Registered Nurse

PURPOSE:

To plan and deliver nursing care to patients requiring acute care.

ENVIROMENT:

Lincoln Community Hospital and Nursing Home is a 15-bed Critical Access Hospital co-located with 35-bed Long Term Care Unit. The facility employs 130-200 employees.

ESSENTIAL DUTIES AND RESPONISILITIES:

1) Works using the guidelines established from the Nurse Practice Act, Lincoln Community Hospital and Nursing Home standards, policies and procedures and nursing judgment.

2) Assesses plans and evaluates nursing care delivered to patients requiring acute care.

3) Delivers nursing care to patients requiring acute care.

4) Implements the patient plan of care and evaluate the patient response.

5) Directs and supervises care given by other nursing personnel.

6) Provides assistance to the Nursing Home on an as needed basis.

7) Provides input in the formulation and evaluation of standards of care.

8) Maintains knowledge of necessary documentation requirements.

9) Maintains knowledge of equipment set-up, maintenance and use (i.e., monitors, infusion devices, drain devices, etc.).

10) Maintains confidentiality and patient rights regarding all patient personnel information.

11) Provides patient/family/caregiver education as directed.

12) Conducts self in a professional manner in compliance with unit and facility policy.

13) Works rotating shifts, holidays and week-ends as scheduled.

14) Initiates emergency support measure (i.e., CPR, protects patients/residents from injury.

15) Participates in the identification of staff educational needs.

16) Servers as a preceptor, as delegated, for new staff.

17) Maintains patient care supplies, equipment and environment.

18) Participates in the development of unit objectives.

19) Participates in the quality assessment and improvement process and activities.

EXPOSURE RISK:

The Registered Nurse is at high risk for exposure to blood and body fluids or other potentially infectious materials.

SUPERVISION RECEIVCED:

Receives administrative supervision form the Assistant Director of Nurses or Director of Nurses. At time may receive functional supervision from other Registered Nurses working on the unit.

SUPERVISION EXERCISED:

Exercises functional supervision in specific situations over unit personnel.

MINIMUM PERFORMANCE STANDARDS:

Performance in the following areas is acceptable when:

Assessment:

1) Admission and routine patient observations/transfer notes are complete and accurately reflect the patient’s status.

2) Documentation of observations is complete and reflects knowledge of unit documentation policies and procedures.

3) Nursing history is present in the medical record of all patients/residents.

4) Assessment identifies changes in the patient’s physical or psychological condition (i.e., changes in lab data, vital signs, mental status).

Planning of Care:

1) Nursing care plans are initiated/reviewed/individualized on assigned patients weekly and PRN.

a. Pertinent nursing problems are identified.

b. Goals are stated.

c. Appropriate nursing orders are formulated.

2) Nursing kardex is initiated, revised and/or completed.

a. Tests and procedures are marked off when completed.

Evaluation of Care:

1) The effectiveness of nursing interventions, medications, etc., are evaluated and documented in the progress notes.

2) Care plans:

a. Evaluation of care plan is noted weekly or as indicated.

b. The care plan is revised as indicated by the patient’s/resident’s status.

General Patient Care:

1) Patient is approached in a kind, gentle and friendly manner. Respect for the patient’s dignity and privacy is consistently provided.

2) Interventions are performed in a timely manner. Explanations for delays in answers/responses are provided.

3) Independence by the patient in activities of daily living is encouraged to the fullest extent possible.

4) Treatments are completed as indicated.

5) Safety concerns are identified and appropriate actions are taken to maintain a safe environment.

a. Siderails and height of beds are adjusted.

b. Patient call light and equipment is within reach.

c. Restraints, when used, are maintained properly.

d. Rooms are neat and orderly.

6) Patient identification and allergy bands (if applicable) are present.

7) Functional assignments are completed.

8) Emergency situations are recognized and appropriate action is instituted.

9) All emergency equipment can be readily located and operated (emergency oxygen supply, drug box, fire extinguisher, etc.).

Patient Education/Discharge Planning:

1) The patient and family are involved in the planning of care and treatment (documented on the plan of care).

2) Patient and/or family are provided with information related to all intervention and activities are indicated.

3) Discharge/death summaries are complete and accurate.

4) Transfer forms are complete and accurate.

5) Active participation in patient care management is evident.

Adherence to the Facility Procedures:

1) Facility procedure manuals or reference materials are utilized as needed.

2) Procedures are performed according to method outlined in procedure manual.

3) Body substance precautions and other appropriate infection control practices are utilized with all nursing interventions.

4) Safety guidelines established by the facility (i.e., proper needle disposal) are followed.

Documentation:

1) The patient’s full name and room number are present on all chart forms. Allergies are noted on chart cover.

2) Only approved abbreviations are utilized.

3) TPR graphic is completed properly and timely.

4) I & O summaries are recorded and added correctly.

5) Blood pressure graphic is completed accurately and timely.

6) Progress notes are timed, dated, and signed with full signature and title.

7) Unit flow sheets are completed properly (i.e., wound care records, treatment records, IV therapy record, etc.).

Medication Administrations/Parenteral Therapy Record:

1) Dates that medications are started or discontinued are documented.

2) Medications are charted correctly with name, dose, route, site, time and initials of nurse administering.

3) Pulse and BP are obtained and recorded when appropriate.

4) Medications not given are circled, reason noted and physician notified if applicable.

5) Appropriate notes are written for medications not given and actions taken.

6) Name and title of nurse administering medication are documented.

7) Patient’s/resident’s medication record is labeled with full name, room number, date and allergies.

8) The procedure for administration and counting of narcotics is followed.

9) All parenteral fluids including additives are charted with time and date started, time infusion completed, site of infusion and signature of nurse.

10) All parenteral fluids are administered according to the ordered infusion rate.

11) Parenteral intake is accurately recorded on the unit flow sheet or I & O record.

12) IV sites are monitored and catheters changed according to unit policy.

13) IV bags and tubing are changed according to unit policy.

14) Appropriate actions are taken related to identified IV infusion problems (infiltration, phlebitis, poor infusion, etc.).

Coordination of Care:

1) Tests are scheduled and preps are completed as indicated.

2) Co-workers are informed of changes in patient/resident conditions or of any other changes occurring on the unit.

3) Information is relayed to other members of the health care team (i.e., physicians, respiratory therapy, physical therapy, social services, etc).

4) Unity activities are coordinated (i.e., changing patients/residents rooms for admissions, coordinating transfer/discharge forms, etc).

Leadership:

1) Equitable care assignments are made prior to shift are appropriate to patient needs.

2) Staffing needs are communicated to the nursing supervisor.

3) Assistance, direction and education are provided to unit personnel and families.

4) Problems are identified, data are gathered, solutions are suggested and communication regarding the problem is appropriate.

5) Transcription of all orders is checked.

6) All work areas are neat and clean.

Communication:

1) Change of shift report is complete, accurate and concise.

2) Incident reports are completed accurately and in a timely manner.

3) Staff meetings are attended, if on duty, or minutes read and initialed if not on duty.

Professionalism:

1) Decisions are made that reflect knowledge and good judgment and demonstrate an awareness of patient/family/physician needs.

2) Awareness of own limitations is evident and assistance is sought when necessary.

3) Dress code is adhered to.

4) Committee meetings (if assigned) are attended. Reports related to the committee are given during staff meetings.

5) Responsibility is taken for own professional growth. All mandatory and other in-services are attended annually.

6) Organizational ability and time management is demonstrated.

7) Confidentiality of patient is respected at all times (i.e., when answering telephone and/or speaking to co-workers).

8) Professional behavior is demonstrated.

Human Relations:

1) A positive working relationship with patients, visitors and facility staff is demonstrated.

2) Authority is acknowledged and response to the direction of supervisors is appropriate.

3) Time is spent with patients rather than other personnel.

4) Co-workers are readily assisted as needed.

Cost Awareness:

1) Supplies are used appropriately.

2) Charge stickers (or charge system) are utilized appropriately.

3) Minimal supplies are stored in the patient’s room.

4) Discharge medications are returned to the pharmacy or destroyed in a timely manner.

5) Floor-stock medications are charged and re-stoked.

Working Conditions:

1) Works inside the facility throughout the Nursing Service area, including the medication rooms, nurses’ station and the patient rooms.

2) Sits, stands, bends, lifts, reaches, walks and moves intermittently during the working hours.

3) Is subject to frequent interruptions.

4) Is subject to a quiet to moderate noise level due to phones, mechanical and occasional construction work.

5) Is involved with patients, personnel, visitors, government agencies/personnel, etc., under all condition and circumstances.

6) Is subject to hostile and emotionally upset patients, family members, personnel and visitors.

7) Communicated with the medical staff, nursing personnel, and other department supervisors.

8) Works beyond normal working hours, and in other positions temporarily, when necessary.

9) Is subject to hazards in the work area including, burns from equipment, odors, exposure to sharp instruments, falls, chemical cleansers, etc., throughout the working hours.

10) Is subject to exposure to infectious waste, diseases, or conditions.

11) Maintains a liaison with patients, their families, support departments, etc., to adequately plan for the patient/resident needs.

12) May be required to wear a facemask, gown or gloves.

EMERGENCY ROOM REQUIREMENTS:

An Emergency Room (ER) Registered Nurse is a healthcare professional who provides immediate medical care to patients experiencing critical or life-threatening medical emergencies, including trauma, by rapidly assessing their condition, prioritizing treatment needs, stabilizing them through necessary interventions like medication administration, IV starts, wound care, and monitoring vital signs, while collaborating closely with the emergency medicine team in a fast-paced environment.

Key responsibilities of an ER Registered Nurse:

· Triage and Patient Assessment:

Quickly evaluate incoming patients to determine the urgency of their condition and prioritize care based on severity.

· Stabilization and Treatment Initiation:

Perform immediate life-saving interventions like CPR, airway management, and administering emergency medications as needed.

· Procedure Assistance:

Assist physicians with procedures such as wound suturing, IV insertion, intubation, and central line placement.

· Monitoring and Observation:

Continuously monitor patient vital signs, identifying changes that require immediate action.

· Medication Administration:

Administer medications as prescribed by the physician, including emergency medications.

· Documentation:

Maintain accurate and detailed patient records, including assessments, interventions, and progress notes.

· Communication and Collaboration:

Effectively communicate patient status to the medical team, including physicians, other nurses, and ancillary staff.

· Patient Education:

Provide clear instructions to patients and their families regarding post-discharge care.

Required Skills:

· Critical Thinking: Ability to rapidly assess situations, make quick decisions, and prioritize interventions under pressure.

· Clinical Expertise: Thorough understanding of emergency medicine procedures and protocols.

· Technical Proficiency: Skilled in using specialized medical equipment like cardiac monitors, defibrillators, and IV infusion pumps.

· Stress Management: Capacity to remain calm and focused in high-stress situations.

· Teamwork: Effectively collaborate with other healthcare professionals to provide optimal patient care.

SPECIFIC REQUIREMENTS:

1) Must possess a current, unencumbered license to practice as a RN in the State of Colorado.

2) Must be able to read, write, speak and understand the English language.

3) Must possess the ability to make independent decisions when necessary.

4) Must be able to relate information concerning a patient’s/resident’s condition.

5) PALS, ACLS, and TNCC or PHTLS are required within 1 year of hire.

PHYSICAL AND SENSORY REQUIREMENTS:

(With or without the Aid of Mechanical Devices)

1) Must be able to move intermittently throughout the work day.

2) Must be able to speak the English language in an understandable manner.

3) Must be able to cope with the mental and emotional stress of the position.

4) Must be able to see and hear, or use prosthetics that will enable the senses to function adequately, to ensure that the requirements of this position can be fully met (i.e., accurately read measurements on patient related equipment such as thermometers, monitors, gauges).

5) Must be able to function independently, have personal integrity, flexibility, and the ability to work effectively with patients, personnel and support agencies.

6) Must be in good general health and demonstrate emotional stability.

7) Must be able to relate and work with the disabled, ill, elderly, emotionally upset, and at times, hostile people within the facility.

8) Must be able to lift, push, pull and move a minimum of fifty (50) pounds.

9) Must be able to assist with the evacuation of patients.

Qualifications:

MINIMUM QUALIFICATION:

1) Graduation from a basic educational program in professional nursing.

2) Current license to practice profession in the State of Colorado.

3) A minimum of one (1) year medical/surgical nursing experience in an acute care (hospital) setting preferred.

4) Critical care experience preferred.

Salary : $30 - $38