ICU

CASS REGIONAL MEDICAL CENTER

Department Name: ICU

Title: RN

EEOC Classification: Non-Exempt

Primary Purpose: To provide critical care in accordance with hospital policies and procedures, as well as state and federal regulations. Stay informed of current trends and changes in the healthcare industry.  The purpose is also to provide a safe and caring environment for patients and families during stressful situations. Performs other duties as assigned.                               

Formal Policy-Setting Responsibilities: No formal responsibility. The policies associated with the job’s purpose and essential responsibilities are set by others.                             

Routine Decision Making: Determines which condition warrants notification of provider; which medications are needed during critical times; which equipment should be used for each patient.                     

Formal Supervisory Responsibility: No formal supervisory responsibility.                                           

Required Knowledge: Critical care medications; IV drips; assessments/monitoring; cardiac dysrhythmias; knowledge of specialized equipment; nursing process; growth and development, disease processes; interpretation of lab results.                                   

Required Skills and Ability: Excellent physical assessment skills; observation; auscultations; palpation; good communication skills; ability to function independently; excellent time management and prioritization skills; computer skills; problem-solving skills; knowledge of hospital policies and procedures.                                          

Unusual Working Conditions: Risk of blood, body fluid contamination. Risk of injury related to poor body mechanics. Risk for injury from aggressive, combative or disoriented patients. Potential exposure to hazardous drugs and chemicals.             

Education and Certification: RN degree required, BSN preferred; current RN licensure in the state of Missouri or compact licensure to practice in Missouri required; BLS and NIH Stroke Certification required within 90 days of hire and ACLS, PALS and TNCC required within 6 months of hire. NVCI or equivalent class as determined to be required by the facility.

• Trauma Educational Requirements: Four (4) continuing education hours (2 adult hours and 2 pediatric hours).       
• Stroke Education Requirements: Four (4) continuing educational hours (3 educational hours awarded per completion of NIH stroke certification).                  

Age Specific Competencies: May provide care for birth to pediatric (birth-2 yrs.), pediatric/child patients between (2 yrs-12 yrs.); adolescent patients between 12 to 18 years of age; adult patients between 18 to 64 years; and geriatric patients 65 years and older.

Essential Responsibilities and Tasks

Demonstrates utilization of the nursing process through patient assessment. (20% of time)

• Assesses and evaluates the patient's condition at the beginning of each shift and as needed.                         
• Re-assesses and evaluates the patients approximately every two (1) to four (4) hours and as needed.   
• Completes the admission database thoroughly, which includes a pertinent patient history, assessment of body systems, medication history and other screenings, within one (1) hour of arrival to the ICU, as acuity allows.                                                        
• Assesses data relative to age specific needs for every patient within one (1) hour of patient's arrival to the unit or at the beginning of each shift.                                               
• Completes appropriate pain assessment at the beginning of each shift and as needed.
• Ensures all patients are placed in the ICU within thirty minutes of being notified of the admission/transfer if bed is available.

Demonstrates utilization of the nursing process through planning for patient care. (15% of time)        

• Collaborates with interdisciplinary team to facilitate the plan of care.                                          
• Completes an individualized care plan and update as appropriate, based on patient diagnosis and assessment.      
• Plans for increased staffing needs according to patient acuity and according to written departmental staffing patterns, notifying nursing management as appropriate.
• Interprets the significance of abnormal patient findings during each assessment and as patient's condition changes.                                           
• Updates white boards each shift, to include personalized patient goals.                                          

Demonstrates utilization of the nursing process through implementation of nursing and medical interventions. (20% of time)                                                  

• Implements nursing and medical interventions/rounding hourly and as needed.                           
• Demonstrates professionalism and competence during emergency situations, acting rapidly and efficiently, and managing self and others to implement patient care according to current standards of practice and hospital policy.
• Demonstrates accountability to provider orders through timely implementation and notation of such orders.                                               
• Interprets appropriately the significance of abnormal assessment findings.                           
• Documents and reports significant abnormal patient findings to the provider immediately.  
• Is knowledgeable of the location, operation and care of all equipment in the ICU.         
• Administers all medications as ordered within one (1) hour of time scheduled according to the five (5) rights on every patient.                                                    
• Ensures all provider orders are correctly recorded on eMAR, on patient's Kardex and in the computer when noting each order.                                             
• Accurately and correctly wastes unused portions of controlled substances timely.         
• Performs narcotic count according to hospital policy.                                                 
• Attaches patient's name band, allergy band, etc. immediately after patient's arrival or upon band(s) being removed.                                                        
• Utilizing the ‘AIDET’ (Acknowledge, Introduction, Duration, Explain, Thank) model, conducts an appropriate introduction, reviews the plan of care, mutually sets attainable patient goals.

Demonstrates utilization of the nursing process through evaluation of patient care. (10% of time)

• Evaluates patient responses to implemented interventions according to current standards of care and to hospital policy.                                                     
• Communicates specific patient responses to implemented care as needed to the provider, obtains necessary modifications to the medical and nursing plan of care.                                                       
• Adapts the individualized plan of care for each patient as conditions change.

Demonstrates accountability to the nursing process through documentation (10% of time)   

• Documents assessments at least every four (4) hours, including cardiac rhythm strips with interpretations.                                                    
• Documents according to the written plan of care at least once per shift.                                 
• Documents clearly the implementation of specific interventions, including details of methods used, with the time of implementation, and evaluation of patient response.
• Documentation follows hospital and departmental policies for frequency and content.
• Utilizes only hospital approved abbreviations in documentation and clarifies non-approved abbreviations utilized by others. 

Provides patient and family education. (10% of time)                                              

• Provides patient and/or family education based on assessments each shift and as needed.                    
• Uses terminology appropriate to patient/family's knowledge base and age-specific needs each shift.                                               
• Evaluates patient and family's learning needs and abilities each shift and as needed.
• Documents education provided including subject taught, method of teaching, who was taught and comprehension of information.                                              
• Provides and documents patient and family follow-up instructions at discharge.

Maintains a safe and comfortable unit. (10% of time)                                              

• Checks code blue carts each shift and upon using the cart, ensuring it has an intact tag attached.         
• Ensures alarms on any assigned areas are audible to alert staff, each shift.                   
• Removes malfunctioning equipment from the direct patient care areas immediately upon discovering a problem.                                                     
• Completes a requisition for repair and sends electronic work request before the end of the shift, pass on any issues to the next shift for follow up and provides a copy to the manager before the end of shift.                                                         
• Utilizes the two-hospital approved patient identification methods for positive patient identification.                                              
• Utilizes correct method of barcode scanning patient identification bracelets for medication administration via eMAR 97% of the time.                                                         
• Utilizes correct method of barcode scanning patient medications for medication administration via eMAR 95% of the time.                                               
• Completes patient assignment/patient acuity record each shift.
• Bedside report and rounding to occur every shift between oncoming and off-going staff.

Develops and promotes performance improvement initiatives. (5% of time)                                          

• Plans, develops and evaluates self-objectives annually.                                             
• Participates in planning methods to solve problems and make improvements in the Intensive Care Unit quarterly and as needed.
• Participates in implementing planned changes and activities to improve the Intensive Care Unit quarterly and as needed.                                                      
• Evaluates planned changes and activities to improve the Intensive Care Unit quarterly and as needed.                                                                                         
• Attends unit staff meetings (3) 80% or greater, (2) 50-80%, (1) less than 50% annually.

ESSENTIAL PHYSICAL REQUIREMENTS

X            Heavy Work: Lifting 100lbs maximum with frequent lifting and/or carrying of objects weighing up to 50lbs.                                                        

PHYSICAL DEMANDS (Check those which apply)

x            Lifting: Raising or lowering an object from one level to another (includes upward pulling).          

x            Carrying: Transporting an object, usually holding it in hands or arms or on the shoulders.          

x            Pushing: Exerting force upon an object so that the object moves away from the force (including slapping, striking, kicking, and treadle actions).                                                       

x            Pulling: Exerting force upon an object so that the object moves toward the force (includes jerking).                                                   

x            Balancing: Maintaining body equilibrium to prevent falling when walking, standing, crouching, or running on a narrow, slippery, or erratically moving surfaces; or maintaining body equilibrium when performing gymnastic feats.                                                                                                           

x            Hearing: Ability to determine audible communication.                                              

x            Stooping: Bending the body downward and forward by bending the spine at the waist.                        

x            Kneeling: Bending the legs at the knees to come to rest on the knee or knees.                              

x            Crawling: Moving about on the hands and knees or hands and feet.                                                         

x            Reaching: Extending the hands and arms in any direction.                                                      

x            Handling: Seizing, holding, grasping, turning, or otherwise working with the hand or hands (fingering not involved).                                          

x            Fingering: Picking, pinching, or otherwise working with the fingers primarily (rather than with the whole hand or arms as in handling).

x            Feeling: Perceiving such attributes of objects and materials as size, shape, temperature, or texture by means of receptors in the skin, particularly those of the finger tips.

x            Speaking: Expressing or exchanging ideas by means of the spoken word.  Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.                                           

x            Seeing: Obtaining impressions through the eyes of the shape, size, distance, motion, color or other characteristics of objects.                                                                                                                

x            Acuity, near - clarity of vision at 20 inches or less.                                                       

x            Depth perception - ability to judge distance and space relationships so as to see objects where and as they actually are.                                                        

x            Field of vision - area seen up and down or to the right or left while eyes are fixed.                

x            Accommodations - adjustment of the lens of the eye to bring an object into sharp focus.            

x            Color vision - the ability to identify and distinguish colors.