Crisis Registered Nurse (RN) – Crisis Stabilization & 23-Hour Observation

Company: iCare Health Services, LLC
Department: Crisis Services
Position: Crisis Registered Nurse (RN)
Employment Type: Full-Time, W-2
Setting: Facility-Based Crisis Stabilization & 23-Hour Observation
Schedule: Day, Night, Weekend and Holiday Shifts as Assigned

Job Summary

iCare Health Services, LLC is seeking an experienced, compassionate, and safety-focused Crisis Registered Nurse (RN) to join our multidisciplinary Crisis Stabilization and 23-Hour Observation team.

The Crisis RN provides nursing assessment, continuous clinical monitoring, medication administration, medical and behavioral health observation, crisis stabilization support, and coordination with psychiatric and behavioral health providers for individuals experiencing acute mental health and/or substance-use-related crises.

Patients may present with suicidal ideation, severe depression or anxiety, psychosis, agitation, behavioral dysregulation, substance intoxication or withdrawal concerns, medication-related issues, co-occurring medical conditions, or other acute behavioral health needs.

The RN plays a critical role in determining whether changes in a patient's condition require additional medical evaluation, psychiatric intervention, emergency medical services, transfer to a higher level of care, or other immediate intervention.

The Crisis RN works collaboratively with PMHNPs/psychiatric providers, licensed behavioral health clinicians, BHTs, peer/recovery support staff, case managers, and other members of the multidisciplinary crisis team.

Essential Responsibilities

Nursing Assessment & Monitoring

• Complete nursing assessments according to facility policy, patient condition, professional nursing standards, and applicable requirements.
• Obtain and monitor vital signs and other clinically indicated measurements.
• Assess and monitor patients for changes in physical health, mental status, behavior, medication response, and overall condition.
• Identify potential medical emergencies or conditions requiring evaluation beyond the capabilities of the crisis stabilization program.
• Monitor patients at intervals established according to their assessed condition and applicable clinical requirements.
• Recognize and promptly respond to significant deterioration or changes in condition.
• Document nursing assessments, reassessments, interventions, patient responses, and monitoring activities accurately and timely in the electronic health record.

Behavioral Health Crisis Stabilization

• Provide nursing support to patients experiencing acute behavioral health crises.
• Monitor patients experiencing suicidal ideation, self-harm risk, aggression, psychosis, severe anxiety, depression, mania, behavioral dysregulation, or other acute psychiatric symptoms.
• Participate in suicide and safety-risk processes within nursing scope and organizational protocols.
• Implement ordered safety precautions and monitoring requirements.
• Utilize trauma-informed and least-restrictive approaches to patient care.
• Provide therapeutic communication and support during crisis stabilization.
• Collaborate with behavioral health clinicians and psychiatric providers regarding changes in patient presentation.
• Participate in crisis and safety planning as appropriate to nursing scope.

Medication Management

• Complete medication reconciliation and identify medication discrepancies or concerns requiring provider review.
• Administer medications according to valid orders, nursing scope, and organizational procedures.
• Monitor patients for medication effectiveness, adverse reactions, side effects, allergies, and other clinically significant responses.
• Communicate medication-related concerns promptly to the prescribing provider.
• Maintain medication-administration documentation accurately.
• Follow applicable medication storage, security, controlled-substance, inventory, and medication-error procedures.
• Provide medication education within nursing scope.

Substance Use & Withdrawal Monitoring

• Assess and monitor patients presenting with substance-use-related concerns.
• Recognize signs and symptoms of intoxication, overdose, withdrawal, or other substance-related medical complications.
• Utilize approved withdrawal-monitoring tools when ordered, appropriate, and within demonstrated competency.
• Immediately escalate concerning findings to the appropriate medical or psychiatric provider.
• Coordinate emergency medical transfer when the patient's condition exceeds the facility's capability.
• Support Medication Assisted Treatment services when applicable, ordered, and within the RN's scope and organizational protocols.

Medical Screening & Emergency Response

• Participate in timely screening of individuals entering crisis stabilization services for immediate physical-health needs.
• Identify symptoms requiring medical-practitioner evaluation.
• Initiate emergency procedures when indicated.
• Coordinate with EMS, emergency departments, hospitals, poison control, pharmacies, laboratories, and other healthcare providers when clinically appropriate.
• Provide emergency nursing interventions within RN scope and competency.
• Ensure appropriate clinical information accompanies patients transferred to another healthcare setting.

Admission & 23-Hour Observation

• Participate in nursing components of the admission process.
• Review medications, allergies, medical history, current symptoms, and relevant healthcare information.
• Establish appropriate nursing monitoring based on patient condition and provider orders.
• Maintain ongoing observation and reassessment throughout the patient's stabilization episode.
• Communicate significant findings to the psychiatric/medical provider and multidisciplinary treatment team.
• Participate in determination of readiness for transition or need for additional medical/psychiatric evaluation within professional scope.

Discharge & Transfer

• Participate in multidisciplinary discharge and transition planning.
• Complete required nursing discharge documentation.
• Review medication and nursing-related discharge instructions with the patient as appropriate.
• Ensure patients understand medication instructions and relevant follow-up recommendations.
• Coordinate medication-related information with pharmacies and receiving providers when authorized.
• Assist with warm handoffs to outpatient providers, hospitals, residential programs, detoxification services, or other levels of care.
• Immediately escalate concerns when discharge appears unsafe from a nursing perspective.

Team Leadership & BHT Coordination

• Provide nursing direction related to patient safety and nursing care during assigned shifts.
• Communicate observation and monitoring requirements to appropriate team members.
• Review and respond to concerns reported by BHTs and other direct-care personnel.
• Ensure significant changes in patient condition are appropriately escalated.
• Participate in shift handoffs and multidisciplinary treatment-team communication.
• Support BHTs and other personnel in maintaining a safe, therapeutic crisis environment.
• Immediately intervene when a patient's condition requires nursing or medical evaluation rather than continued BHT-level monitoring alone.

Documentation & Quality

• Complete nursing documentation accurately, objectively, and within required timelines.
• Maintain complete medication-administration records.
• Document changes in condition and provider notifications.
• Complete incident and emergency documentation as required.
• Participate in chart reviews, quality-management activities, medication audits, and performance-improvement initiatives.
• Maintain patient confidentiality and comply with HIPAA and other applicable privacy requirements.