Job Title: Clinic Nurse                                              

FLSA Status: Exempt

Salary Range: See Salary Scale                              

Job Summary:  Responsible for providing direct and indirect nursing care to assigned Senior Total Life Care (TLC) participants in a clinic, home or community-based model of care in the STLC service area. Works under the direct and indirect supervision of the Center Manager but is independent in the application of advanced nursing knowledge and skills.  Manages complex clinical situations for which (s)he is responsible.  Works within an Interdisciplinary Team (IDT) to help care for the holistic needs of Senior TLC participants.  Takes an active part in the care planning process and provides nursing interventions as appropriate.  Provides on-call phone triage on weekdays, weekends, holidays and emergency situations on a rotating basis and documents those calls/visits in the Electronic Medical Record (EMR). Completes in-home aid re-assessments and supervisory visits as requested by the Home Care Agency (HCA) Supervisor.

Education: Graduate of an accredited school of nursing and a current RN license.

Experience: Has practiced nursing in the last 3 years; 2 years of RN experience preferred including experience working with the frail elderly population.

Number and Type of Employees Supervised (optional): Licensed and non-licensed personnel

Licensure, Registry or Certification Required: RN currently licensed in North Carolina; or compact state, able to present credentials which demonstrate ability to meet performance criteria for RN.

Special Training: Must possess knowledge and skills necessary to treat participants; other training as required by department.  Only act within the scope of his or her authority to practice.  Meets a standardized set of competencies for the specific position description established by Senior TLC and approved by CMS before working independently.

Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact

Ages of Patients Rendered Care: 

  Neonate/Infant   Early Childhood    Adolescent    Adult    Geriatric   All Age Groups

• Collects participant data and completes required forms with appropriate responses according to unit standards; identifies participant’s overt problems/needs and sets priorities; identifies problems requiring further referral and/or follow-up; interprets and records latest diagnostic results; and performs advanced nursing assessments using critical thinking skills. 
• Performs wound care, skin care and other treatments as ordered by the Primary Care Provider (PCP) and documents in the EMR and logs as appropriate. Documents participant care delivered as planned and any variation, with appropriate rationale; makes and records observations related to impending or associated problems; implements nursing measures related to impending or associated problems.
• Schedules participants to be seen in the clinic per the IDT.   Works with Clinic Technician and PCP along with the IDT to assess participants with holistic needs in the clinic setting.  May provide End of Life Care and visits as requested.  
• Using nursing process, delegates nursing care to appropriate personnel; integrates cost effective measures into nursing practice; recognizes unit problems and takes responsibility for documenting; demonstrates active participation in QI processes; complies with policies addressing safe working conditions; monitors unsafe working conditions; recognizes inappropriate and/or ineffective participant care management, resolves issue/problem and completes written reports.
• Takes on-call as scheduled on a rotating basis and documents those calls promptly.   Makes home visits to provide care in crisis situations, to perform assessments, and provide nursing care as requested by the IDT.  During emergency procedures, makes participant welfare checks and documents those calls.  May be required to deliver medications to participants to ensure continuity of care.
• Completes in-home aid re-assessments and supervisory visits as requested by the HCA Supervisor.   Provides feedback to the IDT and the HCA on results of those visits to support participants’ plans of care.
• Attends staff meetings and takes part in participant care planning as required, including Quality Projects as appropriate. Completes clinic reviews and wound logs in a timely manner.
• Provides directions to Clinic Technician and oversees their treatments/procedures.  Assists Medication Aides with monthly orders and reconciling those orders.
• Completes initial, at least every six-month reassessment, and significant change assessments.  
• Participates in participant care planning including the implementation of SMART goals/interventions for the participants’ care plans and enters all care plan information in a timely manner as per organizational protocols. Updates and evaluates participants’ care plans appropriately throughout the reassessment period. 
• Participates in the coordination of 24-hour care delivery while participants are at home, in the hospital, or in a nursing facility, including medication reconciliations.  Communicates participant changes to team members in a timely and appropriate manner.
• Supports the Senior TLC IDTs and promotes unity amongst team members while interacting with the team, other coworkers, and/or participants.  
• Supports team members and functions as a team player while providing that support and adheres to the “do no harm” statement. Accepts teammate’s professional and cultural differences as they relate to participant care and supports team’s decisions while promoting a united team for the participants’ continuity of care and for staff development.
• Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care.
• Other duties as assigned.