community. We provide medical, social, nutritional, rehabilitation, and support services for eligible adults. At Redwood Coast PACE, the goal is to help people stay as healthy and independent as possible. Because their health is monitored on a regular basis, many PACE participants report fewer health crises and better overall health.
The schedule for this position is Monday through Friday, 8:30 am to 5 pm.
JOB SUMMARY: The Registered Nurse (RN) provides comprehensive nursing care and care coordination for participants in a PACE (Program of All-Inclusive Care for the Elderly) setting, supporting the health, safety, and independence of frail and elderly adults. The RN conducts assessments, develops and implements individualized Plans of Care in collaboration with the Interdisciplinary Team, and delivers skilled nursing services in both the clinic and home settings. This role monitors participant health status, manages medications and treatments, and ensures timely communication with Primary Care Providers, caregivers, and team members. The RN also provides education to participants and families, supports quality improvement initiatives, and promotes a safe, compliant, and participant-centered care environment.
ESSENTIAL DUTIES AND RESONSIBILITIES:
- Conducts initial participant assessment and reassessments to identify overt problems/needs and sets nursing priorities. Records participant assessments, reassessments, and care delivered in the medical record.
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Provides treatment and or interventions which address problems requiring immediate referral and/or follow-up; interprets and records latest diagnostic results.
- In coordination with the Interdisciplinary Team, develops a Plan of Care based on a nursing process that incorporates immediate and continuing care needs, including the participant and family perspective to reflect goals for the participant in the Day Center.
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Provides care that conforms to accepted nursing practice standards and age-related characteristics and needs of participants. Functions within nursing scope of practice.
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Provides direct care including, but is not limited to, wound care, IV therapy, blood sugar checks, IM injections, vital sign checks, and/or follow-up on an episodic problem previously identified by Primary Care Providers. Performs nursing treatments and interventions in the Clinic, as appropriate.
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Performs scheduled and as-needed home visits to assess participant health status, provide skilled nursing care, and reinforce care plans.
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Actively participates in daily morning and Interdisciplinary Team (IDT) meetings providing updates on changes in the condition of participants and regarding movement between home, supportive housing, nursing home, hospital, and other residential settings.
- Ensures the information regarding participant health problems, daily schedules, planned tests, appointments, and Medical Specialist appointments, are communicated to the IDT to ensure coordination.
- Consults with and educates participants, family members, and/or caregivers regarding the disease process, self-care techniques, prevention strategies, and medical interventions.
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Provides the appropriate Primary Care Provider with a summary of health findings and any changes in a participant’s health condition.
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Ensures that all tests, lab work, and diagnostic studies ordered by the Primary Care Provider have been executed.
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Coordinates all medication management for Redwood Coast PACE participants with Clinic team members. This may include communication regarding the stocking of non-prescription medications, the ordering of prescription medications, the administering of medication in the Day Center, and the monitoring of participant compliance. Arranges for delivery of needed medications and supplies to the participant’s home.
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Actively monitors participants in the Day Center during mealtime to assess whether participants have adequate food intake. Coordinates with the Registered Dietitian to remedy any problems and provide nutritional counseling.
- Collaborates with Primary Care Providers to ensure that protocols are in place and standing orders are carried out (e.g., bowel care, foot care, skin care, urinary tract infection, vital signs and weight, and wound care). Provides self-care education and training to participants, family members, and caregivers as needed to ensure continuity of care.
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Delegates tasks for the personal care needs of participants to Day Center team members. Provides leadership and/or oversight to CarePartners in the execution of Plans of Care. Provides education, training and competency validation for tasks, skills, and/or interventions assigned to CarePartners. Communicates priorities for care delivery.
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Supports the Infection Control function in coordination with the Quality Assurance Coordinator, Medical Director, and Nurse Practitioner.
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Actively participates in Quality Assessment and Performance Improvement (QAPI) for processes, structures, policies, workflow, and procedures which directly affect the care of participants. Takes immediate action to correct, report, and follow-up on participant health and safety issues and concerns.
- Works collaboratively with the IDT and co-workers to ensure the meeting or exceeding of Redwood Coast PACE quality assessment and performance improvement targets.
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Participates in on-call coverage in conjunction with Primary Care Providers.
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Continually seeks better ways for delivering services and communicating with participants.
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Complies with safety policies and procedures. Identifies and immediately reports any potential or actual unsafe acts or conditions to the Center Manager. Takes necessary measures to ensure a safe environment for oneself, co-workers, contractors, participants, visitors, and others.
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Identifies emergency situations and takes appropriate action.
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Understands and demonstrates respect for participant rights and refers ethical issues to the Redwood Coast PACE Ethics Committee.
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Demonstrates respect for and promotes participant rights including dignity, self-determination, access to care, confidentiality, and independence.
