Scope:

• Responsible for organizing, developing, and directing skilled nursing service in accordance with MN Board of Nursing standards of practice, comprehensive Home Care license, and Knute Nelson’s policies and procedures.
• Responsible for centralized monitoring for Knute Nelson Home and Community and Ethos clients with telemonitoring units.
• Provide supervision and guidance to unlicensed staff.
• Responsible for ensuring the delivery of whole-person care and wellness integration across assigned regions following Knute Nelson’s Mission to “Enrich the Lives of Everyone We Serve” following the Six Dimensions of Wellness.

Key Responsibilities:

• Responsible for centralized monitoring on telehealth/technology in home units. Receive/monitor client text messages, phone calls, and video calls. Will follow up with clients and contact the skilled team member as needed for alerts during business hours and on the on-call rotation.
• Promote a spirit of cooperation with all regulatory organizations managing with an expectation of appropriate compliance and corrective measures. Coordinate clinical care with other health care professionals inside and outside Knute Nelson.
• Communicate effectively with patients, families, referral sources, physicians, and the interdisciplinary team. Demonstrate exceptional verbal and written communication skills.
• Assist in the development of policies and procedures and implementation of them. Works with supervisor to ensure that emergency procedures and practices are appropriate and up to date.
• Complete initial, face to face comprehensive assessment of prospective/new clients and develop a proposed service plan. The assessment must be completed within five days of initiation of our services, and prior to the initiation of any delegated nursing tasks.
• Monitor and reassess clients no more than 14 days after initiation of services. Thereafter, monitors and reassesses client as needed based on changes in the clients’ needs, with the monitoring and reassessment not to exceed 90 days from the date of the previous monitoring/reassessment.
• Develop, review, and implement service plans with all new clients. Review and revise service plan as needed due to changes in clients’ needs and a minimum of once every 12 months. The RN will review any needed changes to the service plan with the client and/or the client’s representative.
• Assure clients have up-to-date care plans that address their needs and preferences, including interventions to address any areas of vulnerability and individualized medication management or treatment or therapeutic management plans. Reassess the client and modify the service plan if necessary whenever the client has a fall or other incident, whenever there is a significant change in the client’s condition or if the client or the client’s representative requests a change in services.
• For any client receiving assistance with medications, the RN is responsible for medication management services identified in the individualized plan, such as setting up or ordering medications and as well as any necessary follow-up with physicians regarding medications and/or medical conditions.
• Assure that each home care staff person is oriented to the individual needs of each client the person will serve and that staff clearly understands and follows all client care procedures. Assure that changes to the plan of care are communicated and understood by staff.
• Assist with implementation of physician orders.
• Ensure accuracy and promptness in transcribing physician orders.
• Carry out proper charting practices and documentation procedures.
• Address client and family concerns or complaints to the extent possible and follows up with appropriate staff to resolve the issue. Document complaints and report complaints to the Home Care Director.
• Use appropriate communication techniques, such as validation or diversion activities, when working with clients with dementia.
• Assist the Home Care Manager and Home Care Director in investigating and reporting incidents of suspected client maltreatment and reporting these findings to the Common Entry Point and to the Home Director.
• Assist the Home Care Manager and Home Care Director in investigating complaints about our services submitted by clients, clients’ representatives or others and identifying steps to address the complaint.
• Recommend tools or devices that may improve the quality of life for the patient.
• Provide care based on the physical, psychosocial, emotional, and spiritual needs of the patient (The Six Dimensions of Wellness).
• Provide PERS & Telehealth installation for new and existing clients as needed.
• Help patients with personal cares such as bathing, dressing, and foot care.
• Provide homemaking tasks requested by clients.
• The duties and responsibilities listed above are representative of the nature and level of work assigned and are not necessarily all inclusive.

Education and Experience Required:

• Must be licensed as a Registered Nurse in the state of Minnesota.
• Must request and obtain licensure in the state of North Dakota for continuation of telehealth care for our clients.
• Must obtain CPR certification within 6 months from date of hire.
• Must have a valid driver’s license and use of an insured personal vehicle.
• Must be flexible and able to adapt quickly to changing situations.
• Able to communicate verbally and in writing to the extent required by the position.
• Must complete and pass a state required background study.
• Able to physically perform the duties required by the position.
• Required to have the ability to read, write and speak English well enough to communicate with staff, clients and families.

Reports To: Regional Clinical Manager