Palliative Care Nurse

Job Summary:   The Palliative Care Nurse is a vital member of the interdisciplinary team, working collaboratively with the Nurse Practitioner and Medical Assistant to deliver compassionate, patient-centered care. This role involves active engagement with patients, families, caregivers, referral sources, facilities, and other healthcare providers to ensure coordinated and responsive care. Strong clinical assessment and therapeutic communication skills are essential to identify patient and family needs, establish goals of care, and determine eligibility for palliative and hospice services. The Palliative Care Nurse must be skilled in guiding end-of-life conversations with empathy and professionalism. Core responsibilities include managing the intake of all palliative care patients, processing hospice referrals, responding to urgent triage needs, assisting with symptom management, and providing routine wellness calls as indicated.

Essential Functions:

1. Performs comprehensive intake assessments for all palliative care referrals to determine eligibility and appropriateness for services.
2. Processes admission information to ensure appropriate clinical documentation is obtained, referral sources are updated, and the electronic medical record (EMR) contains complete and accurate information.
3. Establishes patient profile in the electronic prescribing system to support timely and accurate medication management.
4. Educates patients and families during intake and wellness calls on the goals, benefits, and eligibility criteria for both palliative and hospice care.
5. Provides ongoing education related to symptom management, disease progression, self-care strategies, and available services.
6. Ensures all intake and admission components are completed, including consents and required medical paperwork.
7. Maintains accurate and timely documentation in the EMR to support continuity of care across the interdisciplinary team.
8. Actively obtains and tracks relevant clinical records and updates from community providers, facilities, and specialists to inform treatment planning and transitions of care.
9. Works closely with the Nurse Practitioner and Medical Assistant to ensure seamless care delivery and timely transition to hospice services when appropriate.
10. Participates in monthly Interdisciplinary Team (IDT) meetings to contribute to care planning and ensure patient and family needs are met.
11. Responds to triage calls to assess symptoms and ensure timely, appropriate interventions in collaboration with the provider.
12. Addresses patient and caregiver needs with a therapeutic, compassionate, and flexible approach, based on the acuity and urgency of the situation.
13. Completes routine wellness calls for all palliative care patients as guided by patient acuity and Nurse Practitioner direction.
14. Provides psychosocial support and reinforce individualized self-care strategies to enhance patient and caregiver confidence.
15. Delivers patient and caregiver education via phone on medications, diet, comfort measures, and other provider-directed care plans.
16. Maintains and enhances professional skills through ongoing education and training.
17. Remains current on developments in palliative care and share relevant updates with the care team.
18. Complies with local, state, and federal regulations, agency policies, Quality Partners standards, and privacy guidelines including HIPAA.
19. Assists with MA or nursing coverage as needed during staff PTO/CTO or other leaves of absence.
20. Demonstrates understanding of the Medical Assistant role and assist with non-licensed tasks as appropriate.
21. Promotes positive community relations through professional, compassionate service.
22. Represents the agency's mission, vision, and the core philosophy of palliative and hospice care in all patient and stakeholder interactions.
23. Completes special projects, chart audits, workflow improvements, and other assignments as delegated.
24. Actively participate in organization-wide performance improvement initiatives.
25. Adheres to the organizational Code of conduct and all departmental and organizational policies, procedures, protocols, practices and all regulatory and legal requirements.
26. Adheres to the NorthStar standards to care for every person, every time, 100% of the time.

Qualifications:

1. Graduation from an accredited school of nursing with possession of a current license to practice as a registered professional nurse in the State of Michigan.
2. Two (2) to five (5) years of experience required including clinical nursing experience in an acute care setting (includes a combination of education and experience) is required.
3. At minimum of at least one (1) year's general nursing experience is required with current hospice, medical, surgical, or critical care experience. Experience in hospice and palliative care is preferred.
4. Hospice certification (CHPN) is preferred.
5. A solid understanding of hospice eligibility criteria and the palliative care model is required.
6. Familiarity with end-of-life care, including sensitivity to the physical, emotional, and psychosocial needs of terminally ill patients and their families, is preferred; ability to provide compassionate support and maintain professionalism in emotionally complex situations is essential.
7. Working knowledge of disease progression, anticipated symptoms, and common approaches to symptom management in collaboration with healthcare providers; ability to support interdisciplinary care planning and patient-centered goals of care.
8. Proficient in Microsoft Office and other digital tools; experience with electronic medical records (EMR) systems required.
9. Proof of current tuberculin testing required.  Patient/facility contact will not be allowed until tuberculin clearance is documented.
10. Must be able to read, write and speak English fluently and be able to effectively communicate orally and in writing in internal and external relationships for all essential job functions.
11. Must possess sound judgment and demonstrate strong critical thinking skills and possess the ability to function under stress. Must demonstrate ability to maintain accountability and work independently and creatively while functioning as part of a cooperative, coordinated team.
12. Demonstrated ability to organize, prioritize and manage multiple, competing priorities with great attention to detail, accuracy, tact, and ability to maintain confidential information.
13. The physical demands of the position include: vision, effective speech and hearing for extensive telephone contact; repetitive motion; traveling; driving or riding in motor vehicle for extended periods; standing, sitting, walking, bending, reaching, and stretching; lifting up to forty-five (45) pounds unassisted and the ability to assist in lifting patients using appropriate lifting techniques and/or devices.
14. Must have reliable transportation.
15. Must have the ability to occasionally work extended days, as necessary.
16. Must be eligible to work in the United States.