Care Coordinator (RN) - Pulmonary

Medical University of South Carolina•Charleston, SC

3d•Onsite

About The Position

Under limited supervision, directs the application of clinical expertise to patients with bronchiectasis and/or NTM infection and their families within the Pulmonary Division, managed in the ambulatory care setting and as inpatients in the MUSC Hospital. Coordinates all clinical care to maximize safety, patient and co-worker satisfaction, and quality patient outcomes.

Requirements

Bachelor’s degree in nursing required
Three or more years of related nursing experience.
Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state.
Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required.

Nice To Haves

Some positions require certification as a generalist in a related specialty area by the American Nurses Association (ANA).

Responsibilities

Uses expert clinical judgment and decision-making skills to predict potential patient responses and assist in patient management through an episode of illness.
Analyzes deviations from the expected range of patient/family responses and designs creative strategies to improve patient/family outcomes.
Demonstrates accountability to the patient and family by clear articulation of the role and services provided, remaining visible and available through the patient’s episode of illness, engaging in problem-solving activities on the patient’s behalf, and assuming responsibility for the issues and outcomes related to patient care.
Favorably affects the cost, quality, and outcomes of services provided by engaging in activities such as decreasing the frequency of unnecessary tests and procedures, and by negotiating appropriate changes in care and treatment plans.
Assesses and redirects activities in response to staff, patient population, and clinic needs in collaboration with nursing and physician colleagues.
Interfaces with community services and agencies to support the mission of those services and agencies and to ensure optimal patient outcomes.
Organizes and prioritizes nursing care activities considering the needs of the patient and other care team members.
Negotiates short/long term goals with the patient to develop and evaluate the individualized plan of care.
Provides leadership to develop, analyze, integrate complex data, and update individualized plans of care.
Initiates/facilitates/collaborates with all members of the interdisciplinary team to improve care delivered to the patient, ensuring that appropriate referrals (interdisciplinary and community) are made and completed.
Utilizes the nursing process to facilitate the individualized plan of care using time and resources efficiently and assumes accountability for plans of effectiveness.
Coordinates care with the interdisciplinary team members consistently with roles and responsibilities.
Designs, implements, and evaluates a comprehensive, culturally sensitive patient/family education and treatment plan.
Uses professional judgment to appropriately delegate.
Facilitates all new referrals by obtaining clinical information, radiology films, etc.
Consults the appropriate physicians/team member with new patient information and organizes patient visits with the appropriate providers.
Serves as primary contact for the patient and family throughout their course of treatment and serves as physician liaison.
Demonstrates leadership in advancing clinical knowledge of bronchiectasis and/or NTM infection by collaborating in the development of standards of care and practice, utilizing research methodologies, when necessary, along with active participation in team performance improvement strategies.
Reviews and analyzes current nursing literature and research in bronchiectasis and/or NTM infection as a basis for improving practice.
Identifies clinical problems for study, communicates these to the appropriate resources and seeks opportunities to participate in investigative/evaluative activities.
Participates in QI activities/clinical research as designated by bronchiectasis and NTM care team.
Assists with data collection for evaluation to improve care.
Oversees/assists with mechanisms to ensure accurate data entry into patient database and supervises ancillary staff involved in date entry.
Assists in obtaining consents on newly diagnosed, newly transferred or as local IRB/form revisions require when appropriate.
Coordinates education of newly diagnosed bronchiectasis and/or NTM patients.
Develops and maintains education materials for patients, family members, and care team members.
Provides continuing education to inpatient and outpatient staff and serves as a liaison for the care team and patients.
Participates as a mentor for the care team and assists with team member professional development.
Promotes disease awareness through community educational activities in collaboration with national and state programs.
Attends conferences annually when available to maintain knowledge and competence as a program coordinator.
Coordinates with the care team to ensure all patients are treated appropriately and according to available practice guidelines.
Leads pre-clinic meetings and assists the team in determining needs for each clinic visit (e.g., labs, changes in therapy, influenza vaccines, surveillance testing).
Utilizes patient data to recognize clinical trends.
Participates in local, regional, and national programs and initiatives when available.
Provides supervision and training to administrative staff supporting the bronchiectasis and NTM center.
Provides supervision and training to outpatient clinic staff involved with surveillance procedures as determined by the team.
Participates in annual program updates of standard operating procedures and policies.
Reviews center-specific data to identify QI projects.
Participates in QI projects as appropriate to role and project needs.
Liaises with other healthcare providers regarding QI interventions.
Encourages involvement of staff and patients/families in QI efforts as appropriate.
Reviews and triages the Pulmonary BE, CF, NTM Clinical Support Epic in basket for sick calls and patient inquiries and assists in issue resolution.
Follows up on lab results and/or interpretation as ordered by the Health Care Provider (HCP).
Initiates home infusion and home health therapies as ordered by HCP, including ordering durable medical equipment, access devices, medications, monitoring, and follow-up.
Participates in outpatient clinics to monitor and assist with patient throughput.
All other duties as assigned.