The Registered Nurse Case Manager plans, organizes, and directs hospice care and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individual and families within their homes and communities.
ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES
Patient Care
- Completes an initial, comprehensive, and ongoing comprehensive assessment of patient and family to determine hospice needs.
- Provides a complete physical assessment and history of current and previous illness.
- Provides professional nursing care by utilizing all elements of nursing process.
- Assesses and evaluates patients status by:
- Writing and initiating plan of care
- Regularly re-evaluating patient and family/caregiver needs
- Participating in revising the plan of care as necessary
- Initiating the plan of care and making necessary revisions as patient status and needs change.
- Using health assessment data to determine nursing diagnosis.
- Developing a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process.
- Initiating appropriate preventive and rehabilitative nursing procedures.
- Administering medications and treatments as prescribed by the physician in the physician's plan of care.
- Counseling the patient and family in meeting nursing and related needs.
- Providing health care instructions to the patient as appropriate per assessment and plan.
- Assisting the patient with the activities of daily living and facilitating the patient's efforts toward self-sufficiency and optimal comfort care.
- Acts as RN Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload.
Communication
- Completes, maintains, and submits accurate and relevant clinical notes regarding patients condition and care given.
- Records pain/symptom management changes/outcomes as appropriate.
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