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Coordinates with the Home Care Coordinator and Home Care Manager to support participant care at home.
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Consistently meets or exceeds Redwood Coast PACE targets for productivity.
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Consistently meets or exceeds Redwood Coast PACE service targets.
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Understands the importance of community involvement and participates as appropriate in activities that link Redwood Coast PACE to the community.
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Effectively collaborates with employees, co-workers, and contractors to meet Redwood Coast PACE goals and further success.
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Complies with all policies and procedures.
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Participates in the process of teaching, training, and mentoring student interns and volunteers working within the program area.
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Demonstrates behaviors consistent with agency values.
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Additional duties may be assigned, as needed, that align with the responsibilities of the position and support the vision, mission, and values of the organization.
EDUCATION &/or EXPERIENCE:
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Must be a graduate of an accredited school of professional nursing.
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One (1) year working with a frail or elderly population preferred, preferably with a background in public health nursing.
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At least one (1) year experience working in a hospital is preferred.
LICENSES OR CERTIFICATES:
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Must be a current Registered Nurse licensed by the California Board of Registered Nursing, in good standing.
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Current Basic Life Support (BLS) certification within six (6) months of hire.
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Valid California Driver’s License, and personal auto liability insurance required. Must have a personal vehicle in good driving/operating condition, insured for State minimum liability requirements, and that can be used for the applicable job functions noted above.
PRE-SCREENING REQUIREMENTS:
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This position requires the successful completion of a background check.
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Pre-employment physical, and PPD skin test (TB screening).
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A current Motor Vehicle Report (MVR) is required to determine eligibility for driving on behalf of the organization.
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COVID-19 and Influenza (flu) vaccines preferred.
JOB SKILLS:
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Demonstrates knowledge of practical nursing practices and applies this knowledge within RN scope of practice, follows regulations and protocols, and identifies and responds appropriately to changes in participant condition in collaboration with the care team.
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Knowledgeable of physical, social, and mental health programs operating within a licensed health care facility or clinic.
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Demonstrates proficiency in delivering age-specific care.
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Demonstrates an interest in working with elderly and disabled adults to enhance and encourage their independence.
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Strong verbal and written communication abilities; able to convey information clearly and professionally to staff, participants, families, and external partners.
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Builds positive relationships with diverse populations, including aging and dependent adults, families, caregivers, staff, and community stakeholders.
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Works effectively as part of a multidisciplinary team demonstrating sound listening skills to receive directions and understand participant concerns; maintains a cooperative and supportive attitude.
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Applies good judgement, resourcefulness, and flexibility to resolve issues and adapt to changing circumstances.
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Maintains confidentiality, reliability, and ethical standards; consistently demonstrates punctuality, attendance, and responsibility in work performance.
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Maintains participant privacy and organizational confidentiality, adhering to HIPAA and agency standards.
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Remains calm and effective when priorities shift, deadlines change, and unexpected issues arise.
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Demonstrates administrative and organizational skills; has ability to train and delegate responsibility among staff.
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Demonstrates the ability to be self-directed and to problem-solve.
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Ability to be dependable, accept supervision, follow direction, and improve performance through feedback.
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Basic knowledge of computers and web-based applications such as timekeeping, training and email programs, as well as electronic health records.
PHYSICAL REQUIREMENTS:
This position requires the ability to perform a combination of sedentary and physically active duties in both clinical and community-based settings. The LVN must be able to sit, stand, and walk for extended periods; frequently bend, stoop, reach, and twist; and use hands for fine motor tasks such as medication administration, documentation, and operating medical equipment. The role requires the ability to lift, carry, push, and pull up to 50 pounds regularly, and occasionally assist with heavier transfers (with appropriate equipment or assistance), including supporting participants with ambulation, transfers, and wheelchair mobility. The position also requires visual acuity and manual dexterity sufficient to perform clinical tasks, as well as the ability to travel between locations, including driving, and safely navigate a variety of environments such as participant homes and community settings. Also requires the ability to operate a motor vehicle safely and travel to participant homes.
The above statements are intended to describe the general nature of work performed. They are not to be considered as an exhaustive list of all job tasks performed. The agency reserves the right to change job descriptions, work hours or work sites as required by the program.
The Humboldt Senior Resource Center is a private, non-profit, multi-purpose senior center providing a continuum of social and health related services. The agency currently holds contracts with the California Department of Aging and Area 1 Agency on Aging.
The Humboldt Senior Resource Center is an equal opportunity employer. We will not unlawfully discriminate against qualified applicants or employees with respect to any terms or conditions of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, medical condition, pregnancy, breastfeeding, gender identity, marital status, citizenship status, military or veteran status, genetic information, or other basis protected by applicable federal or state law.
