RN, Flexi Hospice

Responsibilities Specific to Position

• Establish and utilize the plan of care to implement and direct patient care (the plan of care is updated at least monthly and also as changes occur); progress notes should reflect utilization of the care plan
• Recognize the patient and family as the unit of care
• Inform the patient's insurance case manager via the Managed Care Liaison about the ordered visit frequency plan(s) for patient care and patient's status
• Provide clinical supervision of the hospice home care team
• Home Health Aide (HHA) care plans must be reviewed and/or updated with each onsite visit and initialed; the original is kept on the chart and staff are responsible for weekly updates
• Perform HHA onsite supervisory visits every 14 days according to Medicare guidelines, and conduct an onsite with the HHA during the first week after start of care
• Performs all aspects of the skilled nurse home visit:

• Plan and prepare for the visit
• Perform skilled interventions including teaching, pain management, and symptom control
• Report changes in patient condition or other pertinent data to physician as needed
• Comply with established SN frequency as per form 485; change frequency as needed according to physician orders
• Document assessment of patient's status and response to skilled intervention and teaching on hospice SN progress note
• Document ongoing discharge planning from start of care, and prepare discharge summary according to agency policy
• Ensure that documentation shows subsequent planned visits with patient
• Report unexpected changes in patient condition or other pertinent data to the physician according to agency policy
• Provide appropriate support at the time of death and during the period of bereavement
• Utilize supply requisition process in an appropriate and cost effective manner

• Inform the Managed Care Liaison of patient updates regarding care, status, and frequency of visits for all disciplines
• Teach the patient/family about care needs, disease process, and health maintenance measures
• Ensure documentation on the hospice SN progress notes reflect patient/caregiver response to skilled instruction or treatment, as well as an update of status/problems
• Provide skilled instructions according to the nursing plan of care and any teaching guides (as applicable)
• Teach and counsel patient, family, or other primary caregiver regarding expected disease progression, care techniques, and other health measures
• Ensure that the patient's medical record reflects that the patient and caregiver are included in the planning and rendering of care as evidenced by patient/family response to plan of care/intervention/instructions
• Remain knowledgeable regarding current hospice trends and insurance issues
• Participate in joint visits with the Hospice PCC, PRN, and/or designee at least annually
• Seek attending physician, hospice medical director, or hospice PCC intervention and follow up appropriately
• Maintain current update of clinical skills and recognize/report skills review needs to the Hospice PCC
• Demonstrate courtesy, compassion, tact, patience, and respect for patients, families, and co-workers
• Practice hospice nursing with utilization of appropriate palliative tools (i.e. open communication, empathy, acceptance of spiritual and cultural differences, ability to assess and manage caregiver needs/problems, accurate pain assessment and treatment, teaching the family the normal processes of the human body as death approaches, and understanding of stages of grief and bereavement)
• Recognize and assume patient/family advocacy role
• Call the Team Assistant's voice mail each morning with daily plans and changes
• Document all patient care in reimbursable and professional terminology as evidenced by audit review
• The Nursing Plan of Care and any teaching guides used must be on the patient's clinical record within the first week from start of care
• The Plan of care is to be utilized with planning SN visits and updated accordingly
• Medication profiles will have classification completed and on the patient's medical record within the first week of start of care; medication profiles must be updated once per month and/or with additions or changes and signed/dated
• Discharge summaries are due within 48 hours after the patient is discharged from service and are to be submitted to the Hospice PCC
• Admission paperwork and orders must be completed within 48 hours and are to be submitted to the PCC
• Recertification's are due three (3) weeks prior to the end of the current certification period, and must be submitted to the PCC for review
• Phone orders are to be submitted for processing within 48 hours after receiving the order
• QCC reports are to be completed by the involved staff person within 24 hours and are to be submitted to the PCC
• Weekly schedules are to be submitted to the Hospice PCC and Team Assistant on Thursday for the coming week
• Payroll sheets with SN progress notes are to be submitted every Monday, Wednesday, and Friday by 8:00 AM; exceptions for holidays will be determined
• Nursing staff will perform billing audits and chart audits monthly as directed by the PCC

Education and Experience

Minimum Education: Successful completion of an accredited Registered Nursing Program

Preferred Education: Bachelor of Science in Nursing (BSN)

Experience: One (1) or more years' prior med-surg experience is required; prior hospice experience is preferred

Certificates, Licenses, Registrations

Applicant must be licensed to work as a Registered Nurse in the Commonwealth of Virginia and must hold a current CPR certification. CHPN certification is preferred.