2. Work with the Director of Nursing and Supervisory Staff in program planning and coordinating the STD/HIV/AIDS program in Nash County.
3. Responsible for the development and maintenance of the STD/HIV/AIDS Program Manuals. This includes ensuring that the program policies and procedures are current and that any changes are incorporated into the manual as well as communicated to the staff. Notify Nursing Supervisor or Director of Nursing that policies need updating or changing. Makes procedural changes in conjunction with Nursing Supervisor. Collaborates with Medical Director, making changes in medical directives, as necessary, due to new recommendations in care and treatment of disease. Keep signatures of directives, policies and procedures current.
4. Monitor program records for completeness of care, and to ensure proper plan of care, treatment and documentation. To ensure adequate and appropriate follow-up is done as needed. This may include making home visits of those who need additional follow-up for treatment, testing and/or counseling. This involves various levels of independent instruction with consideration given to patient level of understanding and complexity of case. Individual education of staff is done from problems found in documentation. Ensure Medical Director signs records if indication and that any recommendations made are completed. Make appropriate referrals to other medical facilities as needed.
5. Monitor all positive STI reports the Nash County Health Department (HIV, Syphilis, Gonorrhea, Chlamydia, and PID) ensuring that clients are notified by a designated staff person, and adequate treatment and follow-up is done. Includes notifying Disease Intervention Specialist (DIS) for follow-up home visits of positive HIV and Syphilis cases.
6. Check all STI report cards received from hospitals and private doctors for correct completion of forms and adequacy of treatment. Provide follow-up home visits of positive HIV and syphilis cases.
7. STD Coordinator does considerable work in the North Carolina Electronic Disease Surveillance System (NCEDSS). The STD Coordinator has oversight in checking NCEDSS STD workflow daily during the scheduled work week for prompt recognition and treatment. When the coordinator has an extended absence for vacation or illness, a trained nurse in NCEDSS will be responsible for checking NCEDSS STD workflows daily.
8. STD Coordinator or data entry staff manually enters reportable STDs of Nash County residents received from private laboratories or physicians’ offices that are not automatic feeds into NCEDSS. STD Coordinator or designee in Coordinator’s absence reviews each reportable STD report for accuracy and completeness of treatment. STD coordinator and/or assigned certified STD NCEDSS Data Entry staff enters reviewed STD data into NCEDSS Event and reassigns Event to the NC State Disease Registrar for reporting and closure in accordance with local statutory requirements.
9. Ensures that all reportable cases of STD/HIV/AIDS are reported in accordance with local statutory requirements.
10. Serve as a liaison with regional and state offices in interpreting and disseminating new information to the staff at the Nash County Health Department, local clinics, hospital and private physicians in our community. Cooperate with other government and community agencies.
11. Participate in all STD/HIV/AIDS program and record audits. Responsible for informing nursing staff of any deficiencies and devising a plan of action to correct the deficiencies.
12. Organize STD/HIV/AIDS departmental team meetings for collaboration between all other agency programs and divisions. Coordinate the follow-up efforts for ensuring HIV positive clients in each program area of the Health Department are contacted and post-test counseled on results with person-to-person conference in a timely manner.
13. Coordinate patient referral and appropriate actions in program areas for HIV positive clients.
14. Work involves considerable contact and collaboration with local agencies in the community and surrounding regional area such as the NCDHHS DIS, Department of Social Services, Housing Authority, Social Security Administration, Wilson Medical Center, etc., for referrals and follow-up.
15. Participates, along with Health Educators, in local meetings regarding STD/HIV/AIDS.
16. Represents Nash County Health Department in Regional Ryan White meetings.
17. Responsible for ensuring that designated new employees are correctly oriented into the STD/HIV/AIDS Program.
18. Responsible for remaining aware of current information in program areas, especially STD/HIV/AIDS issues. Attend workshops, in-services, programs, video conferences, and updates offered, especially by the STD/HIV state branch. Extensive reading of periodicals and textbooks is required to function in this program. Responsible for accumulating training hours required to remain certified as an STD enhanced role nurse clinician.
19. Perform these additional duties in the STD/HIV/AIDS program as an Enhanced Role Nurse:
a. Completes and initial or interim medical and sexual history.
b. Counsels regarding appropriate communicable disease and discusses general STDs with patients. Identifies and evaluates high risk behavior.
c. Performs thorough STD physical examination based on enhanced role guidelines.
d. Orders appropriate lab tests, per standing orders. (GC, chlamydia, NGU, herpes, serology for syphilis and HIV, and wet preps for trich, bacterial vaginosis and yeast)
e. Provides education and counseling regarding problems identified.
f. Dispenses or administers appropriate treatment according to the STD policy, procedures, and standing orders, and according to the Department’s Pharmacy policy and procedures.
g. Treats genital warts per standing orders after the diagnosis has been established by MD, PA or NP.
h. Provides pre and post-test HIV counseling.
i. Initiates necessary referrals.
j. Refers sex partners for treatment. Provides appropriate individual education and counseling - stressing safer sex practice with condom use.
k. Documents findings and all activities in the client’s medical record according to the program policy, procedures and medical record policy.
20. Orients all new staff to the STD program and its policies and procedures.
21. Serves as member of the Agency's STD Quality Assurance Committee, which includes representation from the Nashville and Rocky Mount Office. Composed of the following: Nursing Supervisor, RN, Lab, Management Support, and Health Education.
5% Women's Health Watch
Performs physical assessment exams in the Women's Health Watch Program
1. Reviews or obtains medical history.
2. Counsels patients regarding acute and chronic disease, communicable disease, lab findings and diet.
3. Performs breast exams and teaches self-breast examination.
4. Follows the agency's procedure manual for the collection of specimens for pap smear, gonorrhea cultures, Chlamydia antigen, herpes cultures and wet mounts and other labs.
5. Performs bimanual and rectal examinations as approved under Category II Nursing Procedures outlined in procedure manual.
6. Evaluates and interprets test results and treats according to Standing Orders signed by Clinician and refers patient as indicated from findings.
7. Dispenses medications according to the Department’s standing orders and Pharmacy policy and procedures.
8. If applicable, offers HIV testing/counseling and BCCCP referral.
4% Family Planning
Interviews/collects lab specimens in Family Planning clinics
1. Counsels patients regarding birth control methods.
2. Obtains medical history and other pertinent data such as Blood Pressures.
3. Assists Clinician with examination.
4. Interprets instructions to patient, interprets consents and obtains signatures.
5. Issues supplies of prescribed methods of birth control and dispenses according to pharmacy policy.
6. Collects specimens such as paps, GC, Chlamydia, and wet preps.
4% Maternity
Interviews in maternity clinics
1. Obtains prenatal history.
2. Teaches patient important information to help her have a healthy pregnancy and baby.
3. Counsels patient about complications of pregnancy, labor and delivery.
4. Assists Clinician with exams and interprets instructions to the patient.
5. Schedules test needed to be performed outside of agency and schedules return appointments.
6. Issues vitamins and iron tablets according to Pharmacy Policy.
2% Pediatrics
Interviews and Administers Immunizations in Pediatric Clinics
1. Interviews parents of infants and children to obtain medical history.
2. Counsels parents regarding diet, growth, development and preventative health care.
3. Administers vision and hearing tests.
4. Evaluates patient for needed lab work and administers immunizations.
2% General Clinic
1. Works General clinic administering immunizations, checking rashes, head lice, blood pressures, administering immunizations for WIC recert appointments, etc.
2. Obtains medical history and orders lab work on TB patients, contacts, reactors.
3. Administers and reads TB skin tests, issues sputum containers, and dispenses medicines per Standing Orders.
2% Community Health
1. Staffs emergency shelters for disaster services.
2. Backs up school nurses and assists other health department staff with school activities (ex., school based screenings, immunizations, communicable diseases services, etc.). Assists with department wide community activities (ex., community flu programs, health fairs, etc.).
1% Other Duties
1. As assigned.
2. Maintain Personnel records.
3. Attends staff meetings and other county education programs.
4. Participates in disaster services as required.
II. B. OTHER POSITION CHARACTERISTICS:
1. Accuracy Required in Work: This position requires a high level of accuracy required in reviewing lab data results, physical assessment exams, in identifying problems and needs and initiating appropriate referrals and treatments. Interpreting findings, initiating standing orders, counseling, and initiating referrals all Legal responsibility falls to acting nurse for herself, her patient and her place of employment.
2. Consequence of Error: Errors may result in bodily harm either physically or mentally. Timely and accurate interpretation is vital to protect patient. Errors may also precipitate malpractice lawsuits and/or enforcement action by the N.C. Board of Nursing. It is imperative that this position be alert to early symptoms of all disease processes and side effects of medications. It is imperative that this position provides accurate test results, and follow-up, and accurate reporting to the appropriate state branch for further follow-up.
