Home Health Palliative Care Nurse

The Palliative Care Nurse is a Registered Nurse who is a member of the patient care team within the Department of Home Health and is directly accountable to the Program Director. The position requires that the individual be clinically competent, demonstrate leadership abilities, and be knowledgeable in home health and hospice regulations. The Palliative Care Nurse provides specialized, patient-centered nursing care and education focused on symptom management, quality of life, and care coordination for patients with serious, chronic, or life-limiting illnesses. This role bridges Home Health, outpatient palliative services, hospital-based palliative teams, and hospice care to ensure continuity, appropriate utilization of services, and smooth transitions across the care continuum. Responsible for assuring patient needs are continually assessed and development, implementation, and updates of the individualized plan of care. Performs other job duties as assigned. Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served; also demonstrates knowledge of the principles of growth and development and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his/her age specific needs, and to provide the care needed.

Must be able to Work Environment in the following environments

• Combination of patient homes, agency branches, and collaboration with hospital/clinic teams
• Exposure to clinical and home care environments
  

Role Impact

This position plays a critical role in:

• Improving symptom management and quality of life
• Enhancing continuity across care settings
• Supporting appropriate hospice utilization
• Reducing avoidable hospitalizations
• Strengthening partnerships between Home Health, Palliative Care, and Hospice

Performance Expectations:

Clinical Care & Visits

• Conduct routine skilled nursing visits within all agency branches, as assigned
• Perform comprehensive assessments, including physical, psychosocial, and symptom burden with a focus on palliative care and hospice eligibility
• Provide evidence-based symptom management and patient/family education
• Monitor disease progression and identify changes requiring escalation or transition of care
• Document accurately and timely in accordance with agency, regulatory, and payer requirements

Care Coordination & Collaboration

• Work closely with the hospital-based palliative care team to:
  • Identify patients who are hospice appropriate but hesitant
  • Identify patients approaching hospice eligibility
  • Support discharge planning and continuity of care
• Collaborate with the outpatient palliative care clinic to:
  • Ensure appropriate follow-up throughout the palliative episode
  • Communicate clinical updates, needs, and concerns to Palliative Care Medical Director or Home Care or Hospice Medical Director as needed
  • Facilitate continuity of symptom management and care planning
• Coordinate directly with the Palliative Care Medical Director, who:
  • Oversees medical management and treatment planning
  • Serves as the designated on-call physician for this role
  
  

Hospice Transition Support

• Identify patients meeting or nearing hospice eligibility criteria
• Educate patients and families on home health palliative vs. hospice services
• Address barriers, misconceptions, and concerns regarding hospice enrollment
• Facilitate referrals and transitions to hospice services when appropriate
• Promote patient-centered decision-making aligned with goals of care

Quality & Compliance

• Adhere to all regulatory, accreditation, and agency policies
• Participate in QAPI initiatives related to palliative/hospice transitions
• Maintain competency in symptom management and end-of-life care practices
• Provide education to medical, nursing, and support staff regarding hospice eligibility as needed and/or requested

• Ability to travel between branches and patient homes

Qualifications:

Education/Skills

Graduate of a recognized non-online RN program.

Work Experience:

• Minimum one (1) year of Home Health or Hospice clinical experience

Certification/Licensure-DUE UPON HIRE

• Licensed RN able to practice within the State of MS

• Valid Driver's License and proof of automobile insurance required.

Additional Certification/Licensure - Obtained based on required timeframe below

• Hospice and Palliative Care Certified (CHPN or equivalent required) or certification within 6 months of entering the position

• Basic Life Support

Within 30 Days of Employment

Required

Mental Demands:

• Must have ability to assess, plan, and coordinate patient care, work independently, carry out orders accurately, demonstrate leadership skills and initiative, prioritize, and function under stress. Must possess strong clinical assessment and communication skills and the ability to work independently and collaboratively within interdisciplinary teams