Job Summary: Provides oversight and management for the day-to-day nursing services including coordination within the interdisciplinary team. Provides input and guidance for clinical staff. Provides feedback to Director of Patient Care to communicate opportunities, challenges, and needs of the Registered Nurses, Spiritual Care Counselors, Social Workers, and Certified Nursing Assistants members of the Hospice team. Participates in annual evaluation of job performance. Delivers comprehensive patient care to all assigned patients/families and serves as case manager for all hospice services provided, working cooperatively within the interdisciplinary team.
Qualifications:
Graduate of approved school of nursing.
Current licensure to practice professional nursing in the State of Texas.
Two years of administrative/supervisory experience with demonstrated ability to manage programs, including developing policies and procedures, supervising staff, and coordinating services desired.
Knowledge of case management approach, working within an interdisciplinary team, and the nursing process as it applies to hospice, palliative care, and home health patients and their families.
At least two years of experience in caring for the terminally ill and their families, including skill in bedside nursing, preferred.
Knowledge of hospice, palliative care, and home health policy and procedures and of state/federal and accrediting body requirements.
Pain and symptom control skills, crisis intervention expertise, and family/ patient counseling skills.
Suitable personal appearance, behavior, attitude, and integrity.
Demonstrates proven decision-making skills
Team player who is flexible, self-motivated, and dependable.
Excellent interpersonal skills and ability to communicate effectively.
Duties and Responsibilities
A. Team Leader
Oversees day-to-day delivery of nursing services and assists the Director of Patient Care with compliance of agency policies, procedures, mission, values, and goals.
Provides resource and oversight to weekend and after-hours nursing, spiritual care counselors, social workers, and hospice aide care while sharing clinical leader on-call duties.
Participates in orientation program of new nurses.
Provides clinical supervision of nursing personnel.
Serves as preceptor to new nursing personnel or delegates responsibility as needed.
Writes annual performance evaluations for assigned nurses, spiritual care counselors, social workers, and CNA’s.
Assists with nursing patient assignments in morning meeting.
Performs specific assignments as directed by Director of Patient Care.
Provides input and guidance for nurses, spiritual care counselors, social workers, and CNA staff through case review
Provides feedback to Director of Patient Care as appropriate.
Provides in-field supervision of nurses, spiritual care counselors, social workers, and CNA competencies as needed and as part of annual evaluation to assure competency.
Provides appropriate documentation of in-field clinical supervision on the date of supervision.
Ensure compliance with the CoPs/Regulations set forth by CMS, which includes, but not limited to re-certifications completed timely, content from the re-certifications is reflective of hospice appropriateness.
Work closely with the QAPI to ensure there is ongoing teaching with staff about areas of improvement, performance improvement plans are being followed, and frequencies are being met, as outlined in the patient’s plan of care.
Work closely with referral sources, as evidenced by making monthly visits as assigned by the Director of Patient Care.
Attend leadership meetings and participate in the ongoing improvement of the agency

B. Interdisciplinary Team (IDT)
Oversees the functioning of the IDT and provides organization and oversight of team meetings.
Facilitate efficient and productive IDT meetings that ensures all documentation is signed within the timeframe and that the patients/families’ needs are being met by the staff
Assists with patient referrals/admissions, as needed.
Acts as liaison with patient, families, physicians, other caregivers, and IDT to resolve complex situations.
Oversees processes and procedures that assure the client’s plan of care is implemented as written and is reassessed and revised as appropriate based on response to care and changing conditions of the patient.
Assures a nursing assessment of a client’s needs is performed when there is a significant change in the client’s condition, at the physician’s request, or after hospitalization.
Oversees documentation of nursing services provided to patients and families, assuring accuracy, completeness, and compliance.
C. Care Manager: Family/Caregiver/Team as needed
Assures caregiver competence by instructing and verifying understanding of disease process, signs, and symptoms of approaching death, equipment, supplies, and medication usage; safety measures, including body mechanics and standard precautions.
Provides supervision RNs and Hospice Aides, evaluating competency, and supervises as required.
Evaluates and coordinates any needed changes in the patient's level of care, including hospitalization, respite care, continuous care and transfers.
Participates in team care planning—interdisciplinary team (IDT) and care planning meetings/family conferences for nursing home patients.
Coordinates additional services needed, such as referrals for contracted therapists (Physical, Speech, Occupational, and Massage) and medical equipment/supply placement and removal.
Monitors caregiver's stress and ability to care for the patient and reports to the Interdisciplinary Team any changes needed.
Provides emotional support for patient/family/caregiver as needed.
Performs and documents initial and on-going skilled nursing assessments of patient's needs - physical, emotional, psychosocial, and spiritual.
Maintains and updates accordingly the patient/family Plan of Care, using the nursing process.
Assesses and documents changes in patient's condition, evaluating and appropriately reporting to the patient’s physician and/or Medical Director and the Interdisciplinary Team.
Evaluates the patient's medication needs for palliation by consulting appropriately with the patient's physician/Medical Director.
Coordinates and completes patient admissions as assigned.
Cooperates with the patient's recertification process by evaluating and documenting the patient's qualifications for on-going hospice services, as appropriate.
D. Death and Bereavement as needed
Assists the patient, family, and caregivers at time of death by attending and by handling necessary arrangements such as: pronouncing death, preparing the body, arranging for funeral home to remove body, notification of appropriate authorities, and medication and equipment disposal or removal, in accordance with hospice policy.
Supports family/caregivers in anticipatory bereavement needs and transition to the bereavement program following the death of the patient.
E. Professional Work Standards
Assures comprehensive patient care by participating in after-hours provision of care and services as required,
Fosters communication, reimbursement, and evidence of compliance by completing all required documentation in a timely manner and per agency policy.
Assures that the Plan of Care is followed, including visits as indicated.
Participates in Risk Management by practicing safety measures, including standard precautions, back precautions, home and personal safety precautions, and by reporting injuries, accidents, and incidents according to policy.
Attends in-services and keeps abreast of all policies, procedures, activities and regulations affecting professional performance, including risk management.
Establishes and maintains professional relationships in nursing facilities, assisted living facilities, and contracted hospitals.
G. General
Supports the philosophy and objectives of Hope Hospice.
Maintains a professional appearance, behavior, attitude, and integrity.
Keeps abreast of and abides by policies and procedures of the agency.
Stays current with governmental and accreditation requirements affecting area of responsibility.
Maintains confidentiality and ethical behavior.
Promotes a team approach through cooperation, mutual respect, flexibility, and dependability.
Participates in appropriate meetings and activities.
Exhibits good stewardship of resources, including self-care.
Reads materials and attends in-services, seminars or conventions as needed for professional growth.
Contributes to an atmosphere of excellence, mutual respect, and caring.
Participates in other projects as assigned.
Physical Demands: Work is performed in an office environment. The position requires manual dexterity, standing, walking, climbing stairs, bending, kneeling, and sitting for extended periods. Occasionally lift or move objects weighing up to 15 pounds. When making patient visits: may work in patients’ home and nursing facilities in various conditions; possible exposure to blood and bodily fluids and infectious diseases; prolonged standing and walking required, with ability to lift up to 50 lbs. and move patients. Ability to work flexible schedule; ability to travel within surrounding areas; some exposure to unpleasant weather.
Travel There is no anticipate overnight travel for this position. Some local day travel may be required.