What are the responsibilities and job description for the RN - ER position at CASS REGIONAL MEDICAL CENTER?
Primary Purpose: To provide quality patient care following the standards using the nursing process in order to maintain a safe environment, to provide patient and family education, and to provide proper documentation for billing.
Formal Policy-Setting Responsibilities: Formally responsible for making recommendations regarding policies associated with the job’s purpose and essential responsibilities.
Routine Decision Making: Triages patients, performs nursing process and determines all aspects of nursing care; administers medications and treatments appropriately.
Formal Supervisory Responsibility: No formal supervisory responsibility.
Required Knowledge: Nursing process; critical care; medications and treatments; growth and development; disease processes; anatomy and physiology.
Required Skills and Ability: Good communication skills; auscultation, palpation and IV skills; time management skills; ability to utilize and interpret emergency equipment.
Unusual Working Conditions: Risk of blood, body fluid contamination. Risk for injury from aggressive, combative or disoriented patients. Potential exposure to hazardous drugs and chemicals.
Education and Certification/ Registration Required for the Position: Two to four-year nursing degree; current licensure in the state of Missouri; NIHSS, BLS, ACLS, and PALS required within 3 months of hire. TNCC required within 6 months of hire. Eight (8) CE’s specific to trauma (six (6) adult trauma CE’s and two (2) pediatric trauma CE’s) that are approved by the trauma medical director and completed annually. Four (4) CE’s specific to stroke that are approved by the stroke medical director and completed annually. NVCI or equivalent class as determined to be required by the facility.
Population Specific Competencies: Recognizes the importance that diversity/cultural beliefs have when delivering care to the populations served at Cass Regional.
Age Specific Competencies: Provides care to neonates (birth to 6 weeks), infants (6 weeks-2 year), children (2 yr-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.
PART TWO: Essential Responsibilities and Tasks
A. Performs the assessment phase of the nursing process. (25% of time)
1. Performs immediate bedding (as resources allow) and assists Charge RN with triaging all patients upon arrival to the emergency department as needed.
2. Performs a patient assessment that includes all pertinent patient history, assessment of body systems and other screenings on arrival to the exam room.
3. Documents patient assessments and re-assessments completely during emergency department stay.
4. Utilizes only approved abbreviations when documenting in patient’s chart.
5. Assesses data relative to age/population specific needs for every patient, upon arrival.
6. Assesses abnormal patient findings throughout emergency department stay.
7. Assesses patient/family's learning needs on admission.
8. Demonstrates ability to communicate effectively with patients that are impaired due to alcohol, drugs or experiencing psychiatric issues.
9. Completes appropriate pain assessment on admission.
10. Completes all aspects of the medication reconciliation process by completing an accurate and complete list of patient’s current medication.
11. Encourages patients to stay for treatment rather than leave prior to the medical screening exam or against medical advice.
12. Communicates in a non-judgmental, friendly manner with guests at all times.
13. Consistently uses AIDET when communicating with patients, family members, etc.
B. Performs the planning phase of the nursing process. (20% of time)
1. Formulates a plan of care with the physician based on the patient assessment on admission that addresses all problem areas.
2. Adapts plan of care with physician as patient's condition changes.
3. Collaborates with ancillary departments to facilitate the plan of care after the physician writes orders.
4. Denotes and documents significant changes in the patient’s condition during emergency department stay.
5. Interprets significance of abnormal patient findings after assessing patient on admission and as condition changes.
6. Notifies Charge Nurse of need for increased number and level of personnel in the event of increased census or patient acuity.
7. Supports the principles of the Patient Experience culture.
8. Participates in the budget process by bringing suggestions to the Director for needed equipment, supplies and resources.
C. Performs the implementation phase of the nursing process. (15% of time)
1. Implements patient care during the emergency department stay.
2. Documents and reports significant abnormal patient findings to the physician immediately.
3. Is proficient at locating, caring for and utilizing emergency department equipment, supplies, etc.
4. Acts rapidly, effectively and manages self and others during emergency situations.
5. Administers IV's and medications as ordered by physician according to hospital policy on every patient.
6. Validates the presence of an order on the chart prior to giving any medications.
7. Scans patient’s wristband and medications according to hospital policy. Documents the administration of all medications on the patient’s MAR immediately after administration.
8. Accurately and correctly wastes unused portions of controlled substances prior to the end of the shift.
9. Implements and documents appropriate interventions to treat patient’s pain while in the emergency department.
10. Performs narcotic count according to hospital policy.
11. Performs frequent rounding on patients registered for emergency department care and continually assesses patient needs
12. Is organized, utilizes critical thinking skills and multi-tasks when delivering patient care
13. Keeps patients and families informed when waiting in the Emergency Department. Responds to patient concerns when expectations are not met in attempt for service recovery.
14. Reviews take-home instructions with patient at discharge to include new medications started in the emergency department, name and number of a physician for purposes of follow up medical care, etc.
15. Explains/teaches patient in a manner the patient can understand by speaking slowly, allow time for questions and assesses understanding prior to discharge.
16. Consistently (95% of time) insures all medications are removed from the Pyxis based on hospital policy. Performs overrides only when emergent patient care needs necessitate (no more than 5% of time).
17. Notifies physician immediately of any positive screening questions.
18. Communicates all pertinent data regarding patient’s condition including fall risks during hand-off, on every patient.
19. Attends 75% of department meetings.
20. Takes initiative to attend mandatory classes (i.e. Safety); also maintains current BLS, PALS, TNCC. NIHSS and ACLS and completes competencies on time without prompting from the Director.
D. Performs the evaluation phase of the nursing process. (20% of time)
1. Evaluates patient care and documents evaluation at discharge or any time patient’s condition changes.
2. Evaluates pain according to hospital policy but specifically on admission and at discharge.
3. Assists Director in formulating action plans in response to the Employee Engagement survey, Joint Commission, State surveys, etc. whenever requested by Director.
4. Assists Director in formulating unit goals and actively implements know methodologies to accomplish these goals every year.
E. Provides patient and family education. (5% of time)
1. Determines patient and family's learning needs and abilities throughout emergency department stay.
2. Uses terminology appropriate to patient/family's knowledge base and age specific needs.
3. Provides and documents patient and/or family's education based on assessments and re-assessments of learning needs throughout emergency department stay.
4. Provides and documents patient and family follow-up instructions at discharge.
F. Maintains a safe and comfortable unit. (5% of time)
1. Removes malfunctioning equipment from the unit immediately upon discovering problem.
2. Completes requisitions for repair on malfunctioning equipment by the end of the shift.
3. Stocks supplies in the department every shift.
4. As assigned checks Code Blue carts (pediatric and adult) and appropriately stocks, each shift.
5. Refrains from taking verbal orders except during emergent situations.
6. Participates in the performance improvement process by assisting with planning, data collection, interpretation of data and implementation of needed changes based on results of PI.
G. Provides and verifies patient charges. (5% of time)
1. Charges patient correctly for supplies at the time of use.
2. Participates in performing daily charge reviews to capture appropriate emergency department level, supply and procedural charges.
H. Other duties as assigned (5% of time)
Qualifications:Education and Certification/ Registration Required for the Position: Two to four-year nursing degree; current licensure in the state of Missouri; NIHSS, BLS, ACLS, and PALS required within 3 months of hire. TNCC required within 6 months of hire. Eight (8) CE’s specific to trauma (six (6) adult trauma CE’s and two (2) pediatric trauma CE’s) that are approved by the trauma medical director and completed annually. Four (4) CE’s specific to stroke that are approved by the stroke medical director and completed annually. NVCI or equivalent class as determined to be required by the facility.