Registered Nurse; RN Case Manager Hospice

Job Description Summary

The registered nurse 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.

This position mainly covers Northgate area.

• Completes an initial, comprehensive and ongoing assessment of patient and family to determine hospice needs.
• Provides a complete physical assessment and history of current and prior illnesses.
• Provides professional nursing care by utilizing all elements of the nursing process.
• Assesses and evaluates patient status by writing and initiating a plan of care, regularly re‑evaluating needs, and revising the plan as necessary.
• Uses health assessment data to determine nursing diagnoses and develops a care plan that establishes goals, incorporates palliative nursing actions, and includes patient and family in the planning process.
• Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician.
• Counsel the patient and family in meeting nursing and related needs, and provides health care instructions per assessment and plan.
• Assists the patient with activities of daily living and facilitates efforts toward self‑sufficiency and optional comfort care.

• Completes, maintains and submits accurate clinical notes concerning patient condition and care; records pain/symptom management changes and outcomes.
• Communicates with the physician regarding patient needs and reports condition changes; obtains orders as required.
• Communicates with community health personnel to coordinate the care plan.
• Reports failures to comply with VA, state, local, and federal law and ethics within 14 days, using Department of Health forms.
• Reports suspected abandonment, abuse, financial exploitation, or neglect of a vulnerable adult to the department of social and health services and proper law enforcement agencies immediately.
• Teaches self‑care techniques to patient and family/caregiver; provides medication, diet, and other instructions as ordered by the physician.
• Provides and maintains a safe environment for the patient.
• Assists patient and family/caregiver and other team members in providing continuity of care.
• Works with the family/caregiver and hospice interdisciplinary group to meet emotional needs of patient and family.
• Attends interdisciplinary group meetings.

• Participates in on‑call duties as defined by the on‑call policy.
• Ensures arrangements for equipment and other necessary items and services are available.
• Supervises ancillary personnel and delegates responsibilities if required.
• Maintains and upgrades professional knowledge and practice skills through continuing education and in‑service classes.
• Fulfills the obligation of requested and/or accepted case assignments.
• Actively participates in quality assessment and performance improvement teams and activities.

• Graduate of an accredited school of nursing.
• Registered Nurse with a license in good standing to practice in the state of Virginia.
• One year of experience as a professional nurse within the last three years (or a baccalaureate degree in nursing with a minimum of two years’ experience, at least one year in public health, home care, or hospice nursing is preferred).
• Management experience not required; may supervise hospice aides.
• Offer contingent upon satisfactory references and criminal background checks.
• Excellent observation, verbal and written communication, problem‑solving, basic math, and nursing skills per competency checklist.
• Physical ability to walk, stand, lift, transfer patients and supplies, reach, stoop, bend, kneel, crouch; visual acuity and hearing to perform required nursing skills.
• Licensed driver with an insured automobile in good working order.