Assesses, plans, implements and evaluates the nursing care of patients/residents (patients) within the skilled nursing setting. Responsible for ensuring continuity and coordination of care of the patients between shifts by providing direct care as well as supervision of the care given by CNAs, LPNs and supportive staff members. Participates in patient and family teaching. Maintains role as patient advocate with a focus on the facility's mission. Provides direct patient care as needed and communicates with Providers and Team Members about changes in the clinical condition and care plan.

NON-EXEMPT

Assesses patient's physical status and nursing needs on admission and as needed when conditions change. Prescribes and updates the Plan of Care and completes the Minimum Data Set (if trained to to MDS) in collaboration with the MDS Coordinator.

Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient, family and team members regarding pain management.

Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of resident and their families.

Performs all aspects of resident care in accordance with the Plan of Care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.

Notifies Provider of changes in patient's condition and follows through until appropriate action is taken.

Notes and carries out physician's/provider's orders in a timely manner.

Performs waived testing (point-of-care testing) per Clinical laboratory's and the unit's policies and procedures.

Interprets results of waived tests and takes appropriate action on waived test results.

Knows and communicates high risk medications for older adults and the appropriate monitoring related to indication and clinical condition including the need for Gradual Dose Reduction (GDR) of Antipsychotic Medications

Documents changes in patient's condition and nursing care provided in the resident's medical record.

Completes documentation in a timely, clear, concise and pertinent manner.

Functions as a patient advocate by protecting the patient's rights.

Teaches and consistently involves patient and family in planning for care, treatment, teaching needs and discharge plans.

Ensures safety by making daily Safety Rounds and coordinates daily Safety Report with follow-up as needed for any Care Plan changes that need to be made.

Treats patients, their families, visitors and co-workers with respect and dignity.

Gives a thorough report to oncoming shift by participating in walking rounds and documenting appropriately on calendar for upcoming needs.

Follows through, as needed, on information given by shift report, resident or family regarding resident concerns.

Functions as a liaison between the patient/family and the provider or management.

Maintains good working relationships between other units and departments.

Functions as a leader for the CNAs, RCA, LPNs and support staff by delegating in a manner that contributes to the excellence of the nursing unit to which RN is assigned.

Works collaboratively with IDT, including Social Worker/Discharge Nurse to secure optimal patient placement.

Motivates others and organizes workload so that all functions are completed appropriately.

Demonstrates creativity in solving problems and looking at situations in new and innovative ways.

Participates in orientation of new personnel and performance evaluations of nursing staff.

Demonstrates ability to remain calm in emergency and/or stressful situations and gives everyone a feeling of confidence that the situation is under control.

Consistently follows policies and procedures of the facility.

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.

Professional Requirements:

Adheres to dress code.

Completes annual educational requirements.

Maintains regulatory requirements.

Wears identification while on duty.

Maintains confidentiality at all times.

Attends department staff meetings as required within the department.

Reports to work on time and as scheduled; completes work in designated time.

Represents the organization in a positive and professional manner.

Actively participates in performance improvement and continuous quality improvement (CQI) activities.

Coordinates efforts in meeting regulatory compliance, federal, state and local regulations and standards

Communicates and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.

Complies with Benefis Health System Organization Policies and Procedures.

Complies with Health and Safety Standards and Guidelines.