REGISTERED NURSE
DEPARTMENT: Nursing FLSA STATUS: Non-exempt
SUPERVISOR: Director of Nursing
AREA OF SUPERVISION: LPN/ Nurse assistants/Nurse Aides/Restorative Aide
Responsible for performing a variety of duty work flow quality nursing care to residents and to coordinate total nursing care for residents; implementing specific procedures and programs; participating with the Director of Nursing in establishing specific goals; determining work procedures and expediting work flow; insuring compliance with all operating policies and procedures and State and Federal regulations; communicating with and supervising appropriate personnel; providing daily reports and other periodic reports.
ESSENTAIL FUNCTIONS:
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Is knowledgeable of resident rights and ensures an atmosphere which allows for the privacy, dignity, and well-being of all residents in a safe, secure environment.
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Supports, cooperates with, and implements specific procedures and programs for:
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Safety, including universal precautions and safe work, practices, established fire/safety/disaster plans, risk management, and security, report and/or correct unsafe working conditions, equipment repairs and maintenance needs.
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Confidentiality of all data, including resident, employee, and operations data.
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Quality Assurance and compliance with all regulatory requirements.
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Compliance with current law and policy to provide a work environment free from sexual harassment and all illegal and discriminatory behavior.
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Supports and participates in common teamwork:
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Cooperates and works together with all co-workers; plan and complete job duties with minimal supervisory direction, including appropriate judgment.
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Uses tactful, appropriate communications in sensitive and emotional situations.
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Follows up as appropriate with supervisor, co-workers or residents regarding reported complaints, problems, and concerns.
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Promotes positive public relations with residents, family members and guests.
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Completes requirements for in-service training, acceptable attendance, uniform, and dress codes including personal hygiene, and other work duties as assigned.
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Perform, various duties to provide quality nursing care to residents to maintain or attain the highest practical level of functioning and to coordinate total nursing care for the residents as illustrated by the following:
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Assess residents and analyze obtained information to develop appropriate
interventions to prevent decline; record signs of change in condition; notify
appropriate staff per facility protocol to evaluate weight loss, decline in ambulation, development of skin breakdown, etc.; observe condition which indicate possible need for restorative nursing programs and then notify appropriate staff per facility protocol of the need for evaluation; inform the physician of changes in assessment when appropriate.
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Participate in the MDS process as assigned with the assessments, such as falls, braden, urinary continence, and AIMS. Assist with completion of the MDS and CAAs as requested.
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Administer medications and treatments to residents; monitor administration of intravenous fluids; place orders for medication from the pharmacy.
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Assess residents upon admission to develop interim care plan and further assess in depth to contribute to the complete care plan. Update care plans as warranted and required. Attend and participate at Plan of Care meetings as scheduled.
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Respond to emergencies; assess the condition of the resident; decide on the type of medical attention; notify the physician when a change in condition occurs; call appropriate ambulance service if needed; notify family when resident is transferred or admitted to the hospital or change in condition.
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Confer with residents and families; make referrals to other departments when
appropriate.
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Maintain resident clinical files; keep charts updated; document appropriately; Documentation requirements include but are not limited to:
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Changes in medical and physical condition
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Response to antibiotic therapy
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Report of weight loss or gain and response to change.
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Complete accurate, and timely physician’s information
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Report of PEG tube potency
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Report of adverse reactions to medication
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Report of unusual behaviors
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Report of pressure ulcer condition and weekly response to treatment.
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Complete employee and resident incident report forms; complete follow-up investigation forms.
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Make rounds to see each resident daily and as needed.
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Ensure that residents are aware of the services that are available to them; encourage residents to participate in activities program and provide staff support to enable residents to get to and from and participate in activities.
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Maintain accountability for controlled substances; inventory medications at the beginning and end of the shift with another licensed nurse; notify supervisor of discrepancies.
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Support the facility’s medical supply system; follow procedures for resident charge items
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Communicate status of residents to incoming personnel according to established procedures; communicate with physicians; transcribe, clarify, and implement physicians’ orders.
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Supervise the certified nursing assistants and determine work procedures, prepare work schedules, expedite workflow, evaluate, counsel and discipline.
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Ensures that certified nursing assistants and all supervised personnel adhere to standard job requirements.
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Perform all duties of the LPN as needed.
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Ability to use the computer to document care, such as eMAR, eTAR, physician orders, activities of daily living and other areas as instructed.
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Performs related duties as assigned or as the situation dictates.
Risk Exposure Categories:
X 1=Tasks may involve exposure to blood/body fluids.
2=Tasks do not involve contact with blood/body fluids but could result
in performing a Category 1 task.
___ 3=Tasks do not involve any risk of exposure to blood/body fluids.
PHYSICAL REQUIREMENTS
These are physical and mental requirements of the position as it is typically performed.
Inability to meet one or more of these physical or mental requirements will not
automatically disqualify a candidate or employee from the position. Upon request for a
reasonable accommodation, the Company may be able to adjust or excuse one or more
of these requirements, depending on the requirement, the essential functions to which it
relates, and the proposed accommodation.
Occasionally
(1-33%)
.1 – 2.6 Hours
Frequently
(34-66%)
2.7 – 5.2 Hours
Continuously
(67-100%)
5.3+ Hours
Lifting /Carrying 0-10 lbs.
X
Lifting/Carrying 11-20 lbs.
X
Lifting/Carrying 21-25 lbs.
X
Lifting/Carrying 26-50 lbs.
X
Lifting/Carrying 51-70+ lbs.
X
Pushing/ Pulling 0-10 lbs.
X
Pushing/Pulling 11-20 lbs.
X
Pushing/Pulling 21-25 lbs.
X
Pushing/Pulling 26-50 lbs.
X
Pushing/Pulling 51-70+ lbs.
X
Hearing/Listening: Must be able to hear well enough to communicate with co-workers and residents
X
Fingering/Grasping/Feeling:
Dexterity necessary to handle and manipulate equipment and supplies.
X
Seeing: Must be able to read reports, instructions, and observe residents
X
Color Perception: (Red, Green, Amber)
X
MENTAL/REASONING REQUIREMENTS
__ Reading Simple X Writing – Complex X Analysis/Comprehension
X Reading-Complex X Clerical X Judgement/Decision Making
__ Writing – Simple X Basic Math Skills
EXPOSURES
X Airborne particules __ Explosives X Muscular Strain X Temperature
X Caustics X Fumes X Noise X Toxicants
X Chemicals __ High places X Odors __ Vibration
X Electrical Current X Moving Parts X Physical Abuse X Vision strain
X Slippery Floors __ Weather
WORK AREA AND ENVIRONMENT
Nursing stations, drug rooms, supply areas, resident rooms, offices, and other areas in the facility.
QUALIFICATIONS
Education: Must be a graduate of a state approved school of professional nursing.
Experience: At least six months as a staff nurse in a long-term care facility.
License/Registration: Hold a current, unencumbered license in this state as a registered nurse.
Continuing Education: As required attend annual in-service programs. Participate in
continuing education activities and obtain required contact hours.
Professional memberships: Recommended and encouraged
Job Knowledge: Nursing policies and procedures; administration of medication, possible
side effects, and treatment as prescribed; federal, state, and local laws and regulations relating
to resident care; comprehensive knowledge of nursing practices; physical, psychological,
social, and medical needs of residents; organizational structure and duties of employees under
supervision of charge nurse. Ability to problem solve and demonstrate sound judgment by
taking appropriate actions regarding questionable finding or concerns. Investigate and
follow-through on orders or request for services, accidents/or prevention of accidents.
Professional standards and the code of ethics must always be adhered to. Cooperative,
willing to work, courteous. Ability to read, write, and follow written and oral instructions.
Standards: Knowledge of and ability to meet regulations of: Centers for Medicare and
Medicaid Services (CMS); State Health Department; OSHA, Life Safety Codes; Facility
Policies and Procedures; Nursing Standards of Practice; and Nurse Practice Act.
BASIC REQUIRMENTS
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Residents always come first, and their needs will be met unless there is a conflict with the needs of others or the organization.
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Residents, resident families, co-workers, and visitors will be treated with respect, dignity, and kindness.
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Support the mission, vision, and values of the facility
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Employee behavior will consistently be in a manner that demonstrates both employee’s and the company’s commitment to an ethical, honest, and above-board approach in all dealings with employees, customers, suppliers, and the community.
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Report to work on time and for scheduled shifts as attendance is required to perform the duties and responsibilities of this position.
ACCEPTANCE STATEMENT
I have carefully read, understand, and accept the job description, including the qualifications and requirements of the position of REGISTERED NURSE/CHARGE NURSE, and, if employed, I certify that I can and will perform the essential functions of the position.
I understand Universal Precautions Risk Classification Categories may apply to this position and I may be exposed to AIDS, HIV, and hepatitis B viruses.
The above statements describe the general nature, level, and type of work performed by the incumbent(s) assigned to this position. They are not intended to be an exhaustive list of all responsibilities, demands, and skills required of personnel so classified. Job descriptions are not intended to and do not imply or create employment, compensation, or contract rights to any person or persons. The Facility reserves the right to add, delete, or modify and and/or all provisions of this description at any time as needed without notice. This job description supersedes earlier versions.
This job description supersedes all prior written and unwritten policies, including any prior job descriptions. Nothing contained in this job description or in any other statement of Facility philosophy, including statements made during performance evaluations and wage reviews, should be taken as constituting an expressed or implied promise of continuing employment.
This job description is not a contract, expressed or implied, guaranteeing employment for any specific duration. Please understand that no supervisor, Administrator, or representative of the Facility may enter an oral employment contract. The President of the Facility, or his representative designated in writing, are the only Facility officials who have the authority to enter into any agreement with you for employment for any specified period.
Further, any employment agreement entered by the President, or his designated representative will not be enforceable unless it is in writing.