3. Instructions Provided to Employee: This position has scheduled clinic assignments. Management responsibilities and program responsibilities are prioritized by the employee. Instructions are received most often from supervisory staff or state program consultants. Instructions are usually oral, however, written instructions are also received through various sources. Attends job related workshops. In-house updates are provided at monthly staff meetings or by written memo. Clinical assignments are scheduled weekly and daily changes are handled by the Nursing Supervisor when unexpected absences occur. Changes of policies and procedures at the state level are received in memos from the STD/AIDS Control Branch. Further written and/or oral instructions are received from the medical consultant, private physicians, physician assistants and the family nurse practitioner.
4. Guides, Regulations, Policies and References Used by Employee:
1. Health Director, Director of Nursing, Supervisory Staff, Program Coordinators, Medical Consultant
2. Nash County Policies, Procedures, and Standing Orders.
3. Physician Orders
4. The Breast Screening Manual: A Guide for Health Departments and Providers.
5. NC BCCCP Guidelines on Mammography Screening (directive of CDC National Breast and Cervical Cancer Early Detection Program).
6. DEHNR directive.
7. Nash County Health Department Personnel policies.
8. STD State Manual
9. Sexually Transmitted Diseases Treatment Guidelines from CDC.
10. Communicable Disease Laws; federal and state statutes and rules
11. NC Nurse Practice Act.
12. Federal and State Statutes and Rules.
13. ACIP Manual.
14. State Consultants
5. Supervision Received by Employee: Work is supervised by the Personal Care Nursing Supervisor. Sexually Transmitted Disease and HIV/AIDS Policies and Procedures, and Standing Orders are reviewed quarterly by members of the Adult Health STD Quality Assurance Committee and updated as needed by the Program Coordinator and Nursing Supervisor.
6. Variety and Purpose of Personal Contacts: Variety of contacts include:
1. Local physicians office.
2. State laboratory staff.
3. Surrounding area Health Department Personnel.
4. Patients on a daily basis to assure that all needed services are provided for referrals made.
5. Local hospitals, Emergency Department, Infection Control, Prison Systems, etc.
6. Uphold HIPAA rules and regulations.
7. Physical Effort: Requires the provision of patient services each day whether physically through applying direct clinical skills, phone calls, mail, record management, or attending a continuing education workshop. Requires travel between the Nashville and Rocky Mount offices. Requires home visits as needed.
8. Work Environment and Conditions: Usual work environment is the office or clinic setting. Has the potential to be exposed to body fluids. Adheres to the BBP and Infection Control Policies of the Agency to minimize this exposure. Also provides care in STD clinics to inmates. Inmates are always accompanied by a deputy. Driving is required sometimes during bad weather for clinic duties and home visits.
9. Machines, Tools, Instruments, Equipment and Materials Used:
Blood Pressure Cuff/Stethoscope, Doppler, Copy Machine, Speculums, Computer/EMR, Scales, Fax Machine, telephone, stadiometer, OAE, lab supplies to collect specimens.
10. Visual Attention, Mental Concentration and Manipulative Skills:
1. Must be able to organize work efficiently.
2. Must be able to perform quality work independently.
3. Must have proficiency in Level II Nursing Procedures.
4. Requires good communications skills.
5. Must have good writing skills to record documentation and initiate referrals.
6. Must have the ability to document what is observed visually, record data the client tells the employee, and observe changes in client condition is crucial; it requires using all the senses to evaluate the client.
8. Position duties involve physical assessment of clients, making program decisions, and/or recommendations, which will affect the client, attentiveness and alertness is required at all times.
9. Manipulative skills are essential and used extensively in performing the nursing functions required to assess and treat clients.
11. Safety for Others: Must follow recommended guidelines to prevent transmitting any communicable diseases. Universal precautions are used for safety of staff and patients. Must be knowledgeable of local policies, procedures, and standing orders. Must have nursing expertise to provide appropriate patient care. Must be adequately immunized per agency policy.
12. Dynamics of Work: Flexibility is an important component of this position. New situations arise every day. Ability to prioritize work is essential since workload and schedule may change. Positive attitude is crucial to be able to motivate patients. Diplomacy and tactfulness in dealing with physicians regarding referrals is very important.