General Statement of Duties: Reports to Home Hospice Team Leader. Provides skilled nursing care according to Coastal Hospice policies and standards. Coordinates with patient/family and other members of the IDT to plan, implement and manage patient/family care.
1. Provides a consistent high quality hospice experience for every patient and family served by:
a. Soliciting and identifying patient and family goals
b. Complying with established nursing visit structure
c. Flexibility to manage frequency and duration of visits based on patient/family needs
2. Coordinates with other members of the IDT to provide for the physical, spiritual, psychosocial, financial and bereavement needs of the patient and family in the home setting.
3. Coordinates with consultant pharmacist and attending physician to optimize symptom management.
4. Develops and amends the patient/family plan of care based upon identified problems and goals.
5. Assesses learning readiness and provides ongoing education and support to the patient and family according to their needs and the plan of care.
6. Communicates timely and effectively with the Home Hospice Team Leader/designee, physicians, team members, patients, families, contracted vendors and community.
7. Appropriately uses information technology to accurately and timely document in the patient electronic clinical record in accordance with Coastal Hospice policy.
8. Maintains continuity and consistency of care by:
a. Recording all pertinent information in a concise, effective manner according to organizational standards.
b. Completing documentation in the patient’s electronic medical record by the end of the assigned work day.
c. Providing hand off communication according to established policy and procedure.
9. Maintains communications with appropriate Home Hospice Team Leader/designee as needed to meet patient/family needs and ensure smooth program operation.
10. Practices safe medication management according to professional standards which requires successful completion of medication mathematic skills competencies.
11. Promotes high quality patient care and team operations by:
a. Functioning within Coastal Hospice care model in meeting team goals
b. Supervising and delegating to LPNs, hospice aides, students and volunteers on the same assigned work day.
c. Maintaining effective relationships with contracted facilities and supporting joint collaboration.
d. Participating in the on-call rotation for night and weekend nursing coverage as assigned.
12. Rotates assignment as necessary to meet program needs.