Responsible for planning, coordinating and documenting care for an assigned caseload of patients. Utilizing physicians' orders and professional skills the Home Health RN in conjunction with the home health care team develops and implements a home health plan that meets each patient's specific needs and is in compliance with federal and state regulations, reimbursement guidelines as well as agency policies and procedures. Participates in performance improvement and continuous quality improvement (CQI) activities.

FLSA: NON-EXEMPT

DUTIES AND RESPONSIBILITIES:
Develops a written plan of care for each patient based upon indications obtained by including completing a comprehensive OASIS Assessment on all clients who meet OASIS requirement regulations.
Provides skilled nursing care as ordered by prescribing physician.
Assesses patient's condition, initiates plan of care, re-evaluates and updates as necessary.
Ability to adequately assess and reassess pain utilizing a formal standardized pain assessment tool. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management.
Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.
Obtains all necessary physician orders and collaborates with the physician as the patient's needs dictate.
Participates in case conferences to discuss multidisciplinary team responsibilities, patient progress, plans for continued care, new problems, etc.
In coordination with scheduler and other disciplines involved in the delivery of care, plans patient discharge from the agency. Recommends referrals for alternative level of care if necessary.
Recommends to physician needed referrals to other disciplines and/or community resources.
Obtains needed supplies and equipment to provide care.
Performs patient care responsibilities considering needs specific to the standard of care for patient's age, pediatric through geriatric.
Plans with the physician to implement changes to improve patient care.
Reports changes in patient's physical and emotional health to the physician.
Communicates patient's data and observations verbally and through documentation.
All documentation, charting and agency forms are completed in the designated time.
Demonstrates knowledge of medications and their correct administration based on age of patient and patient's clinical status.
Addresses and supports cultural practices as long as these practices do not harm the patient/family or interfere with the planned course of medical treatment.
Adheres to all agency, billing and documentation policies and procedures.
The registered nurse will see four and a half to five clients per day as a measure of productivity.
Start of care/Resumption of care/Recertification or other follow up assessments counts as one and a half visits
All other OASIS assessments count as one visit (presuming a visit is completed) 1) Discharge OASIS,2) Transfer, 3) Death at home
Daily visits count as one visit
Mileage of 60 cumulative miles counts as one visit.
The registered nurse will be responsible for all components of the home health paperwork. This paperwork will need to be completed in a timely manner. Daily notes are to be submitted within 24 hours of the visit. OASIS assessments need to be completed and submitted within forty eight hours. The paperwork will need to be accurate and reflect the treatment modalities, and the client's response to the prescribed treatment. Accurate paperwork will be described as five percent or less error margin. Paperwork includes but may not be limited to;
OASIS assessments ;Daily notes; Sixty day summaries; Case conference documentation; Interim orders; Discharge summaries ;Medication profiles; Nursing narrative notes
Teaches, supervises and counsels the patient and family members regarding nursing care needs.
Follows up with obtaining lab results and notifies the physician of any significant changes.
Demonstrates the ability to deal with pressure to meet deadlines, to be accurate, and to handle constantly changing situations.
Demonstrates the ability to deal with a variety of people, deal with stressful situations, and handle conflict